1
|
Robotic Mediastinal Surgery. Thorac Surg Clin 2023; 33:89-97. [DOI: 10.1016/j.thorsurg.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
2
|
Wang CQ, Wang J, Liu FY, Wang W. Robot-assisted thoracoscopic surgery vs. sternotomy for thymectomy: A systematic review and meta-analysis. Front Surg 2023; 9:1048547. [PMID: 36684131 PMCID: PMC9852331 DOI: 10.3389/fsurg.2022.1048547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/25/2022] [Indexed: 01/09/2023] Open
Abstract
Introduction Surgeons have widely regarded sternotomy (ST) as the standard surgical method for thymectomy. Minimally invasive methods for thymectomy, including video-assisted and robot-assisted thoracoscopic surgery (RATS), have been explored. There are some studies have researched and compared the outcomes of patients after robotic and sternotomy procedure. Methods We searched the databases of Pubmed, the Cochrane Library, Embase and selected the studies on the efficacy and safety of RATS or ST for thymectomy. Meta-analysis was performed for operation time, operation blood loss, postoperative drainage time, operative complications and hospitalization time. Results A total of 16 cohort studies with 1,089 patients were included. Compared to ST, RATS is an appropriate alternative for thymectomy which reduced operation blood loss [standardized mean difference (SMD) = -1.82, 95% confidence interval (95% CI): (-2.64, -0.99), p = 0.000], postoperative drainage time [SMD = -2.47, 95% Cl: (-3.45, -1.48), p = 0.000], operative complications [odds ratio (OR) = 0.31, 95% Cl: (0.18, 0.51), p = 0.000] and hospitalization time [SMD = -1.62, 95% Cl: (-2.16, -1.07), p = 0.000]. Conclusions This meta-analysis based on cohort studies shows that RATS has more advantages over ST. Therefore, RATS is a more advanced and suitable surgical method for thymectomy.
Collapse
Affiliation(s)
- Cheng-qian Wang
- Department of Thoracic Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China,The Second Medical College, Binzhou Medical University, Yantai, China
| | - Jie Wang
- The Second Medical College, Binzhou Medical University, Yantai, China
| | - Fei-yu Liu
- Department of Pharmacy, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Wei Wang
- Department of Thoracic Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China,Correspondence: Wei Wang
| |
Collapse
|
3
|
Patel G, Reddy BVK, Patil P. Maximal Thymectomy via Mini Sternotomy with Pleural Preservation. South Asian J Cancer 2022; 11:229-234. [PMID: 36620502 PMCID: PMC9822780 DOI: 10.1055/s-0042-1743162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Gaurav PatelBackground There are different surgical techniques used for maximal thymectomy. Each technique has its own advantages and disadvantages. We propose a mini sternotomy with pleural preservation approach for complete maximal thymectomy. Methods Over time range of 5 years, 32 patients with diagnosis of thymoma with or without myasthenia gravis (MG) underwent maximal thymectomy by mini sternotomy in our institute. Patient records were examined for the following parameters: age, sex, preoperative medication, symptoms of MG as per Myasthenia Gravis Foundation of America grading system, operating time, duration of postoperative ventilation, length of stay in the intensive care unit, overall length of hospitalization, and postoperative complications. Results The mean age of patients in our study was 43.66. Sex ratio in this study was almost equal. Sixty-nine percent of patients were stage I thymoma according to Masaoka staging. Size of the tumor ranged from 3 to 8 cm with mean size being 4.54 cm. Complete resection with negative tumor margins was possible in all the cases. Four patients had intraoperative pleural injury out of which two patients required intercostal tube insertion. We did not have any serious postoperative complications with no perioperative mortality. Conclusions Mini sternotomy allows maximal removal of thymus through a less invasive approach and is associated with a significantly smoother postoperative course, less overall complications, and good clinical outcome. It is a simple technique that can be performed by any thoracic and surgical oncologists especially in Indian subcontinent where facilities of video-assisted thoracoscopic surgery and robotic video-assisted thoracoscopic surgery are not available in all areas and are expensive.
