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Kato T, Watanabe H, Kawasumi Y, Kadomatsu Y, Ueno H, Nakamura S, Mizuno T, Chen-Yoshikawa TF. Impact of the expanded indication of robot-assisted thoracic surgery for mediastinal tumors. Gen Thorac Cardiovasc Surg 2025; 73:443-449. [PMID: 39467900 DOI: 10.1007/s11748-024-02093-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2024] [Accepted: 10/04/2024] [Indexed: 10/30/2024]
Abstract
OBJECTIVE Following the introduction of robot-assisted thoracoscopic surgery (RATS) as a health insurance-covered treatment in Japan, we investigated the current status and impact of the expansion of the indications for RATS for mediastinal tumors. METHODS Between 2018 and 2022, 209 cases of total mediastinal tumor resection were performed in our hospital. The study period was divided into the first half (January 2018 to June 2020) and the second half (July 2020 to December 2022), and perioperative parameters were compared between the two groups. RESULTS Ninety-six surgical procedures were performed in the first half and 113 in the second half. The percentage of RATS approach was significantly higher in the second half compared with the first half (P < 0.001). Indications for RATS in the second half compared with the first half were significantly increased in patients with stage II (P < 0.001) and stage III (P = 0.026) thymomas, tumor diameter ≥ 50 mm (P < 0.011), and patients undergoing extended thymectomy for myasthenia gravis (P < 0.009). In respect of short-term postoperative parameters, the estimated intraoperative blood loss (P < 0.035), postoperative drain duration (P < 0.037), and postoperative hospital stay (P < 0.011) were significantly lower in the second half than in the first half. CONCLUSIONS RATS has recently been expanded for mediastinal tumors with improved short-term outcomes in our hospital after health insurance was applied in Japan. In the future, it will be necessary to discuss the further expansion of its indications by taking into account safety and long-term outcomes.
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Affiliation(s)
- Taketo Kato
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Hiroki Watanabe
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Yuta Kawasumi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Yuka Kadomatsu
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Harushi Ueno
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Shota Nakamura
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Tetsuya Mizuno
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Toyofumi Fengshi Chen-Yoshikawa
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan.
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2
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Rückert JC, Huang L. [Robot-assisted Mediastinal Surgery]. Zentralbl Chir 2023; 148:S17-S25. [PMID: 36195108 DOI: 10.1055/a-1921-1530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Because of the many important anatomical structures located closely together at very small distances, mediastinal surgery has been traditionally demanding and challenging within thoracic surgery. With their great variability, mediastinal masses in the anterior, middle or posterior mediastinal compartment result in surgical indications with different principle focuses. The technical opportunities of robotic assistance can thereby most effectively support the requirement of precision for all oncological aspects. Anterior mediastinal operations are most often performed, thymectomy being the most common operation. The radicality of thymectomy is of special importance. The worldwide tremendous development of robot-assisted mediastinal surgery confirms its initial and continuous role as a pacemaker for minimally invasive thoracic surgery.
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Affiliation(s)
| | - Luyu Huang
- Thoracic Surgery, Charité Universitätsmedizin Berlin, Berlin, Deutschland
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3
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Park S. Robot-Assisted Thoracic Surgery Thymectomy. J Chest Surg 2021; 54:319-324. [PMID: 34353974 PMCID: PMC8350461 DOI: 10.5090/jcs.21.059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/02/2021] [Indexed: 11/16/2022] Open
Abstract
Robotic thymectomy has been adopted recently and has been shown to be safe and feasible in treating thymic tumors and myasthenia gravis. The surgical indications of robotic technology are expanding, with advantages including an excellent surgical view and sophisticated manipulation. Herein, we describe technical aspects, considerations, and outcomes of robotic thymectomy.
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Affiliation(s)
- Samina Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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4
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Li F, Li Z, Chen Y, Bauer G, Uluk D, Elsner A, Swierzy M, Ismail M, Meisel A, Rückert JC. Thymectomy in ocular myasthenia gravis before generalization results in a higher remission rate. Eur J Cardiothorac Surg 2021; 57:478-487. [PMID: 31628812 DOI: 10.1093/ejcts/ezz275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 08/31/2019] [Accepted: 09/11/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES This study aimed to compare the outcomes of patients with ocular myasthenia gravis (OMG) who underwent thymectomy before generalization with the outcomes of those who underwent thymectomy after generalization. METHODS We retrospectively reviewed patients who underwent robotic thymectomy for myasthenia gravis between January 2003 and February 2018. Patients who presented with purely ocular symptoms at myasthenia gravis onset were eligible for inclusion. Exclusion criteria were patients who were lost to follow-up and patients who underwent re-thymectomy. Patients with OMG who developed generalization before thymectomy were categorized into gOMG group and those who did not were categorized into OMG group. The primary outcome was complete stable remission according to the Myasthenia Gravis Foundation of America Post-Intervention Status (MGFA-PIS). RESULTS One hundred and sixty-five (66 males and 99 females) out of 596 patients with myasthenia gravis were eligible for inclusion. Of these, there were 73 and 92 patients undergoing thymectomy before and after the generalization of OMG, respectively. After propensity score matching, a data set of 130 patients (65 per group) was formed and evaluating results showed no statistical differences between the 2 groups. The estimated cumulative probabilities of complete stable remission at 5 years were 49.5% [95% confidence interval (CI) 0.345-0.611] in the OMG group and 33.4% (95% CI 0.176-0.462) in the gOMG group (P = 0.0053). Similar results were also found in patients with non-thymomatous subgroup [55 patients per group, OMG vs gOMG, 53.5% (95% CI 0.370-0.656) vs 28.9% (95% CI 0.131-0.419), P = 0.0041]. CONCLUSIONS Thymectomy in OMG before generalization might result in a higher rate of complete stable remission than thymectomy after generalization.
