Comparison of perioperative outcomes of robotic trans-subxiphoid and video-assisted thoracoscopic extended thymectomy in the treatment of myasthenia gravis complicated with thymoma_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Wei ¹ , LI Chuan ² , LIN Lin ¹ , ZHENG E ¹ , YUAN Yong ² , WANG Yun ² , MEI Jiandong ² ,  YANG Mei ¹

1. West China School of Nursing, Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;
2. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

YANG Mei, Email: yangmei69@126.com

Keywords：

Da Vinci surgical system; thoracoscope; myasthenia gravis; thymoma; surgery

DOI：

10.7507/1007-4848.202007043

Video：

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Objective To compare the perioperative outcomes of subxiphoid robot-assisted extended thymectomy (SRAET) and video-assisted thoracoscopic extended thymectomy (VATET) for myasthenia gravis complicated with thymoma.Methods Retrospective analysis of 61 patients with myasthenia gravis combined with thymoma who were admitted to the Department of Thoracic Surgery, West China Hospital, Sichuan University from January 2017 to June 2019 was performed. All patients underwent extended thymectomy, and the patients were divided into a SRAET group and a VATET group. There were 26 patients in the SRAET group, including 11 males and 15 females, with an average age of 42.20±13.20 years. There were 35 patients in the VATET group, including 14 males and 21 females, with an average age of 45.00±13.00 years. The perioperative outcomes of the two groups including gender, age, operation time, intraoperative blood loss, conversion rate, postoperative drainage, tube removal time, drainage volume, visual analogue scale, hospital stay and postoperative complications were compared.Results There was no conversion to thoracotomy, death or myasthenia crisis in both groups. The operation time (111.42±28.60 min vs. 103.71±26.20 min, P=0.845), intraoperative blood loss (32.31±23.84 mL vs. 63.57±132.22 mL, P=0.239), visual analogue scale at postoperative 24 h (2.46±0.76 vs. 2.40±0.74, P=0.751) and postoperative 48 h (2.12±0.77 vs. 2.26±0.56, P=0.407), complication rate (3.8% vs. 2.9%, P=0.675), drainage volume (206.85±130.09 mL vs. 276.86±173.46 mL, P=0.089) and hospital stay (5.81±2.52 d vs. 5.29±2.17 d, P=0.642) were not significantly different between the two groups. The visual analogue scale of the SRAET group at postoperative 72 h (1.12±0.65 vs. 1.86±0.91, P=0.001) was significantly lower than that of the VATET group.Conclusion SRAET is a safe and feasible method with less postoperative short-term pain, which is an alternative surgical treatment for myasthenia gravis complicated with thymoma.

Citation： WANG Wei, LI Chuan, LIN Lin, ZHENG E, YUAN Yong, WANG Yun, MEI Jiandong, YANG Mei. Comparison of perioperative outcomes of robotic trans-subxiphoid and video-assisted thoracoscopic extended thymectomy in the treatment of myasthenia gravis complicated with thymoma. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(11): 1287-1291. doi: 10.7507/1007-4848.202007043 Copy

