Advertisement

Surgical Endoscopy

, Volume 28, Issue 1, pp 122–126 | Cite as

Surgical treatment of early-stage thymomas: robot-assisted thoracoscopic surgery versus transsternal thymectomy

  • Bo Ye
  • Wang Li
  • Xiao-Xiao Ge
  • Jian Feng
  • Chun-Yu Ji
  • Ming Cheng
  • Ji-Cheng Tantai
  • Heng ZhaoEmail author
Article

Abstract

Background

This study aimed to compare the perioperative outcomes for patients who underwent transsternal or robot-assisted thymectomy and to determine the feasibility of robot-assisted thymectomy for the treatment of Masaoka stages 1 and 2 thymomas.

Methods

The study evaluated the short-term outcomes for 74 patients undergoing surgery for Masaoka stages 1 and 2 thymomas without myasthenia gravis between January 2009 and December 2012. Of these 74 patients, 23 underwent thymoma resection using unilateral robot-assisted thoracoscopic surgery (RATS group), and 51 underwent transsternal thymectomy (TST group). Duration of surgery, amount of intraoperative blood loss, duration of chest drainage, duration of postoperative hospital stay, and postoperative complications were evaluated.

Results

The intraoperative blood loss was significantly less in the RATS groups (61.3 ml) than in the TST group (466.1 ml) (p < 0.01). The postoperative hospital stay was significantly shorter in the RATS group (3.7 vs 11.6 days; p < 0.01). No patients in the RATS group underwent conversion to open surgery. No severe surgical complications (e.g., bleeding caused by injury to the left brachiocephalic vein) and only one case of pulmonary atelectasis (appearing in a male patient 2 days after surgery) were detected in this series.

Conclusion

Robot-assisted thoracoscopic thymectomy for early-stage thymomas is technically feasible, safe, and less invasive for the patient.

Keywords

Robotics Thymoma Minimally invasive surgery Thymus 

Notes

Disclosures

Bo Ye, Xiao-Xiao Ge, Wang Li, Jian Feng, Chun-Yu Ji, Ming Cheng, Ji-Cheng Tantai, and Heng Zhao have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Engels EA, Pfeiffer RM (2003) Malignant thymoma in the United States: demographic patterns in incidence and associations with subsequent malignancies. Int J Cancer 105:546–551PubMedCrossRefGoogle Scholar
  2. 2.
    Kohman LJ (1997) Controversies in the management of malignant thymoma. Chest 112:296S–300SPubMedCrossRefGoogle Scholar
  3. 3.
    Okumura M, Ohta M, Tateyama H et al (2002) The World Health Organization histologic classification system reflects the oncologic behavior of thymoma: a clinical study of 273 patients. Cancer 94:624–632PubMedCrossRefGoogle Scholar
  4. 4.
    Augustin F, Schmid T, Sieb M, Lucciarini P, Bodner J (2008) Video-assisted thoracoscopic surgery versus robotic-assisted thoracoscopic surgery thymectomy. Ann Thorac Surg 85:S768–S771PubMedCrossRefGoogle Scholar
  5. 5.
    Masaoka A, Yamakawa Y, Niwa H et al (1996) Extended thymectomy for myasthenia gravis patients: a 20-year review. Ann Thorac Surg 62:853–859PubMedCrossRefGoogle Scholar
  6. 6.
    Roviaro G, Varoli F, Nucca O, Vergani C, Maciocco M (2000) Videothoracoscopic approach to primary mediastinal pathology. Chest 117:1179–1183PubMedCrossRefGoogle Scholar
  7. 7.
    Yim AP (1996) Video-assisted thoracoscopic resection of anterior mediastinal masses. Int Surg 81:350–353PubMedGoogle Scholar
  8. 8.
    Takeo S, Fukuyama S (2005) Video-assisted thoracoscopic resection of a giant anterior mediastinal tumor (lipoma) using an original sternum-lifting technique. Jpn J Thorac Cardiovasc Surg 53:565–568PubMedCrossRefGoogle Scholar
  9. 9.
    Sugarbaker DJ (1993) Thoracoscopy in the management of anterior mediastinal masses. Ann Thorac Surg 56:653–656PubMedCrossRefGoogle Scholar
  10. 10.
    Rea F, Marulli G, Bortolotti L et al (2000) Experience with the “da Vinci” robotic system for thymectomy in patients with myasthenia gravis: report of 33 cases. Ann Thorac Surg 81:455–459CrossRefGoogle Scholar
  11. 11.
    Fleck T, Fleck M, Muller M et al (2009) Extended videoscopic robotic thymectomy with the da Vinci telemanipulator for the treatment of myasthenia gravis: the Vienna experience. Interact Cardiovasc Thorac Surg 9:784–787PubMedCrossRefGoogle Scholar
  12. 12.
    Mussi A, Fanucchi O, Davini F, et al (2012) Robotic extended thymectomy for early-stage thymomas. Eur J Cardiothorac Surg 41:e43–e46, e47Google Scholar
  13. 13.
    Weksler B, Tavares J, Newhook TE, Greenleaf CE, Diehl JT (2012) Robot-assisted thymectomy is superior to transsternal thymectomy. Surg Endosc 26:261–266PubMedCrossRefGoogle Scholar
  14. 14.
    Bodner J, Wykypiel H, Greiner A et al (2004) Early experience with robot-assisted surgery for mediastinal masses. Ann Thorac Surg 78:259–266PubMedCrossRefGoogle Scholar
  15. 15.
    Hashizume M, Konishi K, Tsutsumi N, Yamaguchi S, Shimabukuro R (2002) A new era of robotic surgery assisted by a computer-enhanced surgical system. Surgery 131:S330–S333PubMedCrossRefGoogle Scholar
  16. 16.
    Savitt MA, Gao G, Furnary AP et al (2005) Application of robotic-assisted techniques to the surgical evaluation and treatment of the anterior mediastinum. Ann Thorac Surg 79:450–455PubMedCrossRefGoogle Scholar
  17. 17.
    Yoshino I, Hashizume M, Shimada M, Tomikawa M, Tomiyasu M, Suemitsu R et al (2001) Thoracoscopic thymomectomy with the da Vinci computer-enhanced surgical system. J Thorac Cardiovasc Surg 122:783–785PubMedCrossRefGoogle Scholar
  18. 18.
    Cheng YJ, Kao EL, Chou SH (2005) Videothoracoscopic resection of stage II thymoma: prospective comparison of the results between thoracoscopy and open methods. Chest 128:3010–3012PubMedCrossRefGoogle Scholar
  19. 19.
    Awad WI, Symmans PJ, Dussek JE (1998) Recurrence of stage I thymoma 32 years after total excision. Ann Thorac Surg 66:2106–2108PubMedCrossRefGoogle Scholar
  20. 20.
    Bodner J, Augustin F, Wykypiel H et al (2005) The da Vinci robotic system for general surgical applications: a critical interim appraisal. Swiss Med Wkly 135:674–678PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Bo Ye
    • 1
  • Wang Li
    • 2
  • Xiao-Xiao Ge
    • 1
  • Jian Feng
    • 1
  • Chun-Yu Ji
    • 1
  • Ming Cheng
    • 1
  • Ji-Cheng Tantai
    • 1
  • Heng Zhao
    • 1
    Email author
  1. 1.Department of Thoracic Surgery, Shanghai Chest HospitalShanghai Jiaotong UniversityShanghaiChina
  2. 2.Renji-MedX Clinical Stem Cell Research Center, Renji HospitalShanghai Jiao Tong University School of MedicineShanghaiChina

Personalised recommendations