Collapse
Affiliation(s)
- Gaurav Patel
- Department of Surgical Oncology, Bombay Hospital and Medical Research Centre, Marine Lines, Mumbai, Maharashtra, India,Address for correspondence Gaurav Patel, MBBS, MS Department of Surgical Oncology, Bombay Hospital and Medical Research CentreMumbai-400020, MaharashtraIndia
| | - Bojja V. Kishore Reddy
- Department of Surgical Oncology, Bombay Hospital and Medical Research Centre, Marine Lines, Mumbai, Maharashtra, India
| | - Prakash Patil
- Department of Surgical Oncology, Bombay Hospital and Medical Research Centre, Marine Lines, Mumbai, Maharashtra, India
| |
Collapse
|
4
|
Aljaafari D, Ishaque N. Thymectomy in myasthenia gravis: A narrative review. SAUDI JOURNAL OF MEDICINE AND MEDICAL SCIENCES 2022; 10:97-104. [PMID: 35602390 PMCID: PMC9121707 DOI: 10.4103/sjmms.sjmms_80_22] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/20/2022] [Accepted: 04/21/2022] [Indexed: 11/04/2022] Open
|
5
|
Kumar A, Asaf BB, Pulle MV, Puri HV, Sethi N, Bishnoi S. Myasthenia is a poor prognostic factor for perioperative outcomes after robotic thymectomy for thymoma. Eur J Cardiothorac Surg 2021; 59:807-813. [PMID: 33279991 DOI: 10.1093/ejcts/ezaa406] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/25/2020] [Accepted: 09/30/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The goal of this study was to compare the early and intermediate surgical outcomes, including the survival of those with and without myasthenic thymoma, following robotic thymectomy. METHODS This is a retrospective analysis of prospectively maintained data of 111 patients who underwent robotic thymectomy for thymoma over 7 years in a thoracic surgery centre in India. We performed a comparative analysis of demographics, intraoperative variables and postoperative outcomes including survival of those with and without myasthenic thymoma. RESULTS Of 111 patients, 68 patients were myasthenic and 43 were non-myasthenic. The need to resect surrounding structures and conversions was greater in the myasthenic group (P = 0.02, P = 0.04). Postoperative complications were significantly higher in the myasthenic group (P = 0.02). No differences were observed in intensive care unit stay, the need for postoperative ventilation and the hospital stay. On correlation, a higher Masaoka stage [odds ratio 1.96, 95% confidence interval (CI) 1.22-3.15] and an aggressive World Health Organization histological diagnosis (odds ratio 1.58, 95% CI 1.10-2.26) were more likely in patients with myasthenia gravis. A total of 7 deaths (6.3%) occurred during the median follow-up of 4.2 years, 5 among those with myasthenic thymoma and 2 among patients with non-myasthenic thymoma. Due to the small number of deaths, there is insufficient evidence to draw any conclusion about the effect of myasthenia gravis on survival after surgery (hazard ratio 0.51, 95% CI 0.09-2.71; P = 0.43). CONCLUSIONS The presence of myasthenia with thymoma is associated with more adjacent structure resection, higher postoperative complications and more conversions. The use of robotic surgery for thymoma resection in patients with myasthenia could not overcome the early postoperative problems related to myasthenia gravis.
Collapse
Affiliation(s)
- Arvind Kumar
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Belal Bin Asaf
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | | | | | - Nitin Sethi
- Department of Anaesthesia, Sir Ganga Ram Hospital, New Delhi, India
| | - Sukhram Bishnoi
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
| |
Collapse
|
6
|
Li F, Li Z, Takahashi R, Ioannis A, Ismail M, Meisel A, Rueckert JC. Robotic-Extended Rethymectomy for Refractory Myasthenia Gravis: A Case Series. Semin Thorac Cardiovasc Surg 2019; 32:593-602. [PMID: 31682904 DOI: 10.1053/j.semtcvs.2019.10.016] [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: 10/25/2019] [Accepted: 10/25/2019] [Indexed: 11/11/2022]
Abstract
To assess the safety and efficacy of robotic-extended rethymectomy in selected refractory myasthenia gravis (MG) patients with suspected residual thymic tissue. Robotic-extended rethymectomy was performed in 6 MG patients with seropositive acetylcholine receptors (AChR) antibody who had undergone a previous thymectomy (1 cervicotomy, 2 video-assisted thoracoscopic surgeries, and 3 sternotomies). The median observation time before robotic rethymectomy was 108 (24-171) months. The main outcomes were perioperative morbidity, mortality, conversion to open surgery, and clinical outcomes according to the Myasthenia Gravis Foundation of America Post-Intervention Status (MGFA-PIS). Before rethymectomy, all patients required immunosuppressants and 5 patients (83.3%) required intravenous immune globulin and/or plasma exchange to control the symptoms. The median specimen weight was 24.5 (14-144) g after rethymectomy, and residual thymic tissue was found in 5 patients (83.3%). No conversion to open surgery or perioperative morbidity and mortality was observed. With a median follow-up time of 46.5 (13-155) months, 3 patients (50%) achieved "improved" and 3 (50%) were "unchanged" according to the MGFA-PIS. Compared with preoperative use, the median daily dose of corticosteroids statistically decreased (25 [7.5-60] vs 0 [0-5] mg, P = 0.002) without significant change in azathioprine use (100 [0-200] vs 50 [0-150] mg, P = 0.360). AChR antibody positive MG patients with a treatment refractory long-term course after thymectomy might have remaining thymic tissue with the 2 commonly associated thymus pathologies, thymoma, and follicular hyperplasia. Robotic-extended rethymectomy might be considered as a safe and beneficial treatment option in these patients.