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Affiliation(s)
- Feng Li
- Department of Surgery, Competence Center of Thoracic Surgery, Charité University Hospital Berlin, Berlin, Germany
| | - Zhongmin Li
- Department of Surgery, Competence Center of Thoracic Surgery, Charité University Hospital Berlin, Berlin, Germany
| | - Yanli Chen
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Gero Bauer
- Department of Surgery, Competence Center of Thoracic Surgery, Charité University Hospital Berlin, Berlin, Germany
| | - Deniz Uluk
- Department of Surgery, Competence Center of Thoracic Surgery, Charité University Hospital Berlin, Berlin, Germany
| | - Aron Elsner
- Department of Surgery, Competence Center of Thoracic Surgery, Charité University Hospital Berlin, Berlin, Germany
| | - Marc Swierzy
- Department of Surgery, Competence Center of Thoracic Surgery, Charité University Hospital Berlin, Berlin, Germany
| | - Mahmoud Ismail
- Department of Surgery, Competence Center of Thoracic Surgery, Charité University Hospital Berlin, Berlin, Germany
| | - Andreas Meisel
- Department of Neurology, Integrated Center for Myasthenia Gravis, NeuroCure Clinical Research Center, Center for Stroke Research Berlin, Charité - University Medicine Berlin, Berlin, Germany
| | - Jens-C Rückert
- Department of Surgery, Competence Center of Thoracic Surgery, Charité University Hospital Berlin, Berlin, Germany
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5
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Kumar A, Asaf BB, Pulle MV, Puri HV, Bishnoi S, Gopinath SK. Minimal Access Surgery for Thymoma. Indian J Surg Oncol 2020; 11:625-632. [PMID: 33281403 DOI: 10.1007/s13193-020-01208-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 08/24/2020] [Indexed: 11/29/2022] Open
Abstract
Thymoma is a rare epithelial tumor of the thymus gland. Despite rarity, it is the most common tumor of the anterior mediastinum. Surgical resection in the form of extended thymectomy is the gold standard operation. Conventionally and even in the current era of significant advances in the minimally invasive surgery, open transsternal extended thymectomy is considered the gold standard, particularly for advanced-stage tumors. There is however significant evidence now available for the use of minimally invasive approaches for early-stage thymomas. This article aims to discuss the various minimally invasive approaches currently being employed for thymomas.
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Affiliation(s)
- Arvind Kumar
- Department of Thoracic Surgery and Institute of Robotic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Belal Bin Asaf
- Department of Thoracic Surgery & Institute of Robotic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Mohan Venkatesh Pulle
- Department of Thoracic Surgery & Institute of Robotic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Harsh Vardhan Puri
- Department of Thoracic Surgery & Institute of Robotic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Sukhram Bishnoi
- Department of Thoracic Surgery & Institute of Robotic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Srinivas Kodaganur Gopinath
- DNB Thoracic Surgery, Department of Thoracic Surgery and Director, Institute of Robotic Surgery, Sir Ganga Ram Hospital, New Delhi, India
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Imielski B, Kurihara C, Manerikar A, Chaudhary S, Kosterski S, Odell D, Kim S, Bharat A. Comparative effectiveness and cost-efficiency of surgical approaches for thymectomy. Surgery 2020; 168:737-742. [PMID: 32641277 DOI: 10.1016/j.surg.2020.04.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/09/2020] [Accepted: 04/16/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND We compared the clinical outcomes and cost-efficiency of surgical approaches (sternotomy-open, video assisted thoracoscopic surgery, and robotic assisted thoracic surgery) for thymectomy. METHODS This is a retrospective review of 220 consecutive patients who underwent thymectomy between January 1, 2007, and January 31, 2017. Surgical approach was determined by the surgeon, but we only included cases that could be resected using any of the 3 approaches. RESULTS Open approach was used in 69 patients, whereas minimally invasive technique was used in 151 (97, video assisted thoracoscopic surgery; 54, robotic assisted thoracic surgery). Open surgery was associated with greater total hospital cost ($22,847 ± $20,061 vs $14,504 ± $10,845, P < .001). Open group also revealed longer duration of intensive care unit (1.2 ± 2.8 vs 0.2 ± 1.3 days, P < .001) and hospital stay (4.3 ± 4.0 vs 2.0 ± 2.6 days, P < .001). There were no differences in major adverse clinical outcomes. Long-term recurrence-free survival after resection of thymoma was similar between the groups. CONCLUSION Minimally invasive techniques were equally efficacious compared with the open approach in the resection of the thymus. Additionally, their use was associated with decreased hospital duration of stay and reduced cost. Hence the use of minimally invasive approaches should be encouraged in the resection of thymus.
