Thoracoscopic Thymectomy Research Articles

The entire technique of bilateral uniportal video-assisted sequential thoracoscopic extended thymectomy in a patient with myasthenia gravis associated to a little thymoma

The entire technique of bilateral uniportal video-assisted sequential thoracoscopic extended thymectomy in a patient with myasthenia gravis associated to a little thymoma

The entire technique of bilateral uniportal video-assisted sequential thoracoscopic extended thymectomy in a patient with myasthenia gravis and thymic hypertrophy

The entire technique of bilateral uniportal video-assisted sequential thoracoscopic extended thymectomy in a patient with myasthenia gravis and thymic hypertrophy

The entire technique of bilateral uniportal video-assisted sequential thoracoscopic extended thymectomy in a patient with thymoma without myasthenia gravis, with Lambert-Eaton myasthenic syndrome

The entire technique of bilateral uniportal video-assisted sequential thoracoscopic extended thymectomy in a patient with thymoma without myasthenia gravis, with Lambert-Eaton myasthenic syndrome

Outcomes of Thoracoscopic Thymectomy in Children: Experience in A Resource Challenged Setup

Outcomes of Thoracoscopic Thymectomy in Children: Experience in A Resource Challenged Setup

Relationship between neuromuscular block induced by cisatracurium for tracheal intubation during anesthesia induction and types of myasthenia gravis

Objective To determine the relationship between neuromuscular block induced by cisatracurium for tracheal intubation during anesthesia induction and types of myasthenia gravis(MG). Methods Sixty-five patients of both sexes with MG, aged 20-75 yr, weighing 53-92 kg, with body height of 155-185 cm, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, undergoing elective video-assisted thoracoscopic thymectomy, were enrolled in the study.Among the 65 patients, there were 8 patients with ocular MG(typeⅠ), 19 patients with mild generalized MG(typeⅡa), 33 patients with subacute generalized MG(typeⅡb), 2 patients with acute MG(type Ⅲ) and 3 patients with late severe MG(type Ⅳ). Neuromuscular monitoring was initiated when the patients lost consciousness after induction of anesthesia.Cisatracurium was administrated with the initial dose of 0.05 mg/kg, and if T1 depression was less than 95% within 6 min, cisatracurium 0.015 mg/kg was intravenously injected until T1 depression was more than 95%.The patients were then tracheally intubated.The amount of cisatracurium consumed for intubation, onset time(from the beginning of cisatracurium injection to T1 depression >95%) and recovery time(recovery of T4/T1 to 25% of control height) of neuromuscular block were recorded.T1 depression > 95% within 6 min after administration of 1-fold ED95 cistracurium was defined as sensitivity to muscle relaxants.The requirement for cistracurium > 1-fold ED95 when T1 depression > 95% was defined as insensitivity to muscle relaxants.The proportion of sensitivity/insensitivity was calculated. Results There was no significant difference in the amount of cisatracurium consumed for intubation and onset time and recovery time of neuromuscular block between patients with typeⅠ and those with typeⅡa(P>0.05). Compared with patients with typeⅠ and type Ⅱa, the amount of cisatracurium consumed for intubation was significantly decreased, the proportion of sensitivity/insensitivity was increased, the onset time was shortened, and the recovery time was prolonged in patients with typeⅡb(P<0.05). Conclusion With the severity of MG, the consumption of cisatracurium is gradually decreased when used for tracheal intubation during anesthesia induction, and the sensitivity is gradually increased in the patients with MG. Key words: Androstanes; Myasthenia gravis; Intubation, intratracheal; Dose-response relationship, drug

Surgical and oncological outcomes of thoracoscopic thymectomy for thymoma.

Thymoma remains the most common primary anterior mediastinal neoplasm. Surgical resection remains central to the treatment of thymoma, with thoracoscopic thymectomy (TT) being increasingly performed. This present review article aimed to summarize current studies comparing TT and open thymectomy (OT). Recently, most patients with Masaoka stage I-II thymoma have been receiving TT. This procedure is associated with a significantly shorter post-operative hospital stay, decreased intraoperative blood loss, and fewer complications compared with OT. Recurrence rates of thymoma after TT range from 0% to 6.7%, and the 5-year disease-free survival (DFS) ranges from 83.3% to 96%. The oncological outcomes of TT are comparable to that of OT. Masaoka stage and the World Health Organization (WHO) type classification are valuable predictors of the prognosis of thymoma; hence, the optimal treatment for thymoma should be performed according to these two. TT is less invasive, with equivalent oncological outcomes, when compared with the OT. Minimally invasive surgery including TT for stage I-II thymomas is becoming the mainstay of therapy.