Collapse
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
| | - Reona Takahashi
- 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 Berlin, Charité University Hospital Berlin, Berlin, Germany
| | - Jens-C Rueckert
- Department of Surgery, Competence Center of Thoracic Surgery, Charité University Hospital Berlin, Berlin, Germany.
| |
Collapse
|
7
|
Li F, Ismail M, Elsner A, Uluk D, Bauer G, Meisel A, Rueckert JC. Surgical Techniques for Myasthenia Gravis. Thorac Surg Clin 2019; 29:177-186. [DOI: 10.1016/j.thorsurg.2018.12.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
8
|
Li F, Takahashi R, Bauer G, Yousef MS, Hotter B, Swierzy M, McAleenan A, Ismail M, Meisel A, Rueckert JC. Results of Robotic Thymectomy Performed in Myasthenia Gravis Patients Older Than 60 Years at Onset. Ann Thorac Surg 2019; 108:912-919. [PMID: 30885848 DOI: 10.1016/j.athoracsur.2019.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 01/29/2019] [Accepted: 02/06/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Data are limited on the safety and efficacy of robotic thymectomy in patients with myasthenia gravis (MG) older than 60 years at onset. METHODS Patients older than 60 years at MG onset who underwent robotic thymectomy in Charite Universitaetsmedizin Berlin between 2003 and 2017 were potentially eligible for inclusion. The main outcomes were perioperative complications and clinical outcome according to the Myasthenia Gravis Foundation of America Post-Intervention Status. RESULTS Sixty-eight (25 women, 43 men) of 580 patients with MG who underwent robotic thymectomy were eligible for perioperative analyses (median age at MG onset 67 years, range: 61 to 85 years). The perioperative morbidity rate was 13.2%, and the only perioperative death was due to aortic dissection. Fifty-one patients were available for further analysis with a median follow-up time of 60 months (range: 12 to 263 months). The complete stable remission rate was 7.8%, the improvement rate was 68.6%, and the overall mortality rate was 11.8%. Compared with preoperative use, the mean daily dose of corticosteroid agents was significantly reduced at the last follow-up (17.6 ± 23.6 mg versus 2.6 ± 6.1 mg, p = 0.0001) without increased use of azathioprine (35.9 ± 61.9 mg versus 42.7 ± 59 mg, p = 0.427). After excluding 2 patients seronegative for the anti-acetylcholine receptor antibody, 10 of 49 seropositive patients achieved "good outcome" (including four complete stable remissions, three pharmacologic remissions, and three minimal manifestations 0) which was predicted by being free of concomitant disease (odds ratio 7.307, 95% confidence interval: 1.188 to 44.937, p = 0.032) and Myasthenia Gravis Foundation of America classification I before thymectomy (odds ratio 6.696, 95% confidence interval: 1.259 to 35.620, p = 0.026). CONCLUSIONS Robotic thymectomy seems to be safe and effective in patients with MG older than 60 years at onset with a statistically significant steroid-sparing effect.
