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Safety and feasibility of a modularized procedure for trans-subxiphoid robotic extended thymectomy

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Abstract

Background

The purpose of this study was to introduce an “eight-step modularized procedure (M-RET)” for trans-subxiphoid robotic extended thymectomy for patients with myasthenia gravis (MG). Its safety and feasibility were further verified in this study.

Materials and methods

This retrospective study included 87 consecutive MG patients who underwent trans-subxiphoid robotic extended thymectomy at our institution between September 2016 and August 2021. According to different resection models, patients were divided into two groups: traditional trans-subxiphoid robotic extended thymectomy group (T-RET group) and eight-step modularized technique group (M-RET group). Baseline demographic characteristics and operation-related parameters were collected and compared between the two groups.

Results

There were 41 (47.1%) patients in the M-RET group and 46 (52.9%) patients in the T-RET group. The M-RET group resected a greater amount of mediastinal adipose tissues and required more dissection time (median and interquartile range: 135.0, 125.0 to 164.0 v. 120.0, 105.0 to 153.8, P = 0.006) compared with the T-RET group. There were no statistically significant differences in terms of the intraoperative blood loss, duration of chest drainage, length of hospital stay, and postoperative complications between the two groups. There was no mortality or conversion in each of the two groups and all patients recovered well upon discharge.

Conclusion

The eight-step modularized technique of trans-subxiphoid robotic extended thymectomy was verified to be a safe, effective, radical procedure, which offers unique superiority over ectopic thymic tissue resection.

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Funding

This work was supported by 1·3·5 project for disciplines of excellence—Clinical Research Incubation Project, West China Hospital, Sichuan University (2021HXFH056) and Post-Doctor Research Project, West China Hospital, Sichuan University (2021HXBH091).

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Author notes

  1. Hanlu Zhang and Fuqiang Wang have contributed equally to this work.

Authors and Affiliations

  1. Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, China

    Hanlu Zhang, Fuqiang Wang, Guanghao Qiu, Zhiyang Li, Lei Peng, Xuyang Wang, Shenglong Xie, Long-Qi Chen & Yun Wang

  2. Department of Thoracic Surgery, Hospital of the University of Electronic Science and Technology of China and Sichuan Provincial People’s Hospital, Chengdu, China

    Shenglong Xie

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  1. Hanlu Zhang
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Correspondence to Yun Wang.

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Drs. Hanlu Zhang, Fuqiang Wang, Guanghao Qiu, Zhiyang Li, Lei Peng, Xuyang Wang, Shenglong Xie, Long-Qi Chen, Yun Wang, and the study funders have no conflicts of interest or financial ties to disclose.

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Zhang, H., Wang, F., Qiu, G. et al. Safety and feasibility of a modularized procedure for trans-subxiphoid robotic extended thymectomy. Surg Endosc 37, 90–100 (2023). https://doi.org/10.1007/s00464-022-09423-3

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