Clinical implementation of robot assisted trans-subxiphoid (extended) thymectomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Hanlu , LIU Lunxu , CHEN Longqi , CHE Guowei , LIN Yidan , WANG Zihao , ZHENG Yu , GENG Yingcai , WANG Fuqiang , YUAN Yong , MA Lin ,  WANG Yun

Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

WANG Yun, Email: yunwwang@yeah.net

Keywords：

Myasthenia gravis; thymic neoplasms; Da Vinci surgical system; robotic surgery

DOI：

10.7507/1007-4848.201708061

Video：

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Objective To present the preliminary clinical experience of robot assisted trans-subxiphoid (extended) thymectomy in patients with thymic neoplasms or myasthenia gravis. Methods A total of 62 patients (34 males and 28 females at an average age of 38±11 years) suffering from thymic neoplasms or myasthenia gravis who underwent robotic (extended) thymectomy via subxiphoid approach were included in our department between August 2016 and August 2017. All of the operation were completed through 4 ports. In details, the observation hole was created just below the xiphoid process, two ports for arm 1 and arm 2 were created below bilateral subcostal arch at the midclavicular line, and trocar for arm 3 was placed in the 5^th or 6^th intercostal space at the anterior axillary line, respectively. Patients with thymic neoplasms received thymectomy. Patients with myasthenia gravis received extended thymectomy. Results All the patients experienced uneventful operations. The mean operative time was 116.0±34.0 min. The mean intraoperative blood loss was 5.6±4.3 ml. The mean postoperative hospital stay was 4.0±2.2 days. There was no intra-operational massive hemorrhage, mortality, conversion or postoperative complication during the postoperative and follow-up period. Conclusion Robotic trans-subxiphoid thymectomy is safe and feasible, which is a promising technique for extensive application.

Citation： ZHANG Hanlu, LIU Lunxu, CHEN Longqi, CHE Guowei, LIN Yidan, WANG Zihao, ZHENG Yu, GENG Yingcai, WANG Fuqiang, YUAN Yong, MA Lin, WANG Yun. Clinical implementation of robot assisted trans-subxiphoid (extended) thymectomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(10): 743-747. doi: 10.7507/1007-4848.201708061 Copy

1.	Qian L, Chen X, Huang J, et al. A comparison of three approaches for the treatment of early-stage thymomas: robot-assisted thoracic surgery, video-assisted thoracic surgery, and median sternotomy. J Thorac Dis, 2017, 9(7): 1997-2005.
2.	Hsu CP, Chuang CY, Hsu NY, et al. Comparison between the right side and subxiphoid bilateral approaches in performing video-assisted thoracoscopic extended thymectomy for myasthenia gravis. Surg Endosc, 2004, 18(5): 821-824.
3.	Park SY, Kim DJ, Do YW, et al. The oncologic outcome of esophageal squamous cell carcinoma patients after robot-assisted thoracoscopic esophagectomy with total mediastinal lymphadenectomy. Ann Thorac Surg, 2017, 103(4): 1151-1157.
4.	Marulli G, Maessen J, Melfi F, et al. Multi-institutional European experience of robotic thymectomy for thymoma. Ann Cardiothorac Surg, 2016, 5(1): 18-25.
5.	Suda T, Kaneda S, Hachimaru A, et al. Thymectomy via a subxiphoid approach: single-port and robot-assisted. J Thorac Dis, 2016, 8(Suppl 3): S265-271.
6.	Fok M, Bashir M, Harky A, et al. Video-assisted thoracoscopic versus robotic-assisted thoracoscopic thymectomy: systematic review and meta-analysis. Innovations (Phila), 2017, 12(4): 259-264.
7.	Jun Y, Hao L, Demin L, et al. Da Vinci robot-assisted system for thymectomy: experience of 55 patients in China. Int J Med Robot, 2014, 10(3): 294-299.
8.	Melfi FM, Fanucchi O, Mussi A. Minimally invasive mediastinal surgery. Ann Cardiothorac Surg, 2016, 5(1): 10-17.
9.	Crescenzo VGD, Napolitano F, Panico C, et al. Surgical approach in thymectomy: Our experience and review of the literature. Int J Surg Case Rep, 2017, 39: 19-24.
10.	Raza A, Woo E. Video-assisted thoracoscopic surgery versus sternotomy in thymectomy for thymoma and myasthenia gravis. Ann Cardiothorac Surg, 2016, 5(1): 33-37.
11.	Jurado J, Javidfar J, Newmark A, et al. Minimally invasive thymectomy and open thymectomy: outcome analysis of 263 patients. Ann Thorac Surg, 2012, 94(3): 974-981.
12.	Zhao J, Wang J, Zhao Z, et al. Subxiphoid and subcostal arch thoracoscopic extended thymectomy: a safe and feasible minimally invasive procedure for selective stage III thymomas. J Thorac Dis, 2016, 8(Suppl 3): S258-264.
13.	Yano M, Moriyama S, Haneda H, et al. The subxiphoid approach leads to less invasive thoracoscopic thymectomy than the lateral approach. World J Surg, 2017, 41(3): 763-770.
14.	Zhang H, Geng Y, Zheng Y, et al. A case of anterior mediastinitis and bilateral multiple lung abscesses occurring after trans-subxiphoid video-assisted thoracoscopic extended thymectomy for thymoma with myasthenia gravis. J Thorac Dis, 2016, 8(9): E970-e973.
15.	Ishikawa N, Sun YS, Nifong LW, et al. Thoracoscopic robot-assisted extended thymectomy in human cadaver. Surg Endosc, 2009, 23(2): 459-461.
16.	Zielinski M, Czajkowski W, Gwozdz P, et al. Resection of thymomas with use of the new minimally-invasive technique of extended thymectomy performed through the subxiphoid-right video-thoracoscopic approach with double elevation of the sternum. Eur J Cardiothorac Surg, 2013, 44(2): e113-e119.