Collapse
Affiliation(s)
- Feng Li
- Department of Surgery, Competence Center of Thoracic Surgery, Charité University Hospital Berlin, Berlin, Germany
| | - Reona Takahashi
- Department of Surgery, Competence Center of Thoracic Surgery, Charité University Hospital Berlin, Berlin, Germany
| | - Gero Bauer
- Department of Surgery, Competence Center of Thoracic Surgery, Charité University Hospital Berlin, Berlin, Germany
| | - Mike-S Yousef
- Department of Surgery, Competence Center of Thoracic Surgery, Charité University Hospital Berlin, Berlin, Germany
| | - Benjamin Hotter
- Department of Neurology, Charité University Hospital Berlin, Berlin, Germany
| | - Marc Swierzy
- Department of Surgery, Competence Center of Thoracic Surgery, Charité University Hospital Berlin, Berlin, Germany
| | - Alexandra McAleenan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Mahmoud Ismail
- Department of Surgery, Competence Center of Thoracic Surgery, Charité University Hospital Berlin, Berlin, Germany
| | - Andreas Meisel
- Department of Neurology, Charité University Hospital Berlin, Berlin, Germany
| | - Jens-C Rueckert
- Department of Surgery, Competence Center of Thoracic Surgery, Charité University Hospital Berlin, Berlin, Germany.
| |
Collapse
|
9
|
Buitrago MR, Restrepo J. Robot-assisted thoracic surgery in Colombia: a multi-institutional initial experience. Ann Cardiothorac Surg 2019; 8:233-240. [PMID: 31032207 DOI: 10.21037/acs.2019.03.01] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Robotic assisted videothoracoscopic surgery (RVATS) adoption has increased worldwide from 3.4% in 2010 to 17.5% in 2015. However, in Latin America, the literature is limited to a report of a series of 10 patients who underwent RVATS lobectomy and one case report of an RVATS thymectomy from Brazil. Methods This is a retrospective review of all RVATS performed in Bogotá Colombia since 2012. A single thoracic surgeon (RB) performed all the operations at three institutions: Clínica de Marly, Fundación Clínica Shaio and Instituto Nacional de Cancerología. Preoperative, intraoperative, postoperative and pathology report variables were included. Patients were analyzed in three groups: robotic RVATS pulmonary resections, RVATS mediastinal surgeries and other RVATS procedures. Descriptive statistics were used to report the median and interquartile range (IQR) of the continuous variables, and number and percentage were used to describe categorical variables. The association between total operative time and the year the surgery was analyzed using a linear regression model. Results Forty-seven patients underwent RVATS pulmonary resections; 72.3% (n=34) of these patients underwent a RVATS lobectomy. The median total operative time was 220 (IQR: 200 to 250) minutes, 6.4% (n=3) had intraoperative complications, and the most frequent histologic diagnosis was adenocarcinoma (n=24, 51.1%). Of 18 patients who underwent RVATS mediastinal surgeries, 50.0% (n=9) had RVATS thymectomy, the median total operative time was 195.5 (IQR: 131 to 221) minutes and two patients (11.1%) had intraoperative complications. The linear regression model of the association between total operative time and the year the surgery showed a 10.3 minute reduction per year (P=0.006). Conclusions This is the second series of RVATS published in Latin America and the first published in Colombia, with comparable perioperative results to other reports.
Collapse
Affiliation(s)
- Miguel Ricardo Buitrago
- Department of Thoracic Surgery, Instituto Nacional de Carcerología, Universidad Militar Nueva Granada, Bogotá, Colombia.,Department of Thoracic Surgery, Clínica de Marly, Bogotá, Colombia.,Department of Thoracic Surgery, Clínica Shaio, Bogotá, Colombia.,Thoracic Surgery, El Bosque University, Bogotá, Colombia
| | - Juliana Restrepo
- Department of Surgical Oncology, Instituto Nacional de Cancerología, Universidad Militar Nueva Granada, Bogotá, Colombia
| |
Collapse
|
10
|
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: 52] [Impact Index Per Article: 10.4] [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.
