Video-assisted Thoracic Surgery Thymectomy Research Articles

Surgical outcomes of thoracoscopic thymectomy via the single-port subxiphoid approach versus the unilateral intercostal approach.

The purpose of this study was to explore the safety and feasibility of video-assisted thoracic surgery (VATS) total thymectomy via the single-port subxiphoid approach compared with the intercostal approach. From January 2018 to May 2022, patients who underwent VATS total thymectomy via the subxiphoid or unilateral intercostal approach and diagnosed with Masaoka-Koga stage I-II, non-myasthenic thymoma were included in this study. Perioperative outcomes, immediate and long-term pain evaluations were compared in a propensity score matching analysis. In total, 95 patients were included and underwent the subxiphoid approach (n = 37) and the intercostal approach (n = 58). Propensity score yield two well-matched cohort of 30 patients and there were no significant demographical imbalance between the two groups. Compared with the intercostal approach, the subxiphoid group demonstrated favourable perioperative outcomes including the intraoperative blood loss (P = 0.025) and the median duration of hospital stay (P = 0.083). The immediate and long-term pain evaluations revealed that the subxiphoid group reported lower visual analogue scales at postoperative 24 hours and lower total doses of fentanyl bolus infusions during hospitalization (p = 0.004 and 0.018, respectively), along with lower long-term neuropathic pain scale scores (p = 0.005) than patients in the intercostal group. VATS thymectomy via the single-port subxiphoid approach showed favourable perioperative outcomes compared to the intercostal approach. Moreover, the subxiphoid approach seemed both to cause minimal immediate postoperative pain and to have advantages in reducing long-term neuropathic pain compared with the intercostal approach. B2207-771-101 (Seoul National University Bundang Hospital, July 13th, 2022).

Minimally invasive thymectomy for myasthenia gravis: a 7-year retrospective study.

Thymectomy has been identified as an effective strategy for patients with myasthenia gravis (MG) and thymic masses. However, the best surgical approach remains a matter of debate. The aim of the present study was to compare the surgical and neurological outcomes of video-assisted thoracoscopic thymectomy with a modified subxiphoid and bilateral approach in patients with MG and thymic masses. From August 2013 to April 2018, 68 patients who were diagnosed with MG and thymic masses and underwent video-assisted thoracoscopic thymectomy with a modified subxiphoid (44 patients) or bilateral (24 patients) approach were included in this retrospective study. The surgical and neurological results were analyzed with propensity score matching. After propensity score matching, the modified subxiphoid approach in video-assisted thoracoscopic thymectomy resulted in an obviously shorter operative time (P=0.00), drainage duration (P=0.00), less intraoperative blood loss (P=0.00), and shorter postoperative hospital stay (P=0.01). In terms of neurological outcomes, no significant difference was observed in the improvement in MG, with 2-year complete stable remission rates of 21.1% and 26.3% (P=0.68) and 2-year pharmacological remission rates of 31.6% and 26.3% (P=0.60) for the bilateral and subxiphoid approaches, respectively. Additionally, the approaches resulted in similar effects on the magnitudes of decrease in the prednisolone and pyridostigmine doses after 2 years, with average pyridostigmine dose reductions of 72.2% and 71.1% (P=0.78) and average prednisolone reductions of 76.8% and 71.7% (P=0.96) for the bilateral and subxiphoid approaches, respectively. The modified subxiphoid approach was found to be superior to the bilateral approach in video-assisted thoracic surgery thymectomy in terms of the surgical outcomes and yielded similar neurological outcomes. Therefore, the modified subxiphoid approach is recommended as an alternative to the bilateral approach in the treatment of patients with MG and thymic masses.

Unilateral Thoracoscopic Thymectomy for Thymoma: Does Side Matter? A Single Institutional Experience.