Videothoracoscopic thymectomy for myasthenia gravis: an overview of complications on 387 VATS thymectomies for myasthenia gravis

Video assisted thoracoscopic (VAT) thymectomy operations for the treatment of myasthenia gravis (MG) and thymic malignancies are increasingly preferred (1,2).

Thoracoscopic subtotal thymectomy (STT) for thymoma. In this case, STT from left thoracic cavity for a large thymoma

Thoracoscopic subtotal thymectomy (STT) for thymoma. In this case, STT from left thoracic cavity for a large thymoma

Uniportal video-assisted thoracoscopic thymectomy

Thymectomy is the treatment for thymoma or Myasthenia Gravis patients. With the development of thoracoscopic surgical instruments and techniques in recent years, single port video assisted thoracoscopic thymectomy is increasingly practiced for such patients. Although single port thymectomy is feasible and may be preferable, there is a lack of detailed step-by-step procedures outlined in the literature that could shorten the learning curve for the beginner. The aim of this article is to unify the operation steps and avoid possible accidents during single port thymectomy.

Thoracoscopic thymectomy is a feasible and less invasive alternative for the surgical treatment of large thymomas.

Thoracoscopic surgery is widely used for the surgical treatment of thymoma. However, large-sized thymomas are typically treated using open surgery. This study evaluated the feasibility of performing thoracoscopic thymectomy (TT) for thymoma ≥50 mm. A retrospective review was conducted on 135 patients who underwent TT or open thymectomy (OT) for Masaoka stage I-IVa thymoma between 1996 and 2014. Patients were first divided into two groups based on thymoma size: thymoma ≥50 mm and thymoma <50 mm groups. There was no significant difference in the 5-year disease-free survival (DFS) between the groups ( P = 0.5352). Patients in the thymoma ≥50 mm group were further subdivided into TT and OT groups. The length of postoperative hospital stay was significantly shorter in the TT group than in the OT group (5 vs 14 days, P < 0.0001), with significantly fewer postoperative complications (6 patients vs 14 patients, P = 0.0008). There was no significant difference in the 5-year DFS between patients with thymoma ≥50 mm in the TT and OT groups ( P = 0.3501). Finally, patients undergoing TT were further subdivided into thymoma ≥50 mm and thymoma <50 mm groups and, no significant difference in the 5-year DFS was found between these groups ( P = 0.6661). Masaoka stages III-IV, but not thymoma size, were an independent prognostic factor for DFS. These results demonstrate the decreased invasiveness and feasibility of TT for large-sized thymomas.

Bilateral VATS thymectomy in the treatment of myasthenia gravis

Surgical removal of the thymus is an important tool in the treatment of myasthenia gravis. While there exist a number of different surgical approaches, the optimal thymectomy removes the most amount of thymic tissue in the least invasive manner, allowing for rapid recovery from the procedure and providing the best chance of remission of disease. The purpose of this paper is to review bilateral video-assisted thoracoscopic thymectomy with regard to both relevant anatomy and surgical technique, as well as in comparison to other existing methods of thymectomy in terms of safety, recovery and outcomes. Bilateral video-assisted thoracoscopic thymectomy appears to have improved recovery time and comparable rates of remission to more invasive approaches, though more high-quality long-term outcomes studies are needed.

Bilateral VATS thymectomy in the treatment of myasthenia gravis

Surgical removal of the thymus is an important tool in the treatment of myasthenia gravis. While there exist a number of different surgical approaches, the optimal thymectomy removes the most amount of thymic tissue in the least invasive manner, allowing for rapid recovery from the procedure and providing the best chance of remission of disease. The purpose of this paper is to review bilateral video-assisted thoracoscopic thymectomy with regard to both relevant anatomy and surgical technique, as well as in comparison to other existing methods of thymectomy in terms of safety, recovery and outcomes. Bilateral video-assisted thoracoscopic thymectomy appears to have improved recovery time and comparable rates of remission to more invasive approaches, though more high-quality long-term outcomes studies are needed.

The clinical study of non-drainage tube after single-port video-assisted thoracoscopic thymectomy