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Affiliation(s)
- Bartlomiej Imielski
- Division of Thoracic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Chitaru Kurihara
- Division of Thoracic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Adwaiy Manerikar
- Division of Thoracic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Satya Chaudhary
- Division of Thoracic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Susan Kosterski
- Division of Thoracic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - David Odell
- Division of Thoracic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Samuel Kim
- Division of Thoracic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Ankit Bharat
- Division of Thoracic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL; Division of Pulmonary and Critical Care Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
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Abstract
The number of interventions using robot-assisted thoracic surgery (RATS) is increasing in Germany, following the previous international development. Robot-assisted surgery provides some technical advantages and can overcome existing limitations of video-assisted thoracic surgery (VATS), especially in the case of extended resections, thus enabling the proportion of minimally invasive operations to be further increased. The safety of the procedure, even in extended resections, has repeatedly been demonstrated but whether there are clinically relevant benefits from RATS is currently the subject of scientific discussions. In addition, a further technical evolution of the RATS can be postulated by the upcoming market introduction of new robotic systems.
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Affiliation(s)
- Thorben Möller
- Klinik für Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität zu Kiel, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland
| | - Matthias Steinert
- Klinik für Herz- und Thoraxchirurgie - Sektion Thoraxchirurgie, Universitätsklinikum Jena, Jena, Deutschland
| | - Thomas Becker
- Klinik für Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität zu Kiel, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland
| | - Jan-Hen Drik Egberts
- Klinik für Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität zu Kiel, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland.
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8
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Chen K, Zhang X, Jin R, Xiang J, Han D, Zhang Y, Li H. Robot-assisted thoracoscopic surgery for mediastinal masses: a single-institution experience. J Thorac Dis 2020; 12:105-113. [PMID: 32190360 DOI: 10.21037/jtd.2019.08.105] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background The objectives of this study were to evaluate the feasibility and safety of robot-assisted thoracic surgery (RATS) using the da Vinci robotic system for mediastinal mass resection and to describe the surgical approach for masses in different mediastinal regions. Methods We retrospectively reviewed data from 84 patients who underwent RATS for resection of a mediastinal mass from June 2015 to April 2019. The results were analyzed with descriptive statistics. Results The mediastinal mass was resected successfully in all patients, with one patient requiring conversion to conventional open surgery. There were no intraoperative complications. The most common diagnoses were thymoma (n=17), bronchogenic cyst (n=16), and schwannoma (n=12). The surgical approach was determined by the location of the lesion and the planned extent of surgical resection. Resection was performed in the lateral decubitus position in 29 patients with posterior mediastinal tumor, semi-lateral decubitus position in 42 patients who only need resection of anterior mediastinal mass, and reverse Trendelenburg position in 13 patients undergoing thymectomy. The mean (± standard deviation) operation time was 91.86±56.42 min, duration of chest tube use was 1.83±0.93 days, and postoperative hospital stay was 3.62±7.52 days. Three patients (3.5%) developed postoperative complications: one chylous fistula, which required reoperation, and one case each of atrial fibrillation and pulmonary infection, which were treated conservatively. Conclusions Our experience demonstrated that different surgical approaches of RATS are safe and feasible for mediastinal mass resection. An appropriate approach can be selected based on the mediastinal region in which the tumor is located.
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Affiliation(s)
- Kai Chen
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Xianfei Zhang
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Runsen Jin
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Jie Xiang
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Dingpei Han
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Yajie Zhang
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Hecheng Li
- Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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9
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Comacchio GM, Marulli G, Mammana M, Natale G, Schiavon M, Rea F. Surgical Decision Making. Thorac Surg Clin 2019; 29:203-213. [DOI: 10.1016/j.thorsurg.2018.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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10
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Tassi V, Vannucci J, Ceccarelli S, Gili A, Matricardi A, Avenia N, Puma F. Stage-related outcome for thymic epithelial tumours. BMC Surg 2019; 18:114. [PMID: 31074388 PMCID: PMC7402578 DOI: 10.1186/s12893-018-0434-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 10/29/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Thymic epithelial tumours (TETs) are characterized by a wide variety of biological behaviors. Radical resection and stage are strong prognostic factors. Aim of this study is to review our Single Center Experience. METHODS One hundred and seventy-seven patients observed in the period from January 2000 to December 2016 were included in the study. Data regarding clinicopathologic features, treatment, and survival were collected. Stage-related clinical standpoints and therapeutic options were also evaluated. RESULTS Non-surgical treatment was primarily performed in 15 (8.47%), unresectable disease was intraoperatively found in 12 cases (7.4%). The analysis of 150 patients undergoing curative surgery revealed 70 stage I TET (46.66%), 49 stage II (32.66%), 19 stage III (12.66%), 6 stage IVa (4%) and 6 stage IVb (4%) at the first hospital admission. Histology identified 12 A thymoma (8%), 38 AB (25.33%), 24 B1 (16%), 50 B2 (33.33%), 19 B3 (12.66%) and 7 carcinomas (4.66%). The mean follow up time was 84.14 months (sd = 61.68 months). Disease relapse occurred in 13 patients (8.78%) at a mean period of 78.85 months (sd = 60.87 months) after surgery. Exitus due to thymoma happened in 6 cases (4.05%) after a mean survival of 56.02 months (sd = 25.17 months). The 5-year overall survival rate was 0.94 (95%CI 0.88-0.97) and the 5-year disease-free survival rate was 0.90 (95%CI 0.83-0.94). The 5-year overall survival rates were 96.1% (95% CI, 89.9-98.5%) for the early stages and 87.4% (95% CI, 65.6-95.8%) for the advanced stages (p = 0.670). The 5-year disease-free survival rates resulted being 98.8% (95% CI, 92.3-99.8%) for the early stages and 59.8% (95% CI, 37.8-76.2%) for the advanced stages (p < 0.001). CONCLUSIONS Advanced stage TETs are characterized by higher mortality and recurrence rates. Although technically demanding, surgery, as part of multimodality therapy, could prolong survival. Iterative surgical treatment of recurrences is a viable option for selected patients. TRIAL REGISTRATION The study was approved by the Institutional Review Board of Perugia and Terni University Hospitals [Code T1003] and was retrospectively registered.