Collapse
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
| |
Collapse
|
11
|
Cerfolio R, Louie BE, Farivar AS, Onaitis M, Park BJ. Consensus statement on definitions and nomenclature for robotic thoracic surgery. J Thorac Cardiovasc Surg 2017. [DOI: 10.1016/j.jtcvs.2017.02.081] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
12
|
Buentzel J, Straube C, Heinz J, Roever C, Beham A, Emmert A, Hinterthaner M, Danner BC, Emmert A. Thymectomy via open surgery or robotic video assisted thoracic surgery: Can a recommendation already be made? Medicine (Baltimore) 2017; 96:e7161. [PMID: 28614249 PMCID: PMC5478334 DOI: 10.1097/md.0000000000007161] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 05/22/2017] [Accepted: 05/23/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Robot-assisted minimally invasive surgery (RVATS) is a relatively new technique applied for thymectomies. Only few studies directly compare RVATS to the mainstay therapy, open surgery (sternotomy). METHODS A systematic search of the literature was performed in October 2016. The meta-analysis includes studies comparing robotassisted and open thymectomy regarding operation time, length of hospitalization, intraoperative blood loss, and chest-in-tube days, postoperative complications, reoperation, arrhythmic events, pleural effusion, and postoperative bleeding. RESULTS Of 626 studies preliminary screened, 7 articles were included. There were no significant differences in comparison of operation time (-3.19 minutes [95% confidence interval, 95% CI -112.43 to 106.05]; P = .94), but patients undergoing RVATS spent significantly less time in hospital (-4.06 days [95% CI -7.98 to -0.13], P = .046). There were fewer chests-in-tube days (-2.50 days [95% CI -15.01 to 10.01]; P = .24) and less intraoperative blood loss (-256.84 mL [95% CI -627.47 to 113.80]; P = .10) observed in the RVATS group; due to a small number of studies, these results were not statistically significant. There were also less post-operative complications in the RVATS group (12 complications in 209 patients vs 51 complications in 259 patients); however, this difference was not statistical significant (odds ratio 0.27, 95% CI 0.07-1.12; P = .06). CONCLUSIONS Patients undergoing RVATS spent less time in hospital than patients treated by open surgery (sternotomy). These patients tended to have less postoperative complications, less intraoperative blood loss, and fewer chest-in-tube days. We found evidence for the safety and feasibility of RVATS compared with open surgery, which has to be further confirmed in randomised controlled trials.
Collapse
Affiliation(s)
| | | | | | | | - Alexander Beham
- Department of General, Visceral and Pediatric Surgery, University of Goettingen, University Medical Center Goettingen, Goettingen
| | - Andreas Emmert
- Westklinikum Hamburg, Department of General and Visceral Surgery, Hamburg
| | - Marc Hinterthaner
- Department of Thoracic and Cardiovascular Surgery, University of Goettingen, University Medical Center Goettingen, Göttingen, Germany
| | - Bernhard C. Danner
- Department of Thoracic and Cardiovascular Surgery, University of Goettingen, University Medical Center Goettingen, Göttingen, Germany
| | - Alexander Emmert
- Department of Thoracic and Cardiovascular Surgery, University of Goettingen, University Medical Center Goettingen, Göttingen, Germany
| |
Collapse
|
13
|
Matilla JR, Klepetko W, Moser B. Thymic minimally invasive surgery: state of the art across the world-Europe. J Vis Surg 2017; 3:70. [PMID: 29078633 DOI: 10.21037/jovs.2017.04.01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 03/29/2017] [Indexed: 11/06/2022]
Abstract
In this brief review of selected peer-reviewed literature on thymic minimally-invasive surgery (MIS) we sought to identify if there is a unique approach to thymic MIS on the European continent.
Collapse
Affiliation(s)
- José Ramon Matilla
- Department of Thoracic Surgery, Medical University Vienna, Vienna, Austria
| | - Walter Klepetko
- Department of Thoracic Surgery, Medical University Vienna, Vienna, Austria
| | - Bernhard Moser
- Department of Thoracic Surgery, Medical University Vienna, Vienna, Austria
| |
Collapse
|
14
|
Renaud S, Santelmo N. [Robotic-assisted thoracic surgery: for or against?]. Rev Mal Respir 2016; 33:199-201. [PMID: 27068871 DOI: 10.1016/j.rmr.2016.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- S Renaud
- Service de chirurgie thoracique, Nouvel Hôpital Civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France; EA 3430 « progression tumorale et micro-environnement ; approches translationnelles et épidémiologie », université de Strasbourg, bâtiment Inserm 3, avenue Molière, 67200 Strasbourg, France
| | - N Santelmo
- Service de chirurgie thoracique, Nouvel Hôpital Civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France.
