Coco Danilo, Leanza Silvana
Department of General Surgery, Ospedali Riuniti Marche Nord, Pesaro (PU), Italy.
Department of General Surgery, Carlo Urbani Hospital, Jesi (AN), Italy.
Kardiochir Torakochirurgia Pol. 2023 Mar;20(1):36-44. doi: 10.5114/kitp.2023.126097. Epub 2023 Apr 3.
Thymectomy is a well-established therapeutic option in the multidisciplinary treatment of nonthymomatous myasthenia gravis (MG) and in thymoma treatment. Although many surgical procedures for thymectomy have been identified, the transsternal method is still regarded as the gold standard. Minimally invasive procedures, on the other hand, have achieved popularity in the last decades and are now extensively used in this field of surgery. Among them, robotic thymectomy has been the most cutting-edge surgical procedure. Several authors and meta-analyses have shown that a minimally invasive approach to thymectomy is associated with improved surgical results and fewer complications in surgery compared to transsternal open thymectomy, without any substantial changes in myasthenia gravis complete rates of remission. Hence, in the present review of the literature, we aimed to describe and delineate the techniques, advantages, outcomes, and future perspectives of robotic thymectomy. Existing evidence suggests that robotic thymectomy will likely become the gold standard for thymectomy in early stage thymomas and MG subjects. Many of the drawbacks related to other minimally invasive procedures appear to be resolved by robotic thymectomy, and long-term neurological outcomes are satisfactory. In addition, improved vision and high dexterity of instrument movements enable safe and complete thymic tissue dissection, superior to standard thoracoscopic procedures. The access with minimally invasive surgery VATS (video-assisted thoracoscopic surgery) or RATS (robot-assisted thoracic surgery) access in its various variants allows the extent of mediastinal fat resection due to the possibility of ectopic thymic foci in the mediastinum determining the long-term outcome in the group of patients operated on for myasthenia gravis. However, it was recommended to carry out better designed, multi-centre, randomized studies to arrive at definitive conclusions on robotic thymectomy for thymomas and myasthenia gravis treatment.
胸腺切除术是多学科治疗非胸腺瘤性重症肌无力（MG）及胸腺瘤治疗中一种成熟的治疗选择。尽管已确定了多种胸腺切除手术方法，但经胸骨手术方法仍被视为金标准。另一方面，微创手术在过去几十年中颇受欢迎，目前在该手术领域广泛应用。其中，机器人胸腺切除术一直是最前沿的手术方法。多位作者及荟萃分析表明，与经胸骨开放性胸腺切除术相比，微创手术方法进行胸腺切除术手术效果更佳，手术并发症更少，而重症肌无力完全缓解率无显著变化。因此，在本次文献综述中，我们旨在描述和阐述机器人胸腺切除术的技术、优势、结果及未来展望。现有证据表明，机器人胸腺切除术可能会成为早期胸腺瘤和MG患者胸腺切除术的金标准。机器人胸腺切除术似乎解决了与其他微创手术相关的许多缺点，长期神经学结果令人满意。此外，视野改善和器械操作的高灵活性使胸腺组织能够安全、完整地切除，优于标准胸腔镜手术。通过各种变体的微创手术VATS（电视辅助胸腔镜手术）或RATS（机器人辅助胸外科手术）入路，由于纵隔中可能存在异位胸腺病灶，从而能够进行纵隔脂肪切除，这决定了重症肌无力手术患者组的长期预后。然而，建议开展设计更完善的多中心随机研究，以便就机器人胸腺切除术治疗胸腺瘤和重症肌无力得出明确结论。