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Affiliation(s)
- Valentina Tassi
- Division of Thoracic Surgery, Department of Surgical and Biomedical Sciences, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy
| | - Jacopo Vannucci
- Division of Thoracic Surgery, Department of Surgical and Biomedical Sciences, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy
| | - Silvia Ceccarelli
- Division of Thoracic Surgery, Department of Surgical and Biomedical Sciences, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy.
| | - Alessio Gili
- Public Health Section, Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Alberto Matricardi
- Division of Thoracic Surgery, Department of Surgical and Biomedical Sciences, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy
| | - Nicola Avenia
- General and Specialized Surgery, "Santa Maria" Hospital, Department of Surgical and Biomedical Sciences, University of Perugia Medical School, Terni, Italy
| | - Francesco Puma
- Division of Thoracic Surgery, Department of Surgical and Biomedical Sciences, S. Maria della Misericordia Hospital, University of Perugia Medical School, Perugia, Italy
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11
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Kamel MK, Villena-Vargas J, Rahouma M, Lee B, Harrison S, Stiles BM, Abdelrahman AM, Altorki NK, Port JL. National trends and perioperative outcomes of robotic resection of thymic tumours in the United States: a propensity matching comparison with open and video-assisted thoracoscopic approaches†. Eur J Cardiothorac Surg 2019; 56:762-769. [DOI: 10.1093/ejcts/ezz111] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/21/2019] [Accepted: 02/26/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
OBJECTIVES:
Despite the recent increased rate of adoption of robotic approaches for the resection of thymic tumours, their use is still limited to large-volume academic centres. To date, a large-scale analysis of the robotic approach has not been performed. We assessed the recent trends and outcomes of robotic thymectomies in the United States compared to those of open and video-assisted thoracoscopic surgical (VATS) approaches.
METHODS:
The National Cancer Database was queried for patients who underwent resection for thymic tumours (2010–2014). Predictors of using the robotic approach were estimated by logistic regression analysis. Propensity matching analysis (robotic versus open and robotic versus VATS) was done (1:1—caliper 0.05), controlling for age, gender, comorbidity index, induction treatment, tumour size and tumour extension.
RESULTS:
A total of 2558 thymectomies were performed (robotic = 300, VATS = 280, open = 1978). The use of a robotic approach increased from 6% (2010) to 14% (2014). The number of hospitals performing at least 1 robotic thymectomy increased from 22 (2010) to 52 (2014). Independent predictors influencing the choice of a robotic approach included an academic research/integrated cancer programme [odds ratio (OR) 1.66, confidence interval (CI) 1.22–2.27], later year of diagnosis (2014; OR 2.23, CI 1.31–3.80) and a patient’s race (Asian) (OR 1.68, CI 1.05–2.69). A robotic approach was less likely to be utilized in midwestern hospitals (OR 0.65, CI 0.42–0.99), in larger tumours (cm) (OR 0.85, CI 0.80–0.90), with invasion of adjacent organs (OR 0.55, CI 0.37–0.82), thymic carcinoma (OR 0.62, CI 0.40–0.97) and following induction chemotherapy (OR 0.22, CI 0.08–0.61). In a propensity-matched analysis, there were no differences in the incidence of positive margins, nodal dissection, 30-day readmission rates and 30-/90-day mortality rates between the groups. However, a robotic approach was associated with fewer conversions compared to VATS, with a trend towards a shorter length of stay compared to an open approach. There were no differences in the 5-year overall survival rate between the matched groups (robotic 93% vs VATS 94%; P = 0.571; robotic 91% vs open 80%; P = 0.094).
CONCLUSIONS:
Over a 4-year study period, there was a significant increase in robotic utilization for thymectomies and an increase in the number of hospitals performing the procedure. In a matched analysis, a robotic approach was comparable to a VATS or an open approach. Current trends demonstrate increased robotic utilization for small thymomas with excellent perioperative results.