Thoracoscopic thymectomy is increasingly performed for the treatment of early stage thymoma. It is characterized by shorter postoperative hospital stay, decreased intraoperative blood loss, and fewer complications compared with transsternal thymectomy. Unilateral video-assisted thoracic surgery (VATS) thymectomy can be easily performed from either side of the thorax, because thymus is located in the middle of mediastinum. However, the side that provides better outcomes remains controversial. The purpose of this study was to compare the efficacy of right and left approaches in performing unilateral thoracoscopic thymectomy for thymoma. Consecutive patients affected by thymoma who underwent VATS thymectomy on either side between February 2001 and March 2020 were enrolled in the study. Clinicopathologic, surgical, and oncological outcomes were retrospectively analyzed and compared among the two surgical approaches. Unilateral VATS approaches were performed on 29 patients: 12 (41%) on the left side and 17 (59%) on the right side. The mean age was 63.1 ± 11.3 years and the female/male ratio was 1.73:1. The mean operative time and the hospital stay for the left-side VATS and right-side VATS groups were, respectively, 168 ± 49.5 versus 171 ± 47.9 minutes (p = 0.9) and 3 ± 1.03 days versus 3.65 ± 1.93 days (p = 0.7). Postoperative complications occurred in one patient (3%) for left-side VATS group and one patient (3%) for right-side VATS. The 5-year disease-free survival was comparable between two groups (p = 0.74). Unilateral VATS thymectomy in patients with thymoma can be safely and effectively performed by experienced surgeons in either side of the thorax with equivalent oncological outcomes.

Intermediate oncologic outcomes after uniportal video-assisted thoracoscopic thymectomy for early-stage thymoma.

BackgroundRecent years have seen a trend towards utilizing a video-assisted thoracic surgery (VATS) approach for treatment of thymoma. Although increasing in practice, intermediate- and long-term oncologic outcome data is lacking for the VATS approach. There is no oncologic data for the uniportal VATS approach. We sought to evaluate the feasibility and impact on patient survival of uniportal VATS thymectomy for early-stage thymoma.MethodThe clinical outcomes for 17 patients with Masaoka stage I to II thymomas treated between January of 2009 and July of 2014 at a single institution were collected retrospectively. Primary endpoint was overall survival (OS) and secondary endpoint was recurrence-free survival (RFS).ResultsTen women and seven men underwent uniportal VATS thymectomy; eleven had stage I thymoma and six had stage II thymoma. There were no conversions to open surgery. Operative mortality was zero. Mean tumor size was 3.8±1.0 centimeters, with a range of 1.9 to 6.0 centimeters. All patients underwent a R0 resection. Five-year survival was 100%, and the estimated RFS was 100%.ConclusionsOur findings suggest that uniportal VATS thymectomy for early-stage thymoma is feasible, and the intermediate-term oncologic outcomes are comparable to historic standards for open and multi-incision VATS thymectomy. However, additional follow-up is required to evaluate for long-term oncologic outcomes.

Uniportal video-assisted thoracoscopic thymectomy: the glove-port with carbon dioxide insufflation

Since 2004, uniportal video-assisted thoracic surgery (VATS) approach was progressively widespread and also applied in the treatment of thymoma, with promising results. We report the first series of patients who undergone uniportal VATS thymectomy using a homemade glove-port with carbon dioxide (CO2) insufflation. The aim of this article is to analyze the safety and feasibility to perform an extended thymectomy (ET). A prospective, single-centre, short-term observational study including patients with mediastinal tumours undergoing scheduled uniportal VATS resection using a glove-port with CO2. Operations were performed through a single incision of 3.5 cm at the fifth intercostal space, right or left anterior axillary line. A 5 mm-30° camera and working instruments were employed through a glove-port with CO2. Thirty-eight patients (20 men; mean age 61.6 years) underwent ET between September 2016 and October 2019. Thirteen patients had a history of Myasthenia Gravis (MG) with thymoma and 8 had incidental findings of thymoma. Additionally, 8 mediastinal cysts and 9 thymic hyperplasia were included. Mean diameter of the tumor was 5.1 cm (range, 1.6-14 cm) and mean operation time was 143 minutes. Mean postoperative drainage duration and hospital stay were 2.3 and 4.3 days, respectively. Mean blood loss was 41 mL. There was no occurrence of surgical morbidity or mortality. During the follow-up period (1-36 months), no recurrence was noted. Our results suggest that uniportal VATS thymectomy through glove-port and CO2 is safe and feasible procedure, even with large thymomas. Furthermore, the glove-port system represents a valid, cheap and widely available alternative to the commercial devices usually adopted in thoracic surgery.

