Expert consensus on the safety of tubeless robotic thymectomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XU Wei ¹ , XU Shiguang ¹ , DIAO Yugang ² ,  WANG Shumin ¹ , The Committee of Thoracic Surgery, Doctor Society of Medical Robotics,Chinese Medical Doctor Association

1. Department of Thoracic Surgery, General Hospital of Northern Theater Command, Shenyang, 110000, P. R. China;
2. Department of Anesthesiology, General Hospital of Northern Theater Command, Shenyang, 110000, P. R. China;

Corresponding author：

WANG Shumin, Email: sureman2003congo@163.com

Keywords：

Thymectomy; robotic surgery; nonintubated anesthesia; safety; expert consensus

DOI：

10.7507/1007-4848.202208051

Video：

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Thymectomy is an important treatment for thymoma and myasthenia gravis. The application of minimally invasive surgery to complete thymectomy and rapid recovery of patients after surgery is a developmental goal in thoracic surgery technology. Surgical robots have many technical advantages and are applied for many years in mediastinal tumor resections, a process that has led to its recognition. We published this consensus with the aim of examining how to ensure surgical safety based on the premise that better use of surgical robots achieving rapid recovery after surgery. We invited multiple experts in thoracic surgery to discuss the safety and technical issues of thymectomy under nonintubated anesthesia, and the consensus was made after several explorations and modifications.

Citation： XU Wei, XU Shiguang, DIAO Yugang, WANG Shumin, The Committee of Thoracic Surgery, Doctor Society of Medical Robotics,Chinese Medical Doctor Association. Expert consensus on the safety of tubeless robotic thymectomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(12): 1554-1561. doi: 10.7507/1007-4848.202208051 Copy