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Affiliation(s)
- Mohamed K Kamel
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Weill Cornell Medicine - New York Presbyterian Hospital, New York, NY, USA
- Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Jonathan Villena-Vargas
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Weill Cornell Medicine - New York Presbyterian Hospital, New York, NY, USA
| | - Mohamed Rahouma
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Weill Cornell Medicine - New York Presbyterian Hospital, New York, NY, USA
- Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Benjamin Lee
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Weill Cornell Medicine - New York Presbyterian Hospital, New York, NY, USA
| | - Sebron Harrison
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Weill Cornell Medicine - New York Presbyterian Hospital, New York, NY, USA
| | - Brendon M Stiles
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Weill Cornell Medicine - New York Presbyterian Hospital, New York, NY, USA
| | | | - Nasser K Altorki
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Weill Cornell Medicine - New York Presbyterian Hospital, New York, NY, USA
| | - Jeffery L Port
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Weill Cornell Medicine - New York Presbyterian Hospital, New York, NY, USA
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12
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O'Sullivan KE, Kreaden US, Hebert AE, Eaton D, Redmond KC. A systematic review of robotic versus open and video assisted thoracoscopic surgery (VATS) approaches for thymectomy. Ann Cardiothorac Surg 2019; 8:174-193. [PMID: 31032201 DOI: 10.21037/acs.2019.02.04] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Median sternotomy has been the most commonly used approach for thymectomy to date. Recent advances in video-assisted thoracoscopic surgery (VATS) and robotic access with CO2 insufflation techniques have allowed more minimally invasive approaches. However, prior reviews have not compared robotic to both open and VATS thymectomy. Methods A systematic review was conducted in accordance with the PRISMA guidelines using PubMed, Embase and Scopus databases. Original research articles comparing robotic to VATS or to open thymectomy for myasthenia gravis, anterior mediastinal masses, or thymomas were included. Meta-analyses were performed for mortality, operative time, blood loss, transfusions, length of stay, conversion to open, intraoperative and postoperative complication rates, and positive/negative margin rates. Results Robotic thymectomy is a valid alternative to the open approach; advantages include: reduced blood loss [weighted mean difference (WMD): -173.03, 95% confidence interval (95% CI): -305.90, -40.17, P=0.01], fewer postoperative complications (odds ratio: 0.37, 95% CI: 0.22, 0.60, P<0.00001), a shorter hospital stay (WMD: -2.78, 95% CI: -3.22, -2.33, P<0.00001), and a lower positive margin rate (relative difference: -0.04, 95% CI: -0.07, -0.01, P=0.01), with comparable operative times (WMD: 6.73, 95% CI: -21.20, 34.66, P=0.64). Robotic thymectomy was comparable with the VATS approach; both have the advantage of avoiding median sternotomy. Conclusions While randomized controlled studies are required to make definitive conclusions, current data suggests that robotic thymectomy is superior to open surgery and comparable to a VATS approach. Long-term follow-up is required to further delineate oncological outcomes.
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Affiliation(s)
- Katie E O'Sullivan
- Department of Thoracic Surgery, Mater Misericordiae University Hospital, Eccles St., Dublin, Ireland
| | - Usha S Kreaden
- Clinical Affairs, Intuitive Surgical Inc., Sunnyvale, CA, USA
| | - April E Hebert
- Clinical Affairs, Intuitive Surgical Inc., Sunnyvale, CA, USA
| | - Donna Eaton
- Department of Thoracic Surgery, Mater Misericordiae University Hospital, Eccles St., Dublin, Ireland
| | - Karen C Redmond
- Department of Thoracic Surgery, Mater Misericordiae University Hospital, Eccles St., Dublin, Ireland
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Video-Assisted Thoracoscopic Versus Robotic-Assisted Thoracoscopic Thymectomy: Systematic Review and Meta-analysis. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018; 12:259-264. [PMID: 28759542 DOI: 10.1097/imi.0000000000000382] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Minimally invasive thoracic surgical procedures, performed with or without the assistance of a robot, have gained popularity over the last decade. They have increasingly become the choice of intervention for a number of thoracic surgical operations. Minimally invasive surgery decreases postoperative pain, hospital stay and leads to a faster recovery in comparison with conventional open methods. Minimally invasive techniques to perform a thymectomy include video-assisted thoracoscopic surgery (VATS) or robotic-assisted thoracoscopic surgery (RATS). In this study, we aim to systematically review and interrogate the literature on minimally invasive thymectomy and draw a meta-analysis on the outcomes between the two approaches. METHODS An extensive electronic health database search was performed on all articles published from inception to May 2015 for studies describing outcomes in VATS and RATS thymectomy. RESULTS A total of 350 patients were included in this study, for which 182 and 168 patients underwent RATS and VATS thymectomy, respectively. There were no recorded in-hospital deaths for either procedure. There was no statistical difference in conversion to open, length of hospital stay, or postoperative pneumonia. Operational times for RATS thymectomy were longer. CONCLUSIONS The VATS and RATS thymectomy offer good and safe operative and perioperative outcomes. There is little difference between the two groups. However, there is poor evidence basis for the long-term outcomes in minimally invasive procedures for thymectomy. It is imperative that future studies evaluate oncological outcomes both short and long term as well as those related to safety.
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Ruffini E, Filosso PL, Guerrera F, Lausi P, Lyberis P, Oliaro A. Optimal surgical approach to thymic malignancies: New trends challenging old dogmas. Lung Cancer 2018; 118:161-170. [DOI: 10.1016/j.lungcan.2018.01.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 01/28/2018] [Accepted: 01/29/2018] [Indexed: 12/12/2022]
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Solinas M, Novellis P, Bottoni E, Errico V, Voulaz E, Alloisio M, Veronesi G. Robotic approach in case of thymoma involving the left anonymous vein: a case report. AME Case Rep 2017; 1:3. [PMID: 30263990 DOI: 10.21037/acr.2017.09.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 09/14/2017] [Indexed: 11/06/2022]
Abstract
The robotic system has several technical advantages over the manual video thoracoscopic approach. It offers a high definition three-dimensional view and robotic arms are more comfortable to use, because they allow more precise, flexible, and intuitive movements. This case report describes a locally advanced thymoma in a 75-year-old male patient, excised through a robotic-assisted thymectomy with atypical resection of the infiltrated left upper lobe, the preservation of the left phrenic nerve and partial resection of the left anonymous vein involved, without necessity of reconstruction. Clinical staging was thymoma T3 B1-2, while the postoperative histological classification and radiation was thymoma T3, B3, Masaoka-Koga stage IIB. The postoperative course was uneventful and the patient was discharged in second postoperative day. This case remarks that robotic devices are of great help in the intraoperative recognition and precise management of infiltrated structure, like important vessels and nerves, avoiding conversion to an open approach, which until now was the main surgical indication in these situations.