| |
Collapse
|
15
|
Miyamoto H, Serradori T, Mikami Y, Selber J, Santelmo N, Facca S, Liverneaux P. Robotic intercostal nerve harvest: a feasibility study in a pig model. J Neurosurg 2015. [PMID: 26207601 DOI: 10.3171/2015.1.jns14603] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The aim of this study was to report the feasibility of robotic intercostal nerve harvest in a pig model. A surgical robot, the da Vinci Model S system, was installed after the creation of 3 ports in the pig's left chest. The posterior edges of the fourth, fifth, and sixth intercostal nerves were isolated at the level of the anterior axillary line. The anterior edges of the nerves were transected at the rib cartilage zone. Three intercostal nerve harvesting procedures, requiring an average of 33 minutes, were successfully performed in 3 pigs without major complications. The advantages of robotic microsurgery for intercostal nerve harvest include elimination of physiological tremor, free movement of joint-equipped robotic arms, and amplification of the surgeon's hand motion by as much as 5 times. Robot-assisted neurolysis may be clinically useful for intercostal nerve harvest for brachial plexus reconstruction.
Collapse
Affiliation(s)
- Hideaki Miyamoto
- Department of Hand Surgery, University Hospital of Strasbourg, FMTS, Illkirch, France;,Department of Orthopaedic Surgery, University of Tokyo, Tokyo, Japan
| | - Thomas Serradori
- General and Digestive Department, University Hospital of Nancy, Nancy, France
| | - Yoji Mikami
- Department of Orthopaedic Surgery, Yokohama Rosai Hospital, Yokohama, Japan
| | | | - Nicola Santelmo
- Department of Thoracic Surgery, University Hospital of Strasbourg, FMTS, Strasbourg, France
| | - Sybille Facca
- Department of Hand Surgery, University Hospital of Strasbourg, FMTS, Illkirch, France
| | - Philippe Liverneaux
- Department of Hand Surgery, University Hospital of Strasbourg, FMTS, Illkirch, France
| |
Collapse
|
16
|
Porto de Melo P, Miyamoto H, Serradori T, Ruggiero Mantovani G, Selber J, Facca S, Xu WD, Santelmo N, Liverneaux P. Robotic phrenic nerve harvest: a feasibility study in a pig model. ACTA ACUST UNITED AC 2014; 33:356-60. [PMID: 25267395 DOI: 10.1016/j.main.2014.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 06/28/2014] [Accepted: 07/17/2014] [Indexed: 11/26/2022]
Abstract
The aim of this study was to report on the feasibility of robotic phrenic nerve harvest in a pig model. A surgical robot (Da Vinci S™ system, Intuitive Surgical(®), Sunnyvale, CA) was installed with three ports on the pig's left chest. The phrenic nerve was transected distally where it enters the diaphragm. The phrenic nerve harvest was successfully performed in 45 minutes without major complications. The advantages of robotic microsurgery for phrenic nerve harvest are the motion scaling up to 5 times, elimination of physiological tremor, and free movement of joint-equipped robotic arms. Robot-assisted neurolysis may be clinically useful for harvesting the phrenic nerve for brachial plexus reconstruction.
Collapse
Affiliation(s)
- P Porto de Melo
- Center for Advanced Studies in Orthopedics and Neurosurgery, São Paulo, Brazil; Neurosurgery Department, São Paulo Military Área Hospital, Brazilian Army, São Paulo, Brazil; Institute of Education and Sciences, German Hospital Oswaldo Cruz, São Paulo, Brazil
| | - H Miyamoto
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, Strasbourg University, 10, avenue Baumann, 67403 Illkirch cedex, France; Department of Orthopaedic Surgery, University of Tokyo, Tokyo, Japan
| | - T Serradori
- General and digestive Departement, University Hospital of Nancy, 54511 Nancy, France
| | - G Ruggiero Mantovani
- São Paulo Hand Center, Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - J Selber
- MD Anderson Center, Houston, TX, USA
| | - S Facca
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, Strasbourg University, 10, avenue Baumann, 67403 Illkirch cedex, France
| | - W-D Xu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - N Santelmo
- Department of Thoracic Surgery, Strasbourg University Hospitals, FMTS, Strasbourg University, 1, place de l'Hôpital, 67000 Strasbourg cedex, France
| | - P Liverneaux
- Department of Hand Surgery, Strasbourg University Hospitals, FMTS, Strasbourg University, 10, avenue Baumann, 67403 Illkirch cedex, France.
| |
Collapse
|
17
|
The end of robot-assisted laparoscopy? A critical appraisal of scientific evidence on the use of robot-assisted laparoscopic surgery. Surg Endosc 2013; 28:1388-98. [DOI: 10.1007/s00464-013-3306-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 10/19/2013] [Indexed: 12/15/2022]
|