Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
Eur J Cardiothorac Surg. 2020 Aug 1;58(Suppl_1):i34-i38. doi: 10.1093/ejcts/ezaa036.
We previously reported a transthoracic approach using the da Vinci Single-Site™ platform. This study describes the outcomes of robotic single-site thymectomy via a subxiphoid approach based on our previous experiences.
This study included patients, who underwent single-site robotic thymectomy via the subxiphoid approach between September 2018 and October 2019. A 3- to 4-cm vertical incision was made over the subxiphoid area, and the Lapsingle port with CO2 gas was introduced. After docking at the single site, a 5-mm curved cannula, 5-mm cardiere grasper and Maryland bipolar forceps or permanent cautery hook was inserted. The single-site robotic platform was used to conduct all surgical procedures except the dissection around the inferior portion of the thymic tissue performed via a thoracoscopic approach through the same incision.
Overall, 13 patients, including 2 with myasthenia gravis, were enrolled. The mean duration of the surgery and chest drainage were 167.3 ± 52.8 (range 73-253) min and 2.2 ± 0.9 (range 1-5) days, respectively. All surgeries were successfully completed without conversion to an open surgery, and there were no major post-surgical complications. The diagnoses based on histopathology included thymoma in 10 patients, thymolipoma in 2 patients and atypical carcinoid tumour in 1 patient with free resection margin.
This study demonstrated that robotic single-site-assisted thymectomy via the subxiphoid approach is a safe and technically feasible procedure. Although this initial series comprised relatively simple cases, more advanced and complex procedures can soon be performed with the advent of single-port robotic platform.
我们之前报道了一种使用达芬奇单孔平台的经胸入路。本研究基于我们之前的经验，描述了经剑突下入路机器人单孔胸腺切除术的结果。
本研究纳入了 2018 年 9 月至 2019 年 10 月期间接受经剑突下入路单孔机器人胸腺切除术的患者。在剑突下区域做一个 3-4cm 的垂直切口，引入 Lapsingle 端口和 CO2 气体。单孔位对接完成后，插入 5mm 弯型套管、5mm 卡迪尔抓钳、马里兰双极镊子或永久电烙钩。除了通过同一切口的胸腔镜入路进行胸腺组织下部解剖外，所有手术均由单孔机器人平台完成。
共有 13 例患者（包括 2 例重症肌无力患者）入组。手术时间和胸腔引流时间的平均值分别为 167.3±52.8（范围 73-253）min 和 2.2±0.9（范围 1-5）天。所有手术均顺利完成，无中转开放手术，且无严重术后并发症。基于组织病理学的诊断包括 10 例胸腺瘤、2 例胸腺脂肪瘤和 1 例无瘤切缘的非典型类癌肿瘤。
本研究表明，经剑突下入路机器人单孔辅助胸腺切除术是一种安全且技术可行的方法。尽管本初始系列病例相对简单，但随着单孔机器人平台的出现，很快就能进行更高级和复杂的手术。
