Timectomía videotoracoscópica para el tratamiento de la miastenia gravis

Video-Assisted Surgery for Lung Cancer. State of the Art and Personal Experience

“…47 VTS has become an increasingly routine procedure in the management of solitary pulmonary nodules, largely because it obviates the need for thoracotomy; results have been published for large series of patients. [48][49][50][51] However, even among experienced surgeons, a common One widely used technique is the immediately preoperative insertion of a CT-guided hookwire. 41,48,49,[53][54][55] This has proved to be highly effective if the nodule is small and/or located deep within the parenchyma, but great caution is required in handling the hookwire as it could work loose during transport of the patient from the X-ray Department to the operating theater, or once there, while changing the patient's position, and it could also work loose during lung collapse, a finding reported in 4% to 47% of patients.…”

“…[48][49][50][51] However, even among experienced surgeons, a common One widely used technique is the immediately preoperative insertion of a CT-guided hookwire. 41,48,49,[53][54][55] This has proved to be highly effective if the nodule is small and/or located deep within the parenchyma, but great caution is required in handling the hookwire as it could work loose during transport of the patient from the X-ray Department to the operating theater, or once there, while changing the patient's position, and it could also work loose during lung collapse, a finding reported in 4% to 47% of patients. 41,[54][55][56][57] To avoid hookwire detachment during lung collapse, once the patient has been placed in the lateral decubitus position, we insert the wire 3-4 cm into the pleural cavity and section it flush with the skin, so that as it collapses, the lung pulls the wire into the pleural cavity.…”

“…Use of a CT-guided hookwire has enabled localization and removal of nodules in almost 100% of patients, because even if it is detached, the wire tends to leave a small bruise mark on the lung, which itself facilitates nodule localization. 48,49,55 Another widely used method for solitary pulmonary nodules localization is CT-guided percutaneous staining with methylene blue. 58 Although excellent results have been reported, the technique is becoming less common because even better results are obtained with the hookwire.…”

El archivo de Archivos: 2004

“…El pasado año comunicaron su serie de 25 timectomías vía VT 26 . El procedimiento mostró la misma eficacia que el abordaje estandarizado clásico vía toracotomía, si bien el porcentaje de complicaciones fue muy inferior.…”

Mejoras en la calidad de vida de los pacientes con Miastenia Gravis sin timoma intervenidos con timectomía videotoracoscópica

“…El objetivo es la extirpación del timo en su totalidad, junto con la grasa peritímica, ya sea por esternotomía media, toracotomía, cervicotomía o por videotoracoscopia. En muchos casos la cirugía estabiliza la enfermedad, reduce la medicación y la incidencia de crisis miasténicas, pero este beneficio no aparece de forma inmediata tras la operación sino de forma progresiva en meses o años después (DeFilippi, Richman, & Ferguson, 1994;Durelli et al, 1991;Loscertales et al, 2004Loscertales et al, , 1999Maggi et al, 1989;Shields, 2005). Varios estudios se han publicado tratando de aclarar los beneficios que esta técnica ha producido, describiendo remisiones que van desde parciales hasta totales, pero sólo han tomado en cuenta parámetros cuantitativos como la medicación, y la presencia o ausencia de sintomatología, dejando a un lado un factor muy importante como son los beneficios tangibles por el enfermo en la esfera psicosocial siendo estos los verdaderos determinantes de los cambios en la calidad de vida tras la intervención (Cakar et al, 2007;Freeman, Ascioti, Van Woerkom, Vyverberg, & Robison, 2011;Keijzers et al, 2014;Maggi et al, 1989;Manlulu et al, 2005;Masaoka et al, 1996;Meacci et al, 2009;Park, Choi, Lee, Kim, & Chung, 2006).…”