Trans-sternotomy versus video-assisted thoracic surgery for early-stage thymoma patients: a meta-analysis.

Over the years, video-assisted thoracic surgery (VATS) thymectomy has progressively replaced trans-sternotomy (TS) in early-stage thymoma (Masaoka stage I and stage II). This meta-analysis aimed to confirm the differences in the efficacies of VATS and TS approaches in early-stage thymoma patients. A thorough literature search of the following online databases was performed: PubMed, Cochrane Library, Web of Science, and EMBASE. Appropriate search terms, such as "thymoma or thymus neoplasms or Thymic Carcinoma" and "Video-Assisted Thoracic Surgeries or Video-Assisted Thoracoscopic", were used with MeSH search methods. Heterogeneity was assessed first with the Q-test and inconsistency index and sensitivity analysis and subgroup analysis were then used to find the source of heterogeneity. We retrieved 1,228 articles, 11 articles were selected as the subjects of our research, and 1,222 patients were included in the research (666 VATS cases versus 556 TS cases). VATS caused less blood loss (P=0.02), and required shorter hospital stay (P<0.001), shorter duration of chest tube drainage (P=0.03) than TS. No obvious difference was found in operative time (P=0.14), postoperative recurrence (OR =0.81, 95% CI: 0.35-1.85, P=0.613), postoperative complications (OR =0.60, 95% CI: 0.31-1.16, P=0.129) and R0 resection (OR =0.35, 95% CI: 0.12-1.04, P=0.06), but the trend showed that more patients in the TS group achieved R0 resection. For early-stage thymoma patients, VATS thymectomy seems to provide many advantages to be considered as a legitimate alternative to TS; however, when performing VATS, surgeons should pay special attention to ensure that R0 resection is achieved.

Comparison between thoracoscopic and open approaches in thymoma resection.

To investigate the feasibility and indications of video-assisted thoracic surgery (VATS) in thymoma resection. The clinical data of 103 patients undergoing thymoma resection via different approaches [including conventional lateral thoracotomy approach (LTA) in 41 cases, median sternotomy approach (MSA) in 40 cases, and right-sided VATS in 22 cases] were analyzed. Among them, 59, 13, 25, and 6 patients were in Masaoka stage I, II, III, and IV, respectively. Myasthenia gravis (MG) was also found in 54 cases. The patients were followed up for postoperative survival and the improvement in MG. The prognostic indicators of patients undergoing thymoma resection via different surgical approaches (i.e., LTA, MSA, and VATS) were statistically analyzed. Eight of 103 patients died. Six patients underwent unilateral sacral nerve resection, among whom 4 patients developed respiratory dysfunction, and 3 died. Two patients died of MG after surgery, 1 patient died of tumor recurrence and metastasis, 1 patient died of heart disease, and the cause of death was unknown in the remaining patient. The drainage time was shorter in VATS group than in open groups, along with smaller tumor size. The VATS group also had shorter hospital stay in the whole series and the subgroup without accompanying MG. The improvement in MG showed no significant difference among the three surgical groups. Both 5- and 10-year survival rates were 91% in the entire cohort. VATS is like a conventional surgeries for improving MG in thymoma patients with accompanying MG. VATS resection can still be considered for thymoma that only invades the mediastinal pleura. For thymomas that have intact capsules and have not invaded mediastinal pleura, MSA surgery shall be performed to ensure patient safety if the anteroposterior diameters of the tumors are large and the masses have produced severe compression of the innominate vein, even if the tumors are still in the Masaoka stage II. For thymomas with large left-to-right diameters and with most parts of the tumors located in the left thoracic cavity, a left-sided approach (either VATS or an open approach) may be used in the absence of MG; if MG accompanies the condition, an MT approach or a bilateral VATS may be considered. In patients with unilateral pericardial phrenic nerve and/or local pericardial involvement, right-sided VATS thymectomy may be considered for thymomas located at the right side and bilateral VATS surgery can be performed for tumors located at the left side. In summary, VATS is feasible for the treatment of thymoma complicated by MG. VATS can be performed in patients with Masaoka stage I, II and (a certain portion of) III thymoma; for some patients with Masaoka stage II thymoma, especially those with compression of the innominate vein, the use of VATS should be cautious.