1. Qian L, Chen X, Huang J, et al. A comparison of three approaches for the treatment of early-stage thymomas: robot-assisted thoracic surgery, video-assisted thoracic surgery, and median sternotomy. J Thorac Dis, 2017, 9(7): 1997-2005.
2. Hsu CP, Chuang CY, Hsu NY, et al. Comparison between the right side and subxiphoid bilateral approaches in performing video-assisted thoracoscopic extended thymectomy for myasthenia gravis. Surg Endosc, 2004, 18(5): 821-824.
3. Park SY, Kim DJ, Do YW, et al. The oncologic outcome of esophageal squamous cell carcinoma patients after robot-assisted thoracoscopic esophagectomy with total mediastinal lymphadenectomy. Ann Thorac Surg, 2017, 103(4): 1151-1157.
4. Marulli G, Maessen J, Melfi F, et al. Multi-institutional European experience of robotic thymectomy for thymoma. Ann Cardiothorac Surg, 2016, 5(1): 18-25.
5. Suda T, Kaneda S, Hachimaru A, et al. Thymectomy via a subxiphoid approach: single-port and robot-assisted. J Thorac Dis, 2016, 8(Suppl 3): S265-271.
6. Fok M, Bashir M, Harky A, et al. Video-assisted thoracoscopic versus robotic-assisted thoracoscopic thymectomy: systematic review and meta-analysis. Innovations (Phila), 2017, 12(4): 259-264.
7. Jun Y, Hao L, Demin L, et al. Da Vinci robot-assisted system for thymectomy: experience of 55 patients in China. Int J Med Robot, 2014, 10(3): 294-299.
8. Melfi FM, Fanucchi O, Mussi A. Minimally invasive mediastinal surgery. Ann Cardiothorac Surg, 2016, 5(1): 10-17.
9. Crescenzo VGD, Napolitano F, Panico C, et al. Surgical approach in thymectomy: Our experience and review of the literature. Int J Surg Case Rep, 2017, 39: 19-24.
10. Raza A, Woo E. Video-assisted thoracoscopic surgery versus sternotomy in thymectomy for thymoma and myasthenia gravis. Ann Cardiothorac Surg, 2016, 5(1): 33-37.
11. Jurado J, Javidfar J, Newmark A, et al. Minimally invasive thymectomy and open thymectomy: outcome analysis of 263 patients. Ann Thorac Surg, 2012, 94(3): 974-981.
12. Zhao J, Wang J, Zhao Z, et al. Subxiphoid and subcostal arch thoracoscopic extended thymectomy: a safe and feasible minimally invasive procedure for selective stage III thymomas. J Thorac Dis, 2016, 8(Suppl 3): S258-264.
13. Yano M, Moriyama S, Haneda H, et al. The subxiphoid approach leads to less invasive thoracoscopic thymectomy than the lateral approach. World J Surg, 2017, 41(3): 763-770.
14. Zhang H, Geng Y, Zheng Y, et al. A case of anterior mediastinitis and bilateral multiple lung abscesses occurring after trans-subxiphoid video-assisted thoracoscopic extended thymectomy for thymoma with myasthenia gravis. J Thorac Dis, 2016, 8(9): E970-e973.
15. Ishikawa N, Sun YS, Nifong LW, et al. Thoracoscopic robot-assisted extended thymectomy in human cadaver. Surg Endosc, 2009, 23(2): 459-461.
16. Zielinski M, Czajkowski W, Gwozdz P, et al. Resection of thymomas with use of the new minimally-invasive technique of extended thymectomy performed through the subxiphoid-right video-thoracoscopic approach with double elevation of the sternum. Eur J Cardiothorac Surg, 2013, 44(2): e113-e119.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical implementation of robot assisted trans-subxiphoid (extended) thymectomy

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