Hartwich Joseph, Tyagi Sanjeev, Margaron Franklin, Oitcica Claudio, Teasley Jean, Lanning David
Division of Pediatric Surgery, Department of Surgery, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia 23298, USA.
J Laparoendosc Adv Surg Tech A. 2012 Nov;22(9):925-9. doi: 10.1089/lap.2012.0042. Epub 2012 Jul 30.
In the United States, the prevalence of myasthenia gravis (MG) is approximately 14-20 per 100,000. One treatment option involves a thymectomy, which can lead to remission of symptoms. The amount of thymic tissue removed is correlated with a better outcome for patients. Thus, it is critical that the procedure used when performing a thymectomy maximize the resection of thymic tissue. Robotic-assisted thoracoscopic thymectomy provides a minimally invasive platform that avoids the mortality and morbidity of a median sternotomy while providing better visualization and a more delicate dissection than is available in a standard thoracoscopic procedure.
Following Institutional Review Board approval, in total, 9 patients who underwent robotic thymectomy were reviewed. Intraoperative statistics such as operative time and blood loss were reviewed from operative records. Postoperative outcomes such as hospital stay, discharge medications, and complications were reviewed from hospital charts. Lastly, disease response was evaluated in consultation with a pediatric neurologist who specializes in MG.
Age at operation ranged from 2 to 15 years of age (average, 9.4 years). A majority of patients had an MGFA classification of II or greater (n=5). All patients were on pyridostigmine preoperatively, and 7 of 9 (77%) were taking prednisone. Mean operative time was 160.1±6.1 minutes. Average postoperative hospital stay was 1.1±0.3 days. One patient had a documented persistent pneumothorax on postoperative Day 1, which was treated with nasal cannula oxygen for an additional day. There were no additional operative complications, and all patients were discharged home on acetaminophen with codeine for pain control. Eight of 9 patients had improvement in MG symptoms after the procedure.
Robotic-assisted thoracoscopic thymectomy is a safe and effective operation for children with MG. Robotic assistance allows for articulating instruments, three-dimensional visualization, and minimal blood loss. These factors may allow for a more complete resection compared with a standard thoracoscopic thymectomy.
在美国，重症肌无力（MG）的患病率约为每10万人中有14 - 20例。一种治疗选择是胸腺切除术，它可使症状缓解。切除的胸腺组织量与患者更好的预后相关。因此，进行胸腺切除术时所采用的手术方法能最大程度切除胸腺组织至关重要。机器人辅助胸腔镜胸腺切除术提供了一个微创平台，避免了正中胸骨切开术的死亡率和发病率，同时与标准胸腔镜手术相比，能提供更好的视野和更精细的解剖。
经机构审查委员会批准，共对9例行机器人胸腺切除术的患者进行了回顾。从手术记录中查看术中统计数据，如手术时间和失血量。从医院病历中查看术后结果，如住院时间、出院用药和并发症。最后，与一位专门研究MG的儿科神经科医生协商评估疾病反应。
手术年龄范围为2至15岁（平均9.4岁）。大多数患者的MGFA分级为II级或更高（n = 5）。所有患者术前均服用吡啶斯的明，9例中有7例（77%）正在服用泼尼松。平均手术时间为160.1±6.1分钟。术后平均住院时间为1.1±0.3天。1例患者术后第1天记录有持续性气胸，通过鼻导管吸氧额外治疗了1天。无其他手术并发症，所有患者出院时均带对乙酰氨基酚加可待因用于控制疼痛。9例患者中有8例术后MG症状有所改善。
机器人辅助胸腔镜胸腺切除术对MG患儿是一种安全有效的手术。机器人辅助可使用关节式器械、三维视野且失血量少。与标准胸腔镜胸腺切除术相比，这些因素可能使切除更完整。