A pitfall of thoracoscopic thymectomy: a case with intraoperative and postoperative complications

We have reported the usefulness of the subxiphoid approach in thymectomy. However, such a new operation method may have unknown complications that rarely occur. Surgeons cannot completely avoid intraoperative and postoperative complications. We report a case of intraoperative injury of the orifice of the left internal thoracic vein flowing to the left brachiocephalic vein and postoperative pericarditis following video-assisted thoracic surgery (VATS) thymectomy. The innominate vein has been considered to be the vessel that is most frequently injured especially at the orifice of the thymic veins. We also suggest that the orifice of the left internal thoracic vein is the second dangerous location that requires special care. In addition, postoperative pericarditis occurred in this patient. Pericardial drainage was necessary. No additional complications have been found in the 9 months since the operation. Though VATS thymectomy using the subxiphoid approach is a safe and less-invasive operation, intraoperative and postoperative complications were possible to be occurred.

Minimally invasive surgical procedures for thymic disease in Asia.

Video-assisted thoracic surgery (VATS) procedures for thymic tumors and myasthenia gravis were introduced in Asia in the middle 1990s in at least two regions, Hong Kong and Japan. To overcome difficulties in obtaining a wide view of the anterior mediastinum, several methods for lifting the sternum or anterior chest wall have been presented, mainly by Japanese surgeons. More recently, single port VATS through a subxiphoid incision was also introduced in Japan. The long-term outcome of a VATS extended thymectomy for myasthenia gravis has been shown to be comparable to that of a trans-sternal extended thymectomy, while the long-term outcome of a VATS thymectomy for thymic epithelial tumors remains to be elucidated. Nevertheless, its indication for tumors in an early stage is now widely accepted, and the number of VATS procedures is steadily increasing in Japan and China. Single-port VATS through a subxiphoid incision was developed in Japan and might become accepted as a useful approach in the near future when combined with robot-assisted thoracoscopic surgery. In addition, robot-assisted thoracoscopic surgery for the thymus has also been introduced in some areas in Asia. Although few of those surgical procedures for the thymus have been performed, results obtained thus far indicate that it might be preferable to lung resection. Several novel minimally invasive thymectomy techniques have been invented and developed in Asia, and further advancements in this field by Asian surgeons are anticipated.

Robotic versus thoracoscopic thymectomy: The current evidence.

The purpose of this study was to analyze all relevant comparative studies comparing robot-assisted minimally invasive thymectomy (RATS) and video-assisted thoracic surgery thymectomy (VATS) in terms of surgical and short-term outcomes. A systematic search for articles describing robot-assisted and video-assisted thymectomy and addressing surgical outcomes, operation time, length of hospitalization, intra-operative blood loss, conversion to sternotomy and post-operative complications was performed using the medical databases. Of the 478 studies from preliminary screening, five articles were included. By pooling these studies, we found no significant differences between the RATS and VATS (odds ratio 1.24 (95% CI 0.51, 3.03; p = 0.63)).There were no significant differences in comparison of conversion rates, operation time (26.29 min (95% CI -2.57, 55.35; p = 0.07)) and length of hospitalization (-1.58 days (95% CI -4.78, 1.62; p = 0.33)). There was a slightly higher blood loss in the RATS group. Our meta-analysis did not detect any statistically significant differences in surgery outcomes between the two groups.