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Affiliation(s)
- Michela Solinas
- Division of Thoracic and General Surgery, Humanitas Clinical and Research Center, Rozzano 20089, Milan, Italy
| | - Pierluigi Novellis
- Division of Thoracic and General Surgery, Humanitas Clinical and Research Center, Rozzano 20089, Milan, Italy
| | - Edoardo Bottoni
- Division of Thoracic and General Surgery, Humanitas Clinical and Research Center, Rozzano 20089, Milan, Italy
| | - Valentina Errico
- Division of Thoracic and General Surgery, Humanitas Clinical and Research Center, Rozzano 20089, Milan, Italy
| | - Emanuele Voulaz
- Division of Thoracic and General Surgery, Humanitas Clinical and Research Center, Rozzano 20089, Milan, Italy
| | - Marco Alloisio
- Division of Thoracic and General Surgery, Humanitas Clinical and Research Center, Rozzano 20089, Milan, Italy.,Humanitas University, Biomedical Science Department, Rozzano 20089, Milan, Italy
| | - Giulia Veronesi
- Division of Thoracic and General Surgery, Humanitas Clinical and Research Center, Rozzano 20089, Milan, Italy
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Gkouma A. Robotically assisted thymectomy: a review of the literature. J Robot Surg 2017; 12:3-10. [PMID: 28905304 DOI: 10.1007/s11701-017-0748-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 09/04/2017] [Indexed: 11/26/2022]
Abstract
The aim of this literature review is to see where the robotic thymectomy stands nowadays. A thorough search of the PubMed revealed eighty-two related articles which reviewed comprehensively. The zero intraoperative mortality, the minimal intraoperative morbidity, as well as the recorded recurrence rate of 0-11.1% and complete stable remission rate of 0-40% suggests that the robotic-assisted thymectomy is a feasible, safe and an upcoming procedure. However, the lack of prospective randomized controlled trials prevents this technique to become the standard approach for the nonce.
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Affiliation(s)
- Antonia Gkouma
- Cardiothoracic Surgery Department, St. Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK.
- 251 General Airforce Hospital, Panagioti Kanellopoulou 3, Athens, 11525, Greece.
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Fok M, Bashir M, Harky A, Sladden D, DiMartino M, Elsyed H, Howard C, Knipe M, Shackcloth MJ. Video-Assisted Thoracoscopic versus Robotic-Assisted Thoracoscopic Thymectomy. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017. [DOI: 10.1177/155698451701200405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Matthew Fok
- Thoracic Aortic Aneurysm Service, Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Mohamad Bashir
- Cardiothoracic Surgery, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Amer Harky
- Cardiothoracic Surgery, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - David Sladden
- Cardiothoracic Surgery, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Mariano DiMartino
- Cardiothoracic Surgery, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Hazim Elsyed
- Thoracic Aortic Aneurysm Service, Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Callum Howard
- Thoracic Aortic Aneurysm Service, Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Maxwell Knipe
- Thoracic Aortic Aneurysm Service, Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Michael J. Shackcloth
- General Thoracic & Oesophageal Surgery, Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
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Kamel MK, Rahouma M, Stiles BM, Nasar A, Altorki NK, Port JL. Robotic Thymectomy: Learning Curve and Associated Perioperative Outcomes. J Laparoendosc Adv Surg Tech A 2017; 27:685-690. [PMID: 28121481 DOI: 10.1089/lap.2016.0553] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Recently, robotic-assisted thymectomy (RAT) has emerged as an alternative to either, an open transsternal approach or to a video-assisted thoracoscopic approach, for both thymic tumors and benign lesions. We have reviewed our early experience with RAT to assess the associated learning curve as well as the short-term perioperative outcomes. METHODS A prospectively collected database was reviewed for patients who underwent RAT for all causes in the period 2012-2016. Robotic thymectomy cases were stratified and compared according to the number of cases performed by each surgeon (≤15 versus >15 cases). A propensity score matching was done to compare perioperative outcomes in patients undergoing robotic and transsternal resection of thymomas. RESULTS Seventy patients (47 females) with a median age of 52, underwent RAT. The median operative time was 102 min with 5 conversions to an open approach for local invasion (n = 3) or for complete pleural symphysis (n = 2). There were 2 rib fractures and 1 recurrent laryngeal nerve palsy. Median length of chest tube drainage and length of stay were 1 and 3 days, respectively. Operative time and estimated blood loss plateaued after surgeon's initial 15-20 cases, which may reflect the initial learning curve. A comparison between early and late robotic cases showed that with the growing experience, the operative time becomes shorter (94 versus 107 min, P = .018). Propensity score analysis between robotic and transsternal resection of thymoma (n = 22 in each group) showed no significant differences in operative time (P = .79), intraoperative complications (P = .99), or postoperative complications (P = .99). CONCLUSIONS Robotic thymectomy is feasible and safe, and is associated with comparable perioperative outcomes to the traditional transsternal approach in patients undergoing thymomectomy. An initial learning curve of 15-20 robotic thymectomy cases may be required by the surgeons to adequately perform this relatively novel technique.