Objective To assess the feasibility of non-drainage tube after single-port video-assisted thoracoscopic thymectomy in patients with myasthenia gravis (MG). Methods According to whether the thoracic drainage tube was placed after thymectomy, the patients with MG were divided into control group (38 cases) and experimental group (25 cases). The thoracic drainage tube was inserted between the ribs in the control group, and not placed in the experimental group. The clinical data including duration and score of post-operative chest pain and post-operative hospital stay were recorded and analyzed by independent samples t test. Results There was statistically significant difference between the two groups in the duration of post-operative chest pain [(32.7±10.2) h vs. (14.2±2.9) h, P=0.000], the score of post-operative chest pain [(2-6) 3.8 scores vs. (1-5) 2.4 scores, P=0.000], duration of post-operative hospital stay [(5.6±1.0) days vs. (4.9±0.7) days, P=0.016], post-operative chest drainage time [(23.6±8.7) h vs. (0) d, P=0.000] and post-operative thoracic drainage volume [(60.8±9.5) ml vs. (0) ml, P=0.000]. At 3rd day after operation, the results of the chest CT examination showed 38 cases in the control group had a small amount of pleural effusion (<50 ml) and no pneumothorax, and 25 cases in the experimental group had a small amount of pleural effusion (<150 ml) and 2 cases had a small amount of pneumothorax (<10%). At first month after operation, the results of the chest CT examination showed that there were no significant pleural effusion (<30 ml) and no pneumothorax in the two groups. Thoracentesis was not needed in the two groups after operation. Conclusion It is safe and feasible that thoracic drainage tube is not placed after single-port video-assisted thoracoscopic thymectomy in patients with MG. Key words: Myasthenia gravis; Video-assisted thoracoscopic surgery; Thymectomy; Draining tube

Thoracoscopic Thymectomy with Tangential Partial Resection of the Innominate Vein

We herein report a case in which thoracoscopic thymectomy with partial resection of the brachiocephalic vein was performed using a subxiphoid approach. We suggest the usefulness of the subxiphoid approach in thymectomy. We could extend the indications of thoracoscopic thymectomy for invasive tumors. Thoracoscopic thymectomy with the combined resection of part of the brachiocephalic vein was possible. The pathological diagnosis of the tumor was diffuse large cell B-cell lymphoma. Since the postoperative complications were minimal, postoperative adjuvant chemotherapy could be initiated without delay. This operation might be unnecessary. However, we could decrease the invasiveness of surgery using our procedures without sternotomy. Thoracoscopic thymectomy using subxiphid approach seems to be an ideal procedure for the surgical treatment of invasive lesions.

Is a diagnostic video-assisted thoracoscopic thymectomy an acceptable first-line approach to the suspicious anterior mediastinal mass?

Introduction:The incidental early-stage thymic mass presents a diagnostic challenge. Video-assisted thoracoscopic (VAT) thymectomy is an attractive but potentially morbid solution. The aim was to show it can be safely applied as a first-line modality in those with undiagnosed thymic enlargement with acceptable long-term results.Methods:A total of 45 patients were identified (24 male, median age 52 interquartile range [IQR]: 41–66 years) in a 14-year experience who had CT evidence of an enlarged, possibly malignant thymic mass, but no tissue diagnosis before undertaking VAT thymectomy. The clinical outcomes of both benign and malignant diagnoses were compared.Results:Myasthenic symptoms were present in 20 patients (44%), whereas 15 (33%) were asymptomatic. Benign lesions were resected in 27 patients (60%): thymic hyperplasia (56%), thymic cyst (33%), lipoma (7%) and xanthogranulomatous inflammation (4%). Of the 18 malignant patients, 82% had thymoma (three had Masaoka Stage I, 11 Stage II and one Stage III), 6% thymic carcinoma, 6% teratoma and 6% seminoma. Seven patients required radiotherapy for R1 resection. There was no difference in median hospital stay in either group: Benign group: 4 versus 5 days (P = 0.07). One patient in both groups required conversion to open. Two patients in the malignant group had significant morbidity (one myocardial infarction and one pulmonary embolism). There were no cases of tumour recurrence or mortality at a median follow-up of 6.6 years (IQR: 4.4–9.5 years).Conclusion:Right-sided diagnostic VAT thymectomy is a safe and effective first-line approach to suspected malignant thymic enlargement. At 5-year follow-up, there were no cases of recurrence in the malignant group.

A 49-Year-Old Man with Combined Myasthenia Gravis, Autoimmune Thyroiditis and IgG4 Orbitopathy

Background: Patients with autoimmune thyroid disease have higher risk of myasthenia gravis, especially the ocular form of myasthenia gravis. IgG4-related disease and autoimmune thyroiditis have been reported to coexist; and IgG4- related thyroiditis pertain higher autoantibodies when compared with non-IgG4 thyroiditis. However, combined occurrence of myasthenia gravis, autoimmune thyroiditis, and IgG4-related disease has not been reported before. Methods: Here we report a case of ocular myasthenia gravis combined with autoimmune thyroiditis and elevated serum IgG4 that initially deteriorated to generalized myasthenia gravis after 3 days of intravenous (IV) pulse methylprednisolone treatment, but was rescued after plasma exchange therapy. The patient was placed on oral prednisolone, azathioprine, pentoxifylline, hydroxychloroquine, but the ocular symptoms relapsed occasionally when he felt tired. Another eight sessions of weekly IV pulse methylprednisolone were administered during outpatient clinic follow-ups. Findings: There was no more deterioration to generalized myasthenia gravis, and his ocular symptoms fully recovered after the treatment. He finally underwent thoracoscopic thymectomy, and pathology shows atrophic thymus. All immunosuppressants were tapered off after surgery, and he remained symptomfree on the last follow-up, about half a year after surgery. Conclusion: Since thyroid associated orbitopathy and IgG4-related orbitopathy respond well to steroid treatment, initial deterioration of concomittent ocular myasthenia gravis to generalized form after IV pulse steroid therapy can be rescued by plasmapheresis, and the follow-up IV pulse steroid therapy should not be precluded as the definitive treatment in this situation. Finally, all immunosuppressants were successfully discontinued and he remained symptomfree after surgical removal of the atrophic thymus.