Left-sided video-assisted thoracic surgery thymectomy

Thymectomy is widely used as integrated treatment of patients with non-thymomatous myasthenia gravis (MG) and in the case of early thymomas. However, the best approach to thymus is still under debate. For decades, median sternotomy was the only option offered. This access provides a massive exposure of the anterior mediastinum allowing an extended thymectomy with the exenteration of the whole mediastinal fat, which are the two mainstays for the therapeutic success of the procedure. Unfortunately, median sternotomy produces a quite significant tissue trauma, with a certain morbidity rate and relevant postoperative pain, thus leading to longer hospital stay. Furthermore, it implies the creation of an unpleasant scar thus meeting a very low acceptance rate in patient’s population manly represented by young women. Over the years, video-assisted thoracic surgery (VATS) thymectomy has progressively replaced transsternal accesses. This approach proved safe and as extended as an open one. The procedure is better accepted by both patients and neurologists given the less postoperative pain, the insignificant cosmetic side-effects and the faster return to normal living and occupational activities. VATS thymectomy requires a perfect preparation and stabilization of the patient by a multidisciplinary group, perfect patient lying on operatory table, correct positioning of trocars, excellent knowledge of mediastinal anatomy gained through a certain number of previous sternotomies, rehearsed surgical team including an anesthesiologist experienced in myasthenic disease. Surgical steps follow grossly a precise sequence, which entails dissection of lower horns, dissection of the veins and dissection of the upper horns. Major complications are represented by innominate vein injury, which often requires rapid conversion to median sternotomy. The procedure can be feasible from either side of the thorax. Since the beginning we preferred the left-sided approach for a number of reasons such as best visualization of the left pericardio-phrenic angle, innominate vein and aorto-pulmonary window, which are most frequently sites of ectopic thymic tissue. However, each side presents different advantages and limits. Long-term results appear similarly effective in the majority of the available series. The choice of the side is prevalently based on the surgeon’s preference and experience, but one should also consider the prevalent location of the thymus or thymoma, and other local conditions predicted by imaging. In conclusion, whatever the side VATS can provide safe, effective and extended thymectomy.

Left video-assisted thoracic surgery thymectomy.

Video-assisted thoracic surgery (VATS) for the management of non-thymomatous myasthenia gravis (MG) as well as the management of small thymomas and other benign thymic pathology has been gaining in acceptance and popularity as an alternative to the traditional median sternotomy approach. Although VATS thymectomy has been described in several variations, our current preference is a left sided VATS approach due to the exposure it provides in critical areas of dissection. Here we describe our technique for the left sided VATS thymectomy including patient selection, preoperative preparation, operative steps, and postoperative care. We also share pitfalls and tips to prevent them at each step of the procedure learned from our experience with this approach.

Single port video-assisted thoracoscopic thymectomy.

Over the past decade, video-assisted thoracic surgery (VATS) has started to replace median sternotomy for the resection of non-invasive anterior mediastinal masses, including thymoma. In fact, many studies confirmed that, compared to standard sternotomy, VATS thymectomy results in less post-operative pain, better preserved pulmonary function, improved cosmesis (which can be particularly important to many young female myasthenia gravis patients) and is oncologically feasible for non-invasive thymomas as long as en bloc resection of the tumour is achieved. Classically three ports are used, but the current trend is to reduce the number of ports and minimize the length of incisions to further decrease postoperative pain, chest wall paraesthesia, and length of hospitalization. Uniportal VATS thymectomy for non-invasive mediastinal tumour resection is proven to be a safe and reliable method. In this paper we describe and illustrate our technique for single port VATS thymectomy.

Uniportal video-assisted thoracic surgery thymectomy.

A 47-year-old gentleman presented with an incidental discovery of a 2.5-cm anterior mediastinal mass. Following radiological review, the diagnosis of likely thymoma is made and the patient is referred for surgical resection. The patient is currently self-employed and working as a carpenter. He is very concerned about the possibility of having a sternotomy as it would impact on his recovery and return to work. A single port, muscle sparing technique seems the best option for this gentleman. He undergoes surgery and is discharged 2 days later. He is back at work in 2 weeks. Over the past 10 years, video-assisted thoracic surgery (VATS) has replaced median sternotomy for the resection of anterior mediastinal masses, including thymoma. In 1993, the thoracoscopic approach to thymectomy was first reported by Sugarbaker from Boston, as well as a Belgian group (1,2). To date, the VATS approach has become the preferred and standard operation for the treatment of thymic disease. Numerous studies confirmed that, compared to standard sternotomy, VATS thymectomy results in less post-operative pain, better preserved pulmonary function, improved cosmesis (which can be particularly important to many young female myasthenia gravis patients) and is oncologically feasible for noninvasive thymomas as long as en bloc resection of the tumor is achieved (3-5). Most published reports regarding this procedure have focused on the right-sided approach, which has been adopted by most surgeons as the space in the right chest cavity is relatively large, with little interference from the heart, and the superior vena cava acts as an anatomical landmark. The current trend is to reduce the number of ports and minimize the length of incisions to further decrease postoperative pain, chest wall paresthesia, and length of hospitalization. Single-port thoracoscopy for mediastinal mass resection is not new. In our early experience with uniportal VATS thymectomy, we adopted the use of a singular access device (SILS port, Covidien) that permits the insertion of three or four instruments, together with CO2 insufflation, through a right-sided single 3-cm incision, without rib spreading.

