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State of the Art of Robotic Thymectomy

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Abstract

Background

Thymectomy is a widely accepted treatment for most cases of myasthenia gravis and essential for the treatment of thymoma. The development of a minimally invasive procedure for thymectomy resulted in a variety of approaches for surgery on the thymic gland. The use of thoracoscopy-based techniques has continued to increase, including the latest advance in this field, robotic thymectomy.

Methods

We review the rapid development and actual use of this approach by examining published reports, worldwide registries, and personal communications and by analyzing our database, which is the largest single-center experience and contains 317 thymectomies until 12/2012. The technical modifications of robotic thymectomy are also described.

Results

Since 2001, approximately 3,500 robotic thymectomies have been registered worldwide. Meanwhile, the results of approximately 500 thymectomy cases have been published. Robotic thymectomy is performed most frequently through a standardized unilateral three-trocar approach. All reports describe promising and satisfactory results for myasthenia gravis. For early-stage thymoma, robotic thymectomy is a technically sound and safe procedure with a very low complication rate and short hospital stay. Oncological outcome without recurrences is promising, but a longer follow-up is needed.

Conclusion

The unilateral robotic technique can be considered an adequate approach for thymectomy, even with demanding anatomical configurations. Robotic thymectomy has spread worldwide over the last decade because of the promising results in myasthenia gravis and thymoma patients.

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References

  1. Marulli G, Rea F, Melfi F et al (2012) Robot-aided thoracoscopic thymectomy for early-stage thymoma: a multicenter European study. J Thorac Cardiovasc Surg 144:1125–1130

    Article  PubMed  Google Scholar 

  2. Jurado J, Javidfar J, Newmark A et al (2012) Minimally invasive thymectomy and open thymectomy: outcome analysis of 263 patients. Ann Thorac Surg 94:974–981, discussion 981–972

    Article  PubMed  Google Scholar 

  3. Shrager JB (2010) Extended transcervical thymectomy: the ultimate minimally invasive approach. Ann Thorac Surg 89:S2128–S2134

    Article  PubMed  Google Scholar 

  4. Prokakis C, Koletsis E, Salakou S et al (2009) Modified maximal thymectomy for myasthenia gravis: effect of maximal resection on late neurologic outcome and predictors of disease remission. Ann Thorac Surg 88:1638–1645

    Article  PubMed  Google Scholar 

  5. Masaoka A, Nagaoka Y, Kotake Y (1975) Distribution of thymic tissue at the anterior mediastinum. Current procedures in thymectomy. J Thorac Cardiovasc Surg 70:747–754

    PubMed  CAS  Google Scholar 

  6. Jaretzki A 3rd, Penn AS, Younger DS et al (1988) “Maximal” thymectomy for myasthenia gravis. Results. J Thorac Cardiovasc Surg 95:747–757

    PubMed  Google Scholar 

  7. Bulkley GB, Bass KN, Stephenson GR et al (1997) Extended cervicomediastinal thymectomy in the integrated management of myasthenia gravis. Ann Surg 226:324–334, discussion 334–325

    Article  PubMed  CAS  Google Scholar 

  8. Mulder DG (1996) Extended transsternal thymectomy. Chest Surg Clin N Am 6:95–105

    PubMed  CAS  Google Scholar 

  9. Rückert J (2003) Die Entwicklung der thorakoskopischenThymektomie—klinische und experimentelle Untersuchung. http://dochost.rz.hu-berlin.de/habilitationen/rueckert-jens-carsten-2003-10-23/html/. Accessed 22 May 2013

  10. Iribarne A, Easterwood R, Russo MJ et al (2011) A minimally invasive approach is more cost-effective than a traditional sternotomy approach for mitral valve surgery. J Thorac Cardiovasc Surg 142:1507–1514

    Article  PubMed  Google Scholar 

  11. Braumann C, Jacobi CA, Menenakos C et al (2008) Robotic-assisted laparoscopic and thoracoscopic surgery with the da Vinci system: a 4-year experience in a single institution. Surg Laparosc Endosc Percutan Tech 18:260–266

    Article  PubMed  Google Scholar 

  12. 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 135:674–678

    PubMed  Google Scholar 

  13. Yoshino I, Hashizume M, Shimada M et al (2001) Thoracoscopic thymomectomy with the da Vinci computer-enhanced surgical system. J Thorac Cardiovasc Surg 122:783–785

    Article  PubMed  CAS  Google Scholar 

  14. Rückert JC, Swierzy M, Ismail M (2011) Comparison of robotic and nonrobotic thoracoscopic thymectomy: a cohort study. J Thorac Cardiovasc Surg 141:673–677

    Article  PubMed  Google Scholar 

  15. Ashton RC Jr, McGinnis KM, Connery CP et al (2003) Totally endoscopic robotic thymectomy for myasthenia gravis. Ann Thorac Surg 75:569–571

    Article  PubMed  Google Scholar 

  16. Bodner J, Wykypiel H, Wetscher G et al (2004) First experiences with the da Vinci operating robot in thoracic surgery. Eur J Cardiothorac Surg 25:844–851

    Article  PubMed  CAS  Google Scholar 

  17. Schneiter D, Tomaszek S, Kestenholz P et al (2013) Minimally invasive resection of thymomas with the da Vinci(R) surgical system. Eur J Cardiothorac Surg 43:288–292

    Article  PubMed  Google Scholar 

  18. Rückert JC, Ismail M, Swierzy M et al (2008) Thoracoscopic thymectomy with the da Vinci robotic system for myasthenia gravis. Ann N Y Acad Sci 1132:329–335

