Timectomia robótica para miastenia gravis

Sardenberg, Rodrigo Afonso da Silva; Abadalla, Ricardo Zugaib; Abreu, Igor Renato Louro Bruno de; Evaristo, Eli Faria; Younes, Riad Naim

doi:10.1590/s1806-37132011000500019

Cited by 6 publications

(3 citation statements)

References 6 publications

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“…Especially, the corticosteroid levels must be reduced before surgery. Pre-operative intravenous immunoglobulin administration or plasmapheresis might reduce the post-operative respiratory failure risk, especially in subjects with symptoms that are partially controlled [ 19 , 20 ]. Although there is no gold standard for surgery timing, it appears that removing the thymic gland early might boost the rate of remission [ 20 ].…”

Section: Patient Selection and Preparationmentioning

confidence: 99%

Robotic thymectomy: a review of techniques and results

Coco¹,

Leanza²

2023

kitp

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Thymectomy is a well-established therapeutic option in the multidisciplinary treatment of nonthymomatous myasthenia gravis (MG) and in thymoma treatment. Although many surgical procedures for thymectomy have been identified, the transsternal method is still regarded as the gold standard. Minimally invasive procedures, on the other hand, have achieved popularity in the last decades and are now extensively used in this field of surgery. Among them, robotic thymectomy has been the most cutting-edge surgical procedure. Several authors and meta-analyses have shown that a minimally invasive approach to thymectomy is associated with improved surgical results and fewer complications in surgery compared to transsternal open thymectomy, without any substantial changes in myasthenia gravis complete rates of remission. Hence, in the present review of the literature, we aimed to describe and delineate the techniques, advantages, outcomes, and future perspectives of robotic thymectomy. Existing evidence suggests that robotic thymectomy will likely become the gold standard for thymectomy in early stage thymomas and MG subjects. Many of the drawbacks related to other minimally invasive procedures appear to be resolved by robotic thymectomy, and long-term neurological outcomes are satisfactory. In addition, improved vision and high dexterity of instrument movements enable safe and complete thymic tissue dissection, superior to standard thoracoscopic procedures. The access with minimally invasive surgery VATS (video-assisted thoracoscopic surgery) or RATS (robot-assisted thoracic surgery) access in its various variants allows the extent of mediastinal fat resection due to the possibility of ectopic thymic foci in the mediastinum determining the long-term outcome in the group of patients operated on for myasthenia gravis. However, it was recommended to carry out better designed, multi-centre, randomized studies to arrive at definitive conclusions on robotic thymectomy for thymomas and myasthenia gravis treatment.

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Section: Patient Selection and Preparationmentioning

confidence: 99%

Robotic thymectomy: a review of techniques and results

Coco¹,

Leanza²

2023

kitp

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“…When surgery is planned, corticosteroids dose should be reduced. In patients with partial symptom control with drugs, preoperative plasmapheresis or intravenous immunoglobulin administration should be considered to reduce the risk of postoperative respiratory failure 33,34…”

Section: Mg and Thymectomymentioning

confidence: 99%

Robotic-assisted thymectomy: current perspectives

Marulli

Comacchio

Stocca

et al. 2016

RSRR

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Thymectomy is the cornerstone in the treatment of thymic tumors and an accepted option for the management of myasthenia gravis. Different surgical approaches have been described, but the gold standard is represented by median sternotomy. In the last two decades, the development of minimally invasive surgery has led to an increased acceptance of thymectomy, especially for benign diseases. Robotic thymectomy seems a further step in the development and evolution of minimally invasive approaches. Since its introduction, different authors described their experience with robotic thymectomy, both for nonthymomatous myasthenia gravis and for thymic tumors. Available data show that robotic thymectomy may be considered a safe and feasible operation. In patients with nonthymomatous myasthenia, robotic thymectomy is effective and the long-term results are encouraging. The role of robotic thymectomy in patients affected by thymoma is still under evaluation, but the intermediate results seem promising both in terms of surgical and oncologic outcomes.

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“…( 7 ) In general terms, thoracoscopic thymectomy has long been successfully performed in young patients with myasthenia, and the results have been satisfactory. ( 8 - 10 ) Regarding the side of the surgical approach, in general terms, left thoracoscopic thymectomy is associated with a lower risk of vena cava injury during surgical manipulation and while gaining access to the aortopulmonary window. However, it has been reported that right thoracoscopy allows better surgical manipulation because of the larger dimensions of the right pleural cavity and easier identification of the innominate vein.…”

Section: To the Editormentioning

confidence: 99%