Kawaguchi Koji, Fukui Takayuki, Nakamura Shota, Taniguchi Tetsuo, Yokoi Kohei
Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
Division of Thoracic Surgery, Komaki City Hospital, Komaki, Japan.
Surg Today. 2018 Feb;48(2):195-199. doi: 10.1007/s00595-017-1567-x. Epub 2017 Jul 11.
We adopted a bilateral approach to complete robotic extended thymectomy with the excision of the pericardial fat tissue from both sides and analyzed the initial outcomes.
The patient cart was docked first from the left shoulder side. After dissection of the thymus and right pericardial fat tissue, the cart was temporarily rolled out, and the bed was rotated approximately 90° clockwise. The cart was then re-docked from the right-side shoulder, and extended thymectomy was performed via the left-side approach. The outcomes were compared with four cases of unilateral approach performed for mediastinal tumor in the same term.
Four patients with myasthenia gravis (two of whom had stage I thymoma) underwent extended thymectomy by the bilateral approach. The mean operative time was 288 min, and the console time was 146 min in the right side and 67 min in the left side. The resected thymus and surrounding adipose tissue were almost symmetrical, in contrast with those obtained via the unilateral approach. No remarkable events were noted.
Bilateral extended thymectomy for myasthenia gravis patients was safe and reasonable based on the initial outcomes.
我们采用双侧入路完成机器人扩大胸腺切除术，双侧切除心包脂肪组织，并分析其初步结果。
患者推车首先从左肩侧对接。在解剖胸腺和右侧心包脂肪组织后，将推车暂时推出，手术床顺时针旋转约90°。然后将推车从右侧肩部重新对接，通过左侧入路进行扩大胸腺切除术。将结果与同期因纵隔肿瘤行单侧入路手术的4例患者进行比较。
4例重症肌无力患者（其中2例为Ⅰ期胸腺瘤）接受了双侧入路扩大胸腺切除术。平均手术时间为288分钟，右侧控制台时间为146分钟，左侧为67分钟。与单侧入路相比，切除的胸腺和周围脂肪组织几乎对称。未观察到明显事件。
基于初步结果，双侧扩大胸腺切除术治疗重症肌无力患者是安全且合理的。