1.	中华医学会神经病学分会神经免疫学组, 中国免疫学会神经免疫学分会. 中国重症肌无力诊断和治疗指南2015. 中华神经科杂志, 2015, 48(11): 934-940.
2.	Kattach H, Anastasiadis K, Cleuziou J, et al. Transsternal thymectomy for myasthenia gravis: Surgical outcome. Ann Thorac Surg, 2006, 81(1): 305-308.
3.	Kamel M, Villena J, Rahouma M, et al. National trends and perioperative outcomes of robotic resection of thymic tumours in the United States: A propensity matching comparison with open and video-assisted thoracoscopic approaches. Eur J Cardiothorac Surg, 2019, 56(4): 762-769.
4.	Agatsuma H, Yoshida K, Yoshino I, et al. Video-assisted thoracic surgery thymectomy versus sternotomy thymectomy in patients with thymoma. Ann Thorac Surg, 2017, 104(3): 1047-1053.
5.	Liu CW, Luo M, Mei JD, et al. Perioperative and long-term outcome of thymectomy for myasthenia gravis: Comparison of surgical approaches and prognostic analysis. Chin Med J, 2013, 126(1): 34-40.
6.	Melfi F, Fanucchi O, Davini F, et al. Ten-year experience of mediastinal robotic surgery in a single referral centre. Eur J Cardiothorac Surg, 2012, 41(4): 847-851.
7.	Keijzers M, de Baets M, Hochstenbag M, et al. Robotic thymectomy in patients with myasthenia gravis: neurological and surgical outcomes. Eur J Cardiothorac Surg, 2015, 48(1): 40-45.
8.	张含露, 刘伦旭, 陈龙奇, 等. 机器人辅助经剑突下胸腺 (扩大)切除手术的临床应用. 中国胸心血管外科临床杂志, 2017, 24(10): 9-13.
9.	Mineo TC, Ambrogi V. Moving around the thymus: More technology, more safety, more efficiency. J Thorac Cardiovasc Surg, 2016, 152(1): 280-281.
10.	Davenport E, Malthaner RA. The role of surgery in the management of thymoma: A systematic review. Ann Thorac Surg, 2008, 86(2): 673-684.
11.	Friedant AJ, Handorf EA, Su S, et al. Minimally invasive versus open thymectomy for thymic malignancies: Systematic review and meta-analysis. J Thorac Oncol, 2016, 11(1): 30-38.
12.	Suda T, Hachimaru A, Tochii D, et al. Video-assisted thoracoscopic thymectomy versus subxiphoid single-port thymectomy: Initial results. Eur J Cardiothoracic Surg, 2015, 49(Suppl 1): i54-i58.
13.	Toker A, Sone J, Zielinski M, et al. Standard terms, definitions, and policies for minimally invasive resection of thymoma. J Thorac Oncol, 2011, 6(7 Suppl 3): S1739-S1742.
14.	Odaka M, Tsukamoto Y, Shibasaki T, et al. Thoracoscopic thymectomy is a feasible and less invasive alternative for the surgical treatment of large thymomas. Interact Cardio Vasc Thorac Surg, 2017, 25(1): 103-108.
15.	Seong YW, Kang CH, Choi JW, et al. Early clinical outcomes of robot-assisted surgery for anterior mediastinal mass: its superiority over a conventional sternotomy approach evaluated by propensity score matching. Eur J Cardiothorac Surg, 2014, 45(3): e68-e73.
16.	Yoshino I, Hashizume M, Shimada M, et al. Thoracoscopic thymomectomy with the da Vinci computer-enhanced surgical system. J Thorac Cardiovasc Surg, 2001, 122(4): 783-785.
17.	Ashrafian H, Clancy O, Grover V, et al. The evolution of robotic surgery: surgical and anaesthetic aspects. Br J Anaesth, 2017, 119(suppl_1): i72-i84.
18.	Rückert JC, Swierzy M, Ismail M. Comparison of robotic and nonrobotic thoracoscopic thymectomy: A cohort study. J Thorac Cardiovasc Surg, 2011, 141(3): 673-677.
19.	Ye B, Li W, Ge XX, et al. Surgical treatment of early-stage thymomas: robot-assisted thoracoscopic surgery versus transsternal thymectomy. Surg Endosc, 2014, 28(1): 122-126.
20.	Ye B, Tantai JC, Ge XX, et al. Surgical techniques for early stage thymoma: video-assisted thoracoscopic thymectomy versus transsternal thymectomy. J Thorac Cardiovasc Surg, 2014, 147(5): 1599-1603.
21.	Şehitogullari A, Nasır A, Anbar R, et al. Comparison of perioperative outcomes of video thoracoscopy and robotic surgical techniques in thymoma. Asian J Surg, 2020, 43(1): 244-250.
22.	Suda T, Tochii D, Tochii S, et al. Trans-subxiphoid robotic thymectomy. Interact Cardiovasc Thorac Surg, 2015, 20(5): 669-671.
23.	Suda T, Kaneda S, Hachimaru A, et al. Thymectomy via a subxiphoid approach: single-port and robot-assisted. J Thorac Dis, 2016, 8(Suppl 3): S265-S271.
24.	Zhang H, Chen L, Zheng Y, et al. Robot-assisted thymectomy via subxiphoid approach: technical details and early outcomes. J Thorac Dis, 2018, 10(3): 1677-1682.

1. 中华医学会神经病学分会神经免疫学组, 中国免疫学会神经免疫学分会. 中国重症肌无力诊断和治疗指南2015. 中华神经科杂志, 2015, 48(11): 934-940.
2. Kattach H, Anastasiadis K, Cleuziou J, et al. Transsternal thymectomy for myasthenia gravis: Surgical outcome. Ann Thorac Surg, 2006, 81(1