Nonintubated single port video-assisted thoracoscopic thymectomy: a promising future of treatment

We read a new article written by Pompeo et al . about glowing surgical technique of single port video assisted thoracoscopic thymectomy with spontaneous ventilation for myasthenia gravis patients (1).

Robotic-assisted thoracoscopic thymectomy

We are going to share the experience of robotic-assisted thoracoscopic thymectomy. A 68-year-old patient underwent robotic-assisted thoracic surgery for a primary thymoma. The patient was discharged on postoperative day 3 without any perioperative complications. This case showed the robotic-assisted thoracoscopic thymectomy is a technically sound and safe approach for anterior mediastinal mass.

Comparative clinical outcomes after thymectomy for myasthenia gravis: Thoracoscopic versus trans-sternal approach

Thymectomy is an effective treatment option for long-term remission of myasthenia gravis. The superiority of the trans-sternal and thoracoscopic surgical approaches is still being debated. The aims of this study are to compare postoperative outcomes and neurologic outcomes between the two approaches and to identify prognostic factors for complete stable remission (CSR). Myasthenia gravis patients who underwent thymectomy with trans-sternal or thoracoscopic approach in MahaRaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand between January1, 2006 and December 31, 2013 were retrospectively reviewed. The endpoints were postoperative outcomes and cumulative incidence function for CSR. The analysis was performed using multilevel model, Cox's proportional hazard model, and propensity score. Ninety-eight patients were enrolled in this study: 53 in the thoracoscopic group and 45 in the trans-sternal group. There were no significant differences between groups in composite postoperative complications, surgical time, ventilator support days, and length of intensive care unit stay. Intraoperative blood loss and length of hospital stay were significant less in the thoracoscopic group. The CSR and median time to remission were not significantly different between the two approaches. Prognostic factors for CSR were nonthymoma (hazard ratio: 3.5, 95% confidence interval: 1.01-12.22) and presence of pharmacological remission (hazard ratio: 24.3, 95% confidence interval: 3.27-180.41). Thoracoscopic thymectomy is safe and provides good neurologic outcomes in comparison to the trans-sternal approach. Two predictive factors should be considered for CSR. Further prospective studies with a larger sample size and longer follow-up period are warranted to confirm these results.

Perioperative Outcomes and Long-term Survival in Clinically Early-stage Thymic Malignancies: Video-assisted Thoracoscopic Thymectomy versus Open Approaches

背景与目的胸腔镜胸腺切除术相比开放手术治疗早期（Masaoka-Koga Ⅰ期或Ⅱ期）胸腺恶性肿瘤在理论上具有优势，然而尚未有研究报道其在长期生存率方面的差异。本研究基于中国胸腺肿瘤研究协作组（Chinese Alliance for Research in Thymomas, ChART）的数据库对此进行了研究。方法以数据库中1994年到2012年间的1, 117例早期（Masaoka-Koga Ⅰ期或Ⅱ期）胸腺恶性肿瘤患者为研究对象。其中241例行胸腔镜胸腺切除术，876例行开放手术。采用单因素分析比较两组的临床资料与围手术期结果方面的差异。采用多因素分析明确影响长期预后的相关因素。结果与开放手术组相比，胸腔镜组的全胸腺切除比例更高（80.5% vs 73.9%, P=0.028），根治性切除率更高（98.8% vs 88.7%, P < 0.000），而复发率更低（2.9% vs 16.0%, P < 0.001），5年无瘤生存率更高（92% vs 83%, P=0.011），而两组的5年生存率接近（92% vs 92%, P=0.15）。Cox比例风险模型分析显示WHO分型、Masaoka-Koga分期和术后辅助治疗是影响胸腺恶性肿瘤长期生存的独立因素。结论胸腔镜胸腺切除术是治疗早期胸腺恶性肿瘤安全有效的方法，与开放手术相比其围手术期效果更好，肿瘤学疗效一致。