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Affiliation(s)
- Mohamed K Kamel
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York Presbyterian Hospital - Weill Cornell Medical College , New York, New York
| | - Mohamed Rahouma
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York Presbyterian Hospital - Weill Cornell Medical College , New York, New York
| | - Brendon M Stiles
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York Presbyterian Hospital - Weill Cornell Medical College , New York, New York
| | - Abu Nasar
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York Presbyterian Hospital - Weill Cornell Medical College , New York, New York
| | - Nasser K Altorki
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York Presbyterian Hospital - Weill Cornell Medical College , New York, New York
| | - Jeffrey L Port
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York Presbyterian Hospital - Weill Cornell Medical College , New York, New York
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Marulli G, Comacchio GM, Stocca F, Zampieri D, Romanello P, Calabrese F, Rebusso A, Rea F. Robotic-assisted thymectomy: current perspectives. ACTA ACUST UNITED AC 2016; 3:53-63. [PMID: 30697556 PMCID: PMC6193423 DOI: 10.2147/rsrr.s93012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
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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Affiliation(s)
- Giuseppe Marulli
- Thoracic Surgery Unit - Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital, Padova, Italy,
| | - Giovanni M Comacchio
- Thoracic Surgery Unit - Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital, Padova, Italy,
| | - Francesca Stocca
- Thoracic Surgery Unit - Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital, Padova, Italy,
| | - Davide Zampieri
- Thoracic Surgery Unit - Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital, Padova, Italy,
| | - Paola Romanello
- Thoracic Surgery Unit - Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital, Padova, Italy,
| | - Francesca Calabrese
- Thoracic Surgery Unit - Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital, Padova, Italy,
| | - Alessandro Rebusso
- Thoracic Surgery Unit - Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital, Padova, Italy,
| | - Federico Rea
- Thoracic Surgery Unit - Department of Cardiologic, Thoracic and Vascular Sciences, University Hospital, Padova, Italy,
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Baste JM, Rinieri P, Sarsam M, Peillon C. Place de la chirurgie robotique dans les pathologies tumorales thoraciques. ONCOLOGIE 2016. [DOI: 10.1007/s10269-016-2630-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Straughan DM, Fontaine JP, Toloza EM. Robotic-Assisted Videothoracoscopic Mediastinal Surgery. Cancer Control 2015; 22:326-30. [PMID: 26351888 DOI: 10.1177/107327481502200310] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Tumors of the mediastinum as well as normal thymus glands in patients with myasthenia gravis have traditionally been resected using large and morbid incisions. However, robotic-assisted mediastinal resections are gaining popularity because of the many advantages that the robot provides. However, few comprehensive reviews of the literature on robotic-assisted mediastinal resections exist. METHODS A systemic review of the current medical literature was performed, excluding cases related to esophageal pathology. These studies were evaluated and their findings are reported in this comprehensive review. Approximately 48 papers met the inclusion criteria for review. RESULTS Robotic-assisted surgical systems are increasingly being used in mediastinal resections. Based on the available literature, robotic-assisted thoracoscopic surgery in the mediastinum is feasible and safe. Robotic-assisted mediastinal surgery appears to be superior to open approaches of the mediastinum and is comparable with videothoracoscopic surgery when patient outcomes are considered. CONCLUSIONS Increased robotic experience and more studies, including randomized controlled trials, are needed to validate the findings of the current literature.
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Affiliation(s)
- David M Straughan
- Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.
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[Implementation of a robotic video-assisted thoracic surgical program]. Rev Mal Respir 2015; 33:207-17. [PMID: 26163391 DOI: 10.1016/j.rmr.2015.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 04/20/2015] [Indexed: 11/24/2022]
Abstract
AIMS Recent publications from North America have shown the benefits of robot-assisted thoracic surgery. We report here the process of setting up such a program in a French university centre and early results in a unit with an average treatment volume. METHODS Retrospective review of a single institution database. The program was launched after a 6-month preparation period. RESULTS From January 2012 to January 2013, totally endoscopic, full robot-assisted procedures were performed on 30 patients (17 males). Median age was 54 [Q1-Q3, 48-63] years and ASA score 2 [1,2]. Operative procedures included thymectomy (9 ; 30%), lobectomy with nodes resection (11 ; 38%), segmentectomy (4 ; 14%), lymphadenectomy (3 ; 10%), Bronchogenic cyst (2, 5%) and posterior mediastinal mass resection (1 ; 3%). No conversion was required. Median blood loss was 50mL [10-100]. Median operating time was 135 min (105-165) including 30 min [20-40] for docking, 90min for robot-assisted operating [70-120] and 15 min [10-15] for lesion extraction. CO2 insufflation was used in 28 cases (93%). Hospital stay was 4 days [4-6] with 6 minor complications (20%) (Grade 1 according to the Clavien-Dindo classification). After a median 4 months follow-up [2-7], all patients were alive and demonstrated a good quality of life. CONCLUSION This series suggests that full robotic thoracic procedures are safe and effective treatment for various pathologies, with low morbidity and without a significant learning curve, even in a lower volume centre. This technology should accompany the development of minimally invasive thoracic surgery. The importance of robotic training should be emphasized to optimize procedures and costs.