Bilateral video-assisted thoracoscopic thymectomy for Masaoka stage IIIA thymomas.

Larger invasive thymomas are generally resected via an open approach with thoracotomy or sternotomy. Following accumulation of experience and modifications to the technique, certain invasive tumors can be safely resected by video-assisted thoracic surgery (VATS) without resorting to sternotomy. Thirteen consecutive patients with large invasive thymomas, who underwent bilateral VATS thymectomy, were analyzed retrospectively. All patients underwent radical en bloc resection of the tumor and the involved structures, without breaching the tumor capsule or tumor seeding. In one patient, difficulties in removal of the tumors from the left brachiocephalic vein necessitated conversion to an open approach with minithoracotomy. No procedure-related hemorrhage occurred. The average operation time, including the case requiring conversion, was 132 minutes. The mean postoperative hospital stay was 4.7 days. There were no perioperative deaths. All patients completed follow up, with a mean duration of 17.4 months. Follow-up chest computed tomography showed no cases of recurrence. With proper patient selection, preoperative planning, and a standardized approach to the operative method, we believe that bilateral VATS thymectomy can be a safe and effective procedure, and may provide an attractive alternative approach to median sternotomy.

Comparative study of video-assisted thoracic surgery versus open thymectomy for thymoma in one single center.

Due to the popularity of video-assisted thoracic surgery (VATS) techniques in clinical, thymoma patients via VATS thymectomy are increasing rapidly. However, compared with open thymectomy, the potential superiorities and defects of VATS thymectomy remain controversial. A number of 129 patients who underwent thymectomy of early stage thymoma (Masaoka stage I and stage II) in one single center from January 2007 to September 2013 were selected in this retrospective study. Of those patients, 38 thymoma patients underwent VATS thymectomy (VATS group) and 91 underwent open thymectomy (open group) via either transsternal [44] or transthoracic approach [47] in the same period. The postoperative variables, which included postoperative hospital length of stay (LOS), the intensive care unit (ICU) LOS, the entire resection ratio, the number of thoracic drainage tubes, the quantity of output and duration of drainage, were analyzed. Meanwhile, the operation time and blood loss were considered as intraoperative variables. All thymoma patients in the analysis included 19 thymoma patients with myasthenia gravis, among which five patients via VATS thymectomy and 14 patients via open thymectomy respectively. There was no death or morbidity due to the surgical procedures perioperatively. The ICU LOS, operation time, entire resection ratio, and the number of chest tubes were not significantly different in two groups. The postoperative hospital LOS of VATS thymectomy was shorter than that of open thymectomy (5.26 versus 8.32 days, P<0.001). The blood loss of VATS thymectomy was less than open thymectomy (114.74 versus 194.51 mL, P=0.002). Postoperatively, the quantity of chest tubes output in VATS group was less than that in open thymectomy group (617.86 versus 850.08 mL, P=0.007) and duration of drainage in VATS group was shorter than that in open thymectomy group (3.87 versus 5.22 days, P<0.001). VATS thymectomy is a safe and practicable treatment for early-stage thymoma patients. Thymoma according with Masaoka staging I-II without evident invading seems to be performed through VATS approach appropriately, which has shorter postoperative hospital LOS, less blood loss and less restrictions to activities, hence patients will recover sooner.

High 18F-Fluorothymidine Uptake for Invasive Thymoma

We report an invasive thymoma discovered incidentally by an 18F-FLT (fluorothymidine) PET study on a 48-year-old woman. The patient had equivocal breast lesions in her bilateral breasts. She entered a clinical 18F-FLT PET trial in our hospital to differentiate malignant breast tumors from benign ones. No 18F FLT-avid lesions in her breasts were revealed. But an intense 18F-FLT uptake lesion was noted in her right anterior mediastinum. However, an F-FDG PET scan showed only mild F-FDG uptake in the lesion. Video-assisted thoracic surgery thymectomy was subsequently performed, and the final pathology showed invasive thymoma.