    Article  PubMed  Google Scholar 

  19. Marulli G, Schiavon M, Perissinotto E et al (2013) Surgical and neurologic outcomes after robotic thymectomy in 100 consecutive patients with myasthenia gravis. J Thorac Cardiovasc Surg 145:730–735, discussion 735–736

    Article  PubMed  Google Scholar 

  20. Freeman RK, Ascioti AJ, Van Woerkom JM et al (2011) Long-term follow-up after robotic thymectomy for nonthymomatous myasthenia gravis. Ann Thorac Surg 92:1018–1022, discussion 1022–1013

    Article  PubMed  Google Scholar 

  21. Melfi F, Fanucchi O, Davini F et al (2012) Ten-year experience of mediastinal robotic surgery in a single referral centre. Eur J Cardiothorac Surg 41:847–851

    Article  PubMed  Google Scholar 

  22. Augustin F, Schmid T, Sieb M et al (2008) Video-assisted thoracoscopic surgery versus robotic-assisted thoracoscopic surgery thymectomy. Ann Thorac Surg 85:S768–S771

    Article  PubMed  Google Scholar 

  23. Cerfolio RJ, Bryant AS, Minnich DJ (2011) Starting a robotic program in general thoracic surgery: why, how, and lessons learned. Ann Thorac Surg 91:1729–1736, discussion 1736–1727

    Article  PubMed  Google Scholar 

  24. Castle SL, Kernstine KH (2008) Robotic-assisted thymectomy. Semin Thorac Cardiovasc Surg 20:326–331

    Article  PubMed  Google Scholar 

  25. Goldstein SD, Yang SC (2010) Assessment of robotic thymectomy using the Myasthenia Gravis Foundation of America Guidelines. Ann Thorac Surg 89:1080–1085, discussion 1085–1086

    Article  PubMed  Google Scholar 

  26. Tomulescu V, Stanciulea O, Balescu I et al (2009) First year experience of robotic-assisted laparoscopic surgery with 153 cases in a general surgery department: indications, technique and results. Chirurgia (Bucur) 104:141–150

    CAS  Google Scholar 

  27. Schumacher ER (1912) Thymektomie bei einem Fall von Morbus Basedowi mit Myasthenie Grenzgeb. Med Chir 25:746–765

    Google Scholar 

  28. Keynes G (1954) Surgery of the thymus gland; second (and third) thoughts. Lancet 266:1197–1202

    Article  PubMed  CAS  Google Scholar 

  29. Gross M (1993) Innovations in surgery. A proposal for phased clinical trials. J Bone Joint Surg Br 75:351–354

    PubMed  CAS  Google Scholar 

  30. Rückert JC, Czyzewski D, Pest S et al (2000) Radicality of thoracoscopic thymectomy—an anatomical study. Eur J Cardiothorac Surg 18:735–736

    Article  PubMed  Google Scholar 

  31. Rückert JC, Ismail M, Swierzy M et al (2008) Minimally invasive thymus surgery. Chirurg 79(18):20–25

    Google Scholar 

  32. Jaretzki A, Steinglass KM, Sonett JR (2004) Thymectomy in the management of myasthenia gravis. Semin Neurol 24:49–62

    Article  PubMed  Google Scholar 

  33. Rea F, Marulli G, Bortolotti L et al (2006) Experience with the “da Vinci” robotic system for thymectomy in patients with myasthenia gravis: report of 33 cases. Ann Thorac Surg 81:455–459

    Article  PubMed  Google Scholar 

  34. Murthy SC (2013) Niche for a technology or technology for a niche? J Thorac Cardiovasc Surg 145:737

    Article  PubMed  Google Scholar 

  35. Baek SJ, Kim SH, Cho JS et al (2012) Robotic versus conventional laparoscopic surgery for rectal cancer: a cost analysis from a single institute in Korea. World J Surg 36:2722–2729. doi:10.1007/s00268-012-1728-4

    Article  PubMed  Google Scholar 

  36. Barbash GI, Glied SA (2010) New technology and health care costs—the case of robot-assisted surgery. N Engl J Med 363:701–704

    Article  PubMed  CAS  Google Scholar 

  37. Yim AP (1997) Thoracoscopic thymectomy: which side to approach? Ann Thorac Surg 64:584–585

    PubMed  CAS  Google Scholar 

  38. Mack MJ (2001) Video-assisted thoracoscopy thymectomy for myasthenia gravis. Chest Surg Clin N Am 11:389–405, discussion xi–xii

    PubMed  CAS  Google Scholar 

  39. Mineo TC, Pompeo E, Lerut TE et al (2000) Thoracoscopic thymectomy in autoimmune myasthesia: results of left-sided approach. Ann Thorac Surg 69:1537–1541

    Article  PubMed  CAS  Google Scholar 

  40. Tripathi M, Srivastava K, Misra SK et al (2001) Peri-operative management of patients for video-assisted thoracoscopic thymectomy in myasthenia gravis. J Postgrad Med 47:258–261

    PubMed  CAS  Google Scholar 

  41. Detterbeck FC (2013) The international thymic malignancy interest group. J Natl Compr Canc Netw 11:589–593

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of General, Visceral, Vascular and Thoracic Surgery, Universitätsmedizin Berlin - Charitè Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany

    Mahmoud Ismail, Marc Swierzy & Jens C. Rückert

Authors
  1. Mahmoud Ismail
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  2. Marc Swierzy
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  3. Jens C. Rückert
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Correspondence to Jens C. Rückert.

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Ismail, M., Swierzy, M. & Rückert, J.C. State of the Art of Robotic Thymectomy. World J Surg 37, 2740–2746 (2013). https://doi.org/10.1007/s00268-013-2250-z

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