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Kumar A, Asaf BB. Robotic thoracic surgery: The state of the art. J Minim Access Surg 2015; 11:60-7. [PMID: 25598601 PMCID: PMC4290121 DOI: 10.4103/0972-9941.147693] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 11/28/2014] [Indexed: 12/20/2022] Open
Abstract
Minimally invasive thoracic surgery has come a long way. It has rapidly progressed to complex procedures such as lobectomy, pneumonectomy, esophagectomy, and resection of mediastinal tumors. Video-assisted thoracic surgery (VATS) offered perceptible benefits over thoracotomy in terms of less postoperative pain and narcotic utilization, shorter ICU and hospital stay, decreased incidence of postoperative complications combined with quicker return to work, and better cosmesis. However, despite its obvious advantages, the General Thoracic Surgical Community has been relatively slow in adapting VATS more widely. The introduction of da Vinci surgical system has helped overcome certain inherent limitations of VATS such as two-dimensional (2D) vision and counter intuitive movement using long rigid instruments allowing thoracic surgeons to perform a plethora of minimally invasive thoracic procedures more efficiently. Although the cumulative experience worldwide is still limited and evolving, Robotic Thoracic Surgery is an evolution over VATS. There is however a lot of concern among established high-volume VATS centers regarding the superiority of the robotic technique. We have over 7 years experience and believe that any new technology designed to make minimal invasive surgery easier and more comfortable for the surgeon is most likely to have better and safer outcomes in the long run. Our only concern is its cost effectiveness and we believe that if the cost factor is removed more and more surgeons will use the technology and it will increase the spectrum and the reach of minimally invasive thoracic surgery. This article reviews worldwide experience with robotic thoracic surgery and addresses the potential benefits and limitations of using the robotic platform for the performance of thoracic surgical procedures.
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Affiliation(s)
- Arvind Kumar
- Department of Thoracic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Belal Bin Asaf
- Department of Thoracic Surgery, Sir Ganga Ram Hospital, New Delhi, India
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Dalela D, Ahlawat R, Sood A, Jeong W, Bhandari M, Menon M. The growth of computer-assisted (robotic) surgery in urology 2000-2014: The role of Asian surgeons. Asian J Urol 2015; 2:1-10. [PMID: 29264114 PMCID: PMC5730690 DOI: 10.1016/j.ajur.2014.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 08/28/2014] [Accepted: 09/06/2014] [Indexed: 11/25/2022] Open
Abstract
Objective A major role in the establishment of computer-assisted robotic surgery (CARS) can be traced to the work of Mani Menon at Vattikuti Urology Institute (VUI), and of many surgeons of Asian origin. The success of robotic surgery in urology has spurred its acceptance in other surgical disciplines, improving patient comfort and disease outcomes and helping the industrial growth. The present paper gives an overview of the progress and development of robotic surgery, especially in the field of Urology; and to underscore some of the seminal work done by the VUI and Asian surgeons in the development of robotic surgery in urology in the US and around the world. Methods PubMed/Medline and Scopus databases were searched for publications from 2000 through June 2014, using algorithms based on keywords “robotic surgery”, ”prostate”, “kidney”, “adrenal”, “bladder”, “reconstruction”, and “kidney transplant”. Inclusion criteria used were published full articles, book chapters, clinical trials, prospective and retrospective series, and systematic reviews/meta-analyses written in English language. Studies from Asian institutions or with the first/senior author of Asian origin were included for discussion, and focused on techniques of robotic surgery, relevant patient outcomes and associated demographic trends. Results A total of 58 articles selected for final review highlight the important strides made by robots in urology, from robotic radical prostatectomy in 2000 to robotic kidney transplant in 2014. In the hands of an experienced robotic surgeon, it has been demonstrated to improve functional patient outcomes and minimize perioperative complications compared to open surgery, especially in urologic oncology and reconstructive urology. With increasing surgeon proficiency, the benefits of robotic surgery were consistently seen across different surgical disciplines, patient populations, and strata. Conclusion The addition of robot to the surgical armamentarium has allowed better patient care and improved disease outcomes. VUI and surgeons of Asian origin have played a pioneering role in dissemination of computer-assisted surgery.
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Affiliation(s)
- Deepansh Dalela
- Henry Ford Health System - Vattikuti Urology Institute, Detroit, MI, USA
| | - Rajesh Ahlawat
- Medanta Hospitals - Medanta Vattikuti Urology Institute, Gurgaon, Haryana, India
| | - Akshay Sood
- Henry Ford Health System - Vattikuti Urology Institute, Detroit, MI, USA
| | - Wooju Jeong
- Henry Ford Health System - Vattikuti Urology Institute, Detroit, MI, USA
| | - Mahendra Bhandari
- Henry Ford Health System - Vattikuti Urology Institute, Detroit, MI, USA
| | - Mani Menon
- Henry Ford Health System - Vattikuti Urology Institute, Detroit, MI, USA
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Dalela D, Ahlawat R, Sood A, Jeong W, Bhandari M, Menon M. WITHDRAWN: The growth of computer-assisted (robotic) surgery in urology 2000–2014: The role of Asian surgeons. Asian J Urol 2014. [DOI: 10.1016/j.ajur.2014.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Keijzers M, de Baets M, Hochstenbag M, Abdul-Hamid M, zur Hausen A, van der Linden M, Kuks J, Verschuuren J, Kessels F, Dingemans AMC, Maessen J. Robotic thymectomy in patients with myasthenia gravis: neurological and surgical outcomes. Eur J Cardiothorac Surg 2014; 48:40-5. [DOI: 10.1093/ejcts/ezu352] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 08/07/2014] [Indexed: 01/23/2023] Open
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Minimally Invasive Esophagectomy: Are There Significant Benefits? CURRENT SURGERY REPORTS 2014. [DOI: 10.1007/s40137-014-0060-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Robotic thymectomy with the da Vinci robotic system is the latest development in the surgery of thymic gland. Thymectomy for myasthenia gravis is best offered to patients with seropositive acetylcholine receptor antibodies and who are seronegative for muscle-specific kinase protein. The robotic operation technique is indicated in all patients with myasthenia gravis in association with a resectable thymoma, typically Masaoka-Koga stages I and II.
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