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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Engels EA, Pfeiffer RM (2003) Malignant thymoma in the United States: demographic patterns in incidence and associations with subsequent malignancies. Int J Cancer 105:546–551
Kohman LJ (1997) Controversies in the management of malignant thymoma. Chest 112:296S–300S
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 94:624–632
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–S771
Masaoka A, Yamakawa Y, Niwa H et al (1996) Extended thymectomy for myasthenia gravis patients: a 20-year review. Ann Thorac Surg 62:853–859
Roviaro G, Varoli F, Nucca O, Vergani C, Maciocco M (2000) Videothoracoscopic approach to primary mediastinal pathology. Chest 117:1179–1183
Yim AP (1996) Video-assisted thoracoscopic resection of anterior mediastinal masses. Int Surg 81:350–353
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 53:565–568
Sugarbaker DJ (1993) Thoracoscopy in the management of anterior mediastinal masses. Ann Thorac Surg 56:653–656
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 81:455–459
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 9:784–787
Mussi A, Fanucchi O, Davini F, et al (2012) Robotic extended thymectomy for early-stage thymomas. Eur J Cardiothorac Surg 41:e43–e46, e47
Weksler B, Tavares J, Newhook TE, Greenleaf CE, Diehl JT (2012) Robot-assisted thymectomy is superior to transsternal thymectomy. Surg Endosc 26:261–266
Bodner J, Wykypiel H, Greiner A et al (2004) Early experience with robot-assisted surgery for mediastinal masses. Ann Thorac Surg 78:259–266
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–S333
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 79:450–455
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 122:783–785
Cheng YJ, Kao EL, Chou SH (2005) Videothoracoscopic resection of stage II thymoma: prospective comparison of the results between thoracoscopy and open methods. Chest 128:3010–3012
Awad WI, Symmans PJ, Dussek JE (1998) Recurrence of stage I thymoma 32 years after total excision. Ann Thorac Surg 66:2106–2108
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
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.
Author information
Authors and Affiliations
Corresponding author
Additional information
Bo Ye and Wang Li contributed equally to this work.
Rights and permissions
About this article
Cite this article
Ye, B., Li, W., Ge, XX. et al. Surgical treatment of early-stage thymomas: robot-assisted thoracoscopic surgery versus transsternal thymectomy. Surg Endosc 28, 122–126 (2014). https://doi.org/10.1007/s00464-013-3137-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-013-3137-7