Robotic thymectomy: The Hong Kong experience.

Thymectomy is widely employed as part of the management for generalized myasthenia gravis. The surgical approach has evolved over the years, and although there is no consensus regarding the optimal surgical approach, minimally invasive techniques such as video-assisted thoracoscopic thymectomy have gained popularity. Robotic-assisted surgical systems have been employed in recent years to perform thymectomies as the robotic arm allows extra wrist action of the instruments which provide seven degrees of movement, giving improved dexterity compared to the conventional thoracoscopic approach. Here we describe our early experience with the da Vinci system in thymectomy. Between April 2006 and November 2009, 12 robotic-assisted complete thymectomy procedures were performed with no need for conversion to open procedures. Operation times ranged from 100 minutes to 200 minutes (mean time 140 minutes). There were no intraoperative or postoperative complications. Nearly all chest drains were removed on postoperative day 1 and the mean hospital stay was 4 days. The follow-up period ranged from 2 to 44 months. Early postoperative evaluations showed one patient had complete remission of symptoms (DeFilippi class 1) and 11 patients became asymptomatic or less symptomatic with a decreased medication requirement (DeFilippi class 2 and 3). Our early experience suggests that robotic thymectomy is comparable to video-assisted thoracic surgery thymectomy, and our results appear to be comparable to those reported in the literature. A larger number of cases and more extended follow up is needed to fully evaluate the merits of robotic thymectomy.

Application of video-assisted thoracic surgery in the standard operation for thoracic tumors.

ObjectiveTo evaluate the short-term outcomes of video-assisted thoracic surgery (VATS) for thoracic tumors.MethodsThe data of 1,790 consecutive patients were retrospectively reviewed. These patients underwent VATS pulmonary resections, VATS esophagectomies, and VATS resections of mediastinal tumors or biopsies at the Cancer Institute & Hospital, Chinese Academy of Medical Sciences between January 2009 and January 2012.ResultsThere were 33 patients converted to open thoracotomy (OT, 1.84%). The overall morbidity and mortality rate was 2.79% (50/1790) and 0.28% (5/1790), respectively. The overall hospitalization and chest tube duration were shorter in the VATS lobectomy group (n=949) than in the open thoracotomy (OT) lobectomy group (n=753). There were no significant differences in morbidity rate, mortality rate and operation time between the two groups. In the esophageal cancer patients, no significant difference was found in the number of nodal dissection, chest tube duration, morbidity rate, mortality rate, and hospital length of stay between the VATS esophagectomy group (n=81) and open esophagectomy group (n=81). However, the operation time was longer in the VATS esophagectomy group. In the thymoma patients, there was no significant difference in the chest tube duration, morbidity rate, mortality rate, and hospital length of stay between the VATS thymectomy group (n=41) and open thymectomy group (n=41). However, the operation time was longer in the VATS group. The median tumor size in the VATS thymectomy group was comparable with that in the OT group.ConclusionsIn early-stage (I/II) non-small cell lung cancer patients who underwent lobectomies, VATS is comparable with the OT approach with similar short-term outcomes. In patients with resectable esophageal cancer, VATS esophagectomy is comparable with OT esophagectomy with similar morbidity and mortality. VATS thymectomy for Masaoka stage I and II thymoma is feasible and safe, and tumor size is not contraindicated. Longer follow-ups are needed to determine the oncologic equivalency of VATS lobectomy, esophagectomy, and thymectomy for thymoma vs. OT.

Video-Assisted Thoracic Surgery Thymectomy: The Better Approach

Minimally invasive video-assisted thoracic surgery (VATS) thymectomy has evolved significantly over the last decade. The most common indication for VATS thymectomy is the treatment of myasthenia gravis (MG). Video-assisted thoracic surgery thymectomy results in less postoperative pain, better preserved pulmonary function, and improved cosmesis, which can be particularly important to many young female MG patients. Results of VATS thymectomy, in terms of complete stable remission from MG and symptomatic improvement, as well as safety, are comparable with conventional surgical techniques. This more patient-friendly approach would lead to wider acceptance by MG patients and their neurologists for earlier thymectomies and improved outcomes.