1.	Detterbeck FC, Zeeshan A. Thymoma: Current diagnosis and treatment. Chin Med J(Engl), 2013, 126(11): 2186-2191.
2.	NCCN clinical practice guidelines in oncology: Thymomas and thymic carcinomas (version2.2022). https://www.nccn.org/professionals/physician_gls/pdf/thymic.pdf.
3.	Jaretzki A 3rd, Penn AS, Younger DS, et al. "Maximal" thymectomy for myasthenia gravis. Results. J Thorac Cardiovasc Surg, 1988, 95(5): 747-757.
4.	Ashton RC Jr, McGinnis KM, Connery CP, et al. Totally endoscopic robotic thymectomy for myasthenia gravis. Ann Thorac Surg, 2003, 75(2): 569-571.
5.	高长青. 探索的脚步: 解放军总医院机器人外科手术探索实践纪实. 中华腔镜外科杂志(电子版), 2017, 10(5): 257-259.
6.	黄佳, 罗清泉, 赵晓菁, 等. 胸腺瘤切除术中机器人辅助胸腔镜技术的应用. 肿瘤, 2009, 29(8): 796-798.
7.	Ruffini E, Filosso PL, Guerrera F, et al. Optimal surgical approach to thymic malignancies: New trends challenging old dogmas. Lung Cancer, 2018, 118: 161-170.
8.	刘星池, 李博, 徐惟, 等. 达芬奇机器人手术系统行纵隔肿瘤切除术后不放置引流管的病例对照研究. 中国胸心血管外科临床杂志, 2015, 22(10): 940-943.
9.	中国医师协会医学机器人医师分会胸外科专业委员会筹备组, 谭群友, 陶绍霖, 等. 机器人辅助纵隔肿瘤手术中国专家共识(2019版). 中国胸心血管外科临床杂志, 2020, 27(2): 117-125.
10.	李剑涛, 罗清泉. 微创外科时代达芬奇机器人在胸外科的应用经验与思考. 中华腔镜外科杂志(电子版), 2020, 13(5): 260-264.
11.	宋世源, 吴子恒, 徐惟, 等. 机器人辅助非气管插管纵隔肿瘤切除术后住院时间影响因素分析及流程优化. 中国胸心血管外科临床杂志, 2022. [Epub ahead of print].
12.	刘博, 汪明敏, 许世广, 等. 达芬奇机器人纵隔肿瘤切除术的学习曲线. 中国胸心血管外科临床杂志, 2017, 24(2): 127-131.
13.	Ternovykh I, Kreis O, Gavrilov Y, et al. Diagnosis of anxiety and depression in patients with myasthenia gravis. J Neurol Sci, 2021, 429(S): 19769.
14.	王圣中, 刘晨熙, 胡玉川, 等. 胸腺增生的影像学研究进展. 国际医学放射学杂志, 2021, 44(4): 438-441.
15.	Strange CD, Ahuja J, Shroff GS, et al. Imaging evaluation of thymoma and thymic carcinoma. Front Oncol, 2022, 11: 810419.
16.	Assuncao CM, Grein HT. The importance of single-fiber electromyography in myasthenia gravis diagnosis and prognosis: A systematic review. J Neurol Sci, 2021, 429(S): 118508.
17.	Enkhtuya S, Khutagbaatar D, Rentsenbat M. Repetitive nerve stimulation test in patients with myasthenia gravis. J Neurol Sci, 2021, 429(S): 118357.
18.	Chimedregzen O, Jambal S, Rentsenbat M, et al. Thymus characteristics in seropositive and seronegative myasthenia gravis. J Neurol Sci, 2021, 429(S): 118396.
19.	周怡, 赵卫国, 保鹏涛, 等. 重症肌无力患者胸腺切除手术前后呼吸肌功能变化. 中国神经精神疾病杂志, 2011, 37(11): 679-682.
20.	姜格宁, 张雷, 朱余明, 等. 肺切除手术患者术前肺功能评估肺科共识. 中国胸心血管外科临床杂志, 2020, 27(1): 1-9.
21.	Tonev D, Georgieva R, Vavrek E. Our clinical experience in the treatment of myasthenia gravis acute exacerbations with a novel nanomembrane-based therapeutic plasma exchange technology. J Clin Med, 2022, 11(14): 4021.
22.	Kondo K, Monden Y. Therapy for thymic epithelial tumors: A clinical study of 1, 320 patients from Japan. Ann Thorac Surg, 2003, 76(3): 878-84.
23.	Hamaji M, Allen MS, Cassivi SD, et al. The role of surgical management in recurrent thymic tumors. Ann Thorac Surg, 2012, 94(1): 247-254.
24.	Zielinski M, Hauer L, Hauer J, et al. Comparison of complete remission rates after 5 year follow-up of three different techniques of thymectomy for myasthenia gravis. Eur J Cardiothorac Surg, 2010, 37(5): 1137-143.
25.	Masaoka A, Yamakawa Y, Niwa H, et al. Extended thymectomy for myasthenia gravis patients: A 20-year review. Ann Thorac Surg, 1996, 62(3): 853-859.
26.	Nakagawa K, Asamura H, Sakurai H, et al. Does the mode of surgical resection affect the prognosis/recurrence in patients with thymoma? J Surg Oncol, 2014, 109(3): 179-183.
27.	Voulaz E, Perroni G, Russo A, et al. Thymomectomy versus complete thymectomy in early-stage non-myasthenic thymomas: A multicentric propensity score-matched study. Interact Cardiovasc Thorac Surg, 2022, 35(1): ivac167.
28.	井淼, 蔡文涵, 温佳新, 等. 全胸腺切除与胸腺瘤切除治疗早期非重症肌无力胸腺瘤的围术期指标和预后比较. 解放军医学院学报, 2022, 43(5): 502-506.
29.	Papadimas E, Tan YK, Luo H, et al. Partial versus complete thymectomy in non-myasthenic patients with thymoma: A systematic review and meta-analysis of clinical outcomes. Heart Lung Circ, 2022, 31(1): 59-68.
30.	Jarrar E, Naija S, Amara N, et al. Prognosis of thymectomy in myasthenia gravis patients, in a Tunisan cohort. J Neurol Sci, 2021, 429(S): 118831.
31.	Pulle MV, Asaf BB, Puri HV, et al. Meta-analysis of limited thymectomy versus total thymectomy for masaoka stage Ⅰ and Ⅱ thymoma. J Chest Surg, 2021, 54(2): 127-136.
32.	Rückert JC, Zhang H, Li F, et al. Complete thymectomy for myasthenia gravis. J Vis Surg, 2021. [Epub ahead of print].
33.	Huang Y, Su L, Zhang Y, et al. Risk factors for postoperative myasthenic crisis after thymectomy in patients with myasthenia gravis. J Surg Res, 2021, 262: 1-5.
34.	Chu XY, Xue ZQ, Wang RW, et al. Predictors of postoperative myasthenic crisis in patients with myasthenia gravis after thymectomy. Chin Med J (Engl), 2011, 124(8): 1246-1250.
35.	谭群友, 陶绍霖, 刘宝东, 等. 重症肌无力外科治疗中国临床专家共识. 中国胸心血管外科临床杂志, 2022, 29(5): 529-541.
36.	Beckers PAJ, Mercelis R, Heyman S, et al. Myasthenia gravis appearing after thymectomy heralding recurrent thymoma. Acta Chir Belg, 2019, 119(3): 195-197.
37.	中国医师协会肿瘤多学科诊疗专业委员会. 中国胸腺上皮肿瘤临床诊疗指南(2021版). 中华肿瘤杂志, 2021, 43(4): 395-404.
38.	Kiss G, Castillo M. Non-intubated anesthesia in thoracic surgery-technical issues. Ann Transl Med, 2015, 3(8): 109.
39.	陈凛, 陈亚进, 董海龙, 等. 加速康复外科中国专家共识及路径管理指南(2018版). 中国实用外科杂志, 2018, 38(1): 1-20.
40.	谭潮, 吴浩, 王嘉华, 等. 全身麻醉下喉罩通气并发症的研究进展. 国际麻醉学与复苏杂志, 2021, 12: 1325-1329.
41.	Bussières JS, Somma J, Del Castillo JL, et al. Bronchial blocker versus left double-lumen endotracheal tube in video-assisted thoracoscopic surgery: A randomized-controlled trial examining time and quality of lung deflation. Can J Anaesth, 2016, 63(7): 818-827.
42.	Campos JH. Update on selective lobar blockade during pulmonary resections. Curr Opin Anaesthesiol, 2009, 22(1): 18-22.
43.	邓小明, 姚尚龙, 于布为, 等. 主编. 现代麻醉学. 第 5 版. 北京: 人民卫生出版社, 2020. 2127.
44.	朱勇, 施舜缤, 张林, 等. 2种径路胸腔镜全胸腺切除术的对比研究. 中国微创外科杂志, 2019, 19(2): 121-123.
45.	王维, 李川, 林琳, 等. 经剑突下达芬奇机器人手术与传统胸腔镜手术治疗重症肌无力合并胸腺瘤的对比研究. 中国胸心血管外科临床杂志, 2020, 27(11): 1287-1291.
46.	徐建国, 吴新民, 罗爱伦, 等. 成人术后疼痛处理专家共识. 临床麻醉学杂志, 2010, 26(36): 190-196.

