Negi Takahiro, Morota Mizuki, Tochii Daisuke, Tochii Sachiko, Suda Takashi
Department of Thoracic Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan.
J Thorac Dis. 2024 Oct 31;16(10):6778-6788. doi: 10.21037/jtd-24-914. Epub 2024 Oct 15.
We previously reported on subxiphoid uniportal thymectomy (SUT) and subxiphoid robotic thymectomy (SRT). This descriptive study aimed to evaluate the feasibility and safety of both SUT and SRT techniques.
Between March 2011 and December 2022, 268 patients underwent subxiphoid thymectomy. In cases demonstrating no evidence of invasion into other organs, SUT was selected due to its minimal invasiveness. In cases where the tumor was in contact with the innominate vein or those with suspected invasion into other organs, SRT with additional intercostal ports was selected due to the enhanced operability provided by the robotic system. The patients' backgrounds and the perioperative outcomes of each technique were evaluated.
SUT was performed in 207 patients, while SRT was performed in 61 patients. In the SUT group, 15 patients required an additional intercostal port, and 2 patients required a median sternotomy; the SUT completion rate was 91.78%. The median operative time was 117.00 [interquartile range (IQR), 88.00-148.50] min, with a median blood loss of 5.00 (IQR, 1.00-5.00) mL. Combined resection was performed in 11 (5.31%) patients, and postoperative complications were observed in 4 patients (1.93%). None of the patients in the SRT group required median sternotomy. The median operative time was 203.00 (IQR, 158.00-278.00) min, with a median blood loss of 5.00 (IQR, 5.00-22.00) mL. Combined resection was performed in 14 patients (22.95%), and postoperative complications were observed in 5 patients (8.20%). No mortalities occurred in either group.
Subxiphoid thymectomy is a safe and feasible technique for both early and advanced stages of the disease requiring complex surgical procedures.
我们之前报道过剑突下单孔胸腺切除术（SUT）和剑突下机器人辅助胸腺切除术（SRT）。本描述性研究旨在评估SUT和SRT技术的可行性和安全性。
2011年3月至2022年12月期间，268例患者接受了剑突下胸腺切除术。对于无侵犯其他器官证据的病例，因其微创性选择SUT。对于肿瘤与无名静脉接触或怀疑侵犯其他器官的病例，由于机器人系统提供了更高的可操作性，选择带有额外肋间切口的SRT。评估了患者的背景以及每种技术的围手术期结果。
207例患者接受了SUT，61例患者接受了SRT。在SUT组中，15例患者需要额外的肋间切口，2例患者需要正中胸骨切开术；SUT完成率为91.78%。中位手术时间为117.00[四分位数间距（IQR），88.00 - 148.50]分钟，中位失血量为5.00（IQR，1.00 - 5.00）毫升。11例（5.31%）患者进行了联合切除，4例患者（1.93%）出现术后并发症。SRT组中没有患者需要正中胸骨切开术。中位手术时间为203.00（IQR，158.00 - 278.00）分钟，中位失血量为5.00（IQR，5.00 - 22.00）毫升。14例患者（22.95%）进行了联合切除，5例患者（8.20%）出现术后并发症。两组均未发生死亡。
剑突下胸腺切除术对于需要复杂手术的疾病的早期和晚期阶段都是一种安全可行的技术。
