Refai Majed, Gonzalez-Rivas Diego, Guiducci Gian Marco, Roncon Alberto, Tiberi Michela, Xiumè Francesco, Salati Michele, Andolfi Marco
Unit of Thoracic Surgery, AOU Ospedali Riuniti, Ancona, Italy.
Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain.
Gland Surg. 2020 Aug;9(4):879-885. doi: 10.21037/gs-19-521.
Since 2004, uniportal video-assisted thoracic surgery (VATS) approach was progressively widespread and also applied in the treatment of thymoma, with promising results. We report the first series of patients who undergone uniportal VATS thymectomy using a homemade glove-port with carbon dioxide (CO) insufflation. The aim of this article is to analyze the safety and feasibility to perform an extended thymectomy (ET).
A prospective, single-centre, short-term observational study including patients with mediastinal tumours undergoing scheduled uniportal VATS resection using a glove-port with CO. Operations were performed through a single incision of 3.5 cm at the fifth intercostal space, right or left anterior axillary line. A 5 mm-30° camera and working instruments were employed through a glove-port with CO.
Thirty-eight patients (20 men; mean age 61.6 years) underwent ET between September 2016 and October 2019. Thirteen patients had a history of Myasthenia Gravis (MG) with thymoma and 8 had incidental findings of thymoma. Additionally, 8 mediastinal cysts and 9 thymic hyperplasia were included. Mean diameter of the tumor was 5.1 cm (range, 1.6-14 cm) and mean operation time was 143 minutes. Mean postoperative drainage duration and hospital stay were 2.3 and 4.3 days, respectively. Mean blood loss was 41 mL. There was no occurrence of surgical morbidity or mortality. During the follow-up period (1-36 months), no recurrence was noted.
Our results suggest that uniportal VATS thymectomy through glove-port and CO is safe and feasible procedure, even with large thymomas. Furthermore, the glove-port system represents a valid, cheap and widely available alternative to the commercial devices usually adopted in thoracic surgery.
自2004年以来，单孔电视辅助胸腔镜手术（VATS）方法逐渐普及，并应用于胸腺瘤的治疗，取得了令人满意的结果。我们报告了首例使用自制手套端口并进行二氧化碳（CO₂）充气的单孔VATS胸腺切除术患者系列。本文旨在分析进行扩大胸腺切除术（ET）的安全性和可行性。
一项前瞻性、单中心、短期观察性研究，纳入计划使用带CO₂的手套端口进行单孔VATS切除纵隔肿瘤的患者。手术通过在右或左腋前线第五肋间进行3.5 cm的单一切口进行。通过带CO₂的手套端口使用5 mm - 30°摄像头和操作器械。
2016年9月至2019年10月期间，38例患者（20例男性；平均年龄61.6岁）接受了ET。13例患者有胸腺瘤合并重症肌无力（MG）病史，8例为偶然发现的胸腺瘤。此外，还包括8例纵隔囊肿和9例胸腺增生。肿瘤平均直径为5.1 cm（范围1.6 - 14 cm），平均手术时间为143分钟。术后平均引流时间和住院时间分别为2.3天和4.3天。平均失血量为41 mL。未发生手术并发症或死亡。在随访期（1 - 36个月）内，未发现复发。
我们的结果表明，通过手套端口和CO₂进行单孔VATS胸腺切除术是一种安全可行的手术，即使对于较大的胸腺瘤也是如此。此外，手套端口系统是胸外科通常采用的商业设备的一种有效、廉价且广泛可用的替代方案。