1. Detterbeck FC, Zeeshan A. Thymoma: Current diagnosis and treatment. Chin Med J(Engl), 2013, 126(11): 2186-2191.
2. NCCN clinical practice guidelines in oncology: Thymomas and thymic carcinomas (version2.2022). https://www.nccn.org/professionals/physician_gls/pdf/thymic.pdf.
3. Jaretzki A 3rd, Penn AS, Younger DS, et al. "Maximal" thymectomy for myasthenia gravis. Results. J Thorac Cardiovasc Surg, 1988, 95(5): 747-757.
4. Ashton RC Jr, McGinnis KM, Connery CP, et al. Totally endoscopic robotic thymectomy for myasthenia gravis. Ann Thorac Surg, 2003, 75(2): 569-571.
5. 高长青. 探索的脚步: 解放军总医院机器人外科手术探索实践纪实. 中华腔镜外科杂志(电子版), 2017, 10(5): 257-259.
6. 黄佳, 罗清泉, 赵晓菁, 等. 胸腺瘤切除术中机器人辅助胸腔镜技术的应用. 肿瘤, 2009, 29(8): 796-798.
7. Ruffini E, Filosso PL, Guerrera F, et al. Optimal surgical approach to thymic malignancies: New trends challenging old dogmas. Lung Cancer, 2018, 118: 161-170.
8. 刘星池, 李博, 徐惟, 等. 达芬奇机器人手术系统行纵隔肿瘤切除术后不放置引流管的病例对照研究. 中国胸心血管外科临床杂志, 2015, 22(10): 940-943.
9. 中国医师协会医学机器人医师分会胸外科专业委员会筹备组, 谭群友, 陶绍霖, 等. 机器人辅助纵隔肿瘤手术中国专家共识(2019版). 中国胸心血管外科临床杂志, 2020, 27(2): 117-125.
10. 李剑涛, 罗清泉. 微创外科时代达芬奇机器人在胸外科的应用经验与思考. 中华腔镜外科杂志(电子版), 2020, 13(5): 260-264.
11. 宋世源, 吴子恒, 徐惟, 等. 机器人辅助非气管插管纵隔肿瘤切除术后住院时间影响因素分析及流程优化. 中国胸心血管外科临床杂志, 2022. [Epub ahead of print].
12. 刘博, 汪明敏, 许世广, 等. 达芬奇机器人纵隔肿瘤切除术的学习曲线. 中国胸心血管外科临床杂志, 2017, 24(2): 127-131.
13. Ternovykh I, Kreis O, Gavrilov Y, et al. Diagnosis of anxiety and depression in patients with myasthenia gravis. J Neurol Sci, 2021, 429(S): 19769.
14. 王圣中, 刘晨熙, 胡玉川, 等. 胸腺增生的影像学研究进展. 国际医学放射学杂志, 2021, 44(4): 438-441.
15. Strange CD, Ahuja J, Shroff GS, et al. Imaging evaluation of thymoma and thymic carcinoma. Front Oncol, 2022, 11: 810419.
16. Assuncao CM, Grein HT. The importance of single-fiber electromyography in myasthenia gravis diagnosis and prognosis: A systematic review. J Neurol Sci, 2021, 429(S): 118508.
17. Enkhtuya S, Khutagbaatar D, Rentsenbat M. Repetitive nerve stimulation test in patients with myasthenia gravis. J Neurol Sci, 2021, 429(S): 118357.
18. Chimedregzen O, Jambal S, Rentsenbat M, et al. Thymus characteristics in seropositive and seronegative myasthenia gravis. J Neurol Sci, 2021, 429(S): 118396.
19. 周怡, 赵卫国, 保鹏涛, 等. 重症肌无力患者胸腺切除手术前后呼吸肌功能变化. 中国神经精神疾病杂志, 2011, 37(11): 679-682.
20. 姜格宁, 张雷, 朱余明, 等. 肺切除手术患者术前肺功能评估肺科共识. 中国胸心血管外科临床杂志, 2020, 27(1): 1-9.
21. Tonev D, Georgieva R, Vavrek E. Our clinical experience in the treatment of myasthenia gravis acute exacerbations with a novel nanomembrane-based therapeutic plasma exchange technology. J Clin Med, 2022, 11(14): 4021.
22. Kondo K, Monden Y. Therapy for thymic epithelial tumors: A clinical study of 1, 320 patients from Japan. Ann Thorac Surg, 2003, 76(3): 878-84.
23. Hamaji M, Allen MS, Cassivi SD, et al. The role of surgical management in recurrent thymic tumors. Ann Thorac Surg, 2012, 94(1): 247-254.
24. Zielinski M, Hauer L, Hauer J, et al. Comparison of complete remission rates after 5 year follow-up of three different techniques of thymectomy for myasthenia gravis. Eur J Cardiothorac Surg, 2010, 37(5): 1137-143.
