Hess Nicholas R, Baker Nicholas, Levy Ryan M, Pennathur Arjun, Christie Neil A, Luketich James D, Sarkaria Inderpal S
Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
J Thorac Dis. 2020 Feb;12(2):114-122. doi: 10.21037/jtd.2020.01.11.
Thoracoscopic approaches to thymectomy and anterior mediastinal mass resection has become increasingly common due to the potential for decreased blood loss and hospital length of stay. However, contralateral mediastinal and phrenic nerve visualization if often difficult from these unilateral approaches, which may affect the ability to achieve a full phrenic to phrenic dissection Herein, we present our early experience of robotic assisted minimally invasive thymectomy (RAMIT) with simultaneous bilateral thoracoscopy and contralateral phrenic nerve visualization.
This was a retrospective review of all sequential patients undergoing RAMIT with simultaneous bilateral thoracoscopy from January 2015 to May 2016. This study was approved by our Institutional Review Board (PRO15080367). Individual patient consent was waived.
Twenty-six patients [median age 58 (range, 29-76) years] were included in this study. Sixteen operations were performed for anterior mediastinal mass, 7 for non-thymomatous myasthenia gravis, and 3 for concurrent myasthenia gravis and thymoma. Median blood loss and hospital stay were 25 mL (range, 3-150 mL) and 3 days (range, 2-8 days), respectively. Twenty-one (80.8%) patients experienced an uncomplicated hospital course. The highest graded complication by Clavien Dindo Classification was a grade III due to pleural effusion requiring drainage via pleural catheter. One patient experienced asymptomatic hemidiaphram palsy postoperatively. There were no 90-day postoperative deaths.
RAMIT with simultaneous bilateral thoracoscopy is a feasible approach that may allow for enhanced visualization and more complete thymic resection compared to existing unilateral minimally invasive operations. Comparative studies and long-term follow up are needed to adequately assess the potential benefits of RAMIT.
由于有可能减少失血量和缩短住院时间，胸腔镜下胸腺切除术和前纵隔肿物切除术已变得越来越普遍。然而，从这些单侧入路往往难以观察到对侧纵隔和膈神经，这可能会影响进行完整的膈神经至膈神经解剖的能力。在此，我们介绍我们在机器人辅助微创胸腺切除术（RAMIT）中同时进行双侧胸腔镜检查和观察对侧膈神经的早期经验。
这是一项对2015年1月至2016年5月期间接受RAMIT并同时进行双侧胸腔镜检查的所有连续患者的回顾性研究。本研究经我们的机构审查委员会批准（PRO15080367）。免除了个体患者的知情同意。
本研究纳入了26例患者[中位年龄58岁（范围29 - 76岁）]。16例手术用于切除前纵隔肿物，7例用于非胸腺瘤性重症肌无力，3例用于合并重症肌无力和胸腺瘤。中位失血量和住院时间分别为25毫升（范围3 - 150毫升）和3天（范围2 - 8天）。21例（80.8%）患者的住院过程无并发症。根据Clavien Dindo分类法分级最高的并发症是Ⅲ级，原因是胸腔积液需要通过胸腔导管引流。1例患者术后出现无症状性半膈肌麻痹。术后90天内无死亡病例。
与现有的单侧微创手术相比，RAMIT同时进行双侧胸腔镜检查是一种可行的方法，可能有助于增强视野并更完整地切除胸腺。需要进行比较研究和长期随访以充分评估RAMIT的潜在益处。