25. Masaoka A, Yamakawa Y, Niwa H, et al. Extended thymectomy for myasthenia gravis patients: A 20-year review. Ann Thorac Surg, 1996, 62(3): 853-859.
26. Nakagawa K, Asamura H, Sakurai H, et al. Does the mode of surgical resection affect the prognosis/recurrence in patients with thymoma? J Surg Oncol, 2014, 109(3): 179-183.
27. Voulaz E, Perroni G, Russo A, et al. Thymomectomy versus complete thymectomy in early-stage non-myasthenic thymomas: A multicentric propensity score-matched study. Interact Cardiovasc Thorac Surg, 2022, 35(1): ivac167.
28. 井淼, 蔡文涵, 温佳新, 等. 全胸腺切除与胸腺瘤切除治疗早期非重症肌无力胸腺瘤的围术期指标和预后比较. 解放军医学院学报, 2022, 43(5): 502-506.
29. Papadimas E, Tan YK, Luo H, et al. Partial versus complete thymectomy in non-myasthenic patients with thymoma: A systematic review and meta-analysis of clinical outcomes. Heart Lung Circ, 2022, 31(1): 59-68.
30. Jarrar E, Naija S, Amara N, et al. Prognosis of thymectomy in myasthenia gravis patients, in a Tunisan cohort. J Neurol Sci, 2021, 429(S): 118831.
31. Pulle MV, Asaf BB, Puri HV, et al. Meta-analysis of limited thymectomy versus total thymectomy for masaoka stage Ⅰ and Ⅱ thymoma. J Chest Surg, 2021, 54(2): 127-136.
32. Rückert JC, Zhang H, Li F, et al. Complete thymectomy for myasthenia gravis. J Vis Surg, 2021. [Epub ahead of print].
33. Huang Y, Su L, Zhang Y, et al. Risk factors for postoperative myasthenic crisis after thymectomy in patients with myasthenia gravis. J Surg Res, 2021, 262: 1-5.
34. Chu XY, Xue ZQ, Wang RW, et al. Predictors of postoperative myasthenic crisis in patients with myasthenia gravis after thymectomy. Chin Med J (Engl), 2011, 124(8): 1246-1250.
35. 谭群友, 陶绍霖, 刘宝东, 等. 重症肌无力外科治疗中国临床专家共识. 中国胸心血管外科临床杂志, 2022, 29(5): 529-541.
36. Beckers PAJ, Mercelis R, Heyman S, et al. Myasthenia gravis appearing after thymectomy heralding recurrent thymoma. Acta Chir Belg, 2019, 119(3): 195-197.
37. 中国医师协会肿瘤多学科诊疗专业委员会. 中国胸腺上皮肿瘤临床诊疗指南(2021版). 中华肿瘤杂志, 2021, 43(4): 395-404.
38. Kiss G, Castillo M. Non-intubated anesthesia in thoracic surgery-technical issues. Ann Transl Med, 2015, 3(8): 109.
39. 陈凛, 陈亚进, 董海龙, 等. 加速康复外科中国专家共识及路径管理指南(2018版). 中国实用外科杂志, 2018, 38(1): 1-20.
40. 谭潮, 吴浩, 王嘉华, 等. 全身麻醉下喉罩通气并发症的研究进展. 国际麻醉学与复苏杂志, 2021, 12: 1325-1329.
41. Bussières JS, Somma J, Del Castillo JL, et al. Bronchial blocker versus left double-lumen endotracheal tube in video-assisted thoracoscopic surgery: A randomized-controlled trial examining time and quality of lung deflation. Can J Anaesth, 2016, 63(7): 818-827.
42. Campos JH. Update on selective lobar blockade during pulmonary resections. Curr Opin Anaesthesiol, 2009, 22(1): 18-22.
43. 邓小明, 姚尚龙, 于布为, 等. 主编. 现代麻醉学. 第 5 版. 北京: 人民卫生出版社, 2020. 2127.
44. 朱勇, 施舜缤, 张林, 等. 2种径路胸腔镜全胸腺切除术的对比研究. 中国微创外科杂志, 2019, 19(2): 121-123.
45. 王维, 李川, 林琳, 等. 经剑突下达芬奇机器人手术与传统胸腔镜手术治疗重症肌无力合并胸腺瘤的对比研究. 中国胸心血管外科临床杂志, 2020, 27(11): 1287-1291.
46. 徐建国, 吴新民, 罗爱伦, 等. 成人术后疼痛处理专家共识. 临床麻醉学杂志, 2010, 26(36): 190-196.

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Expert consensus on the safety of tubeless robotic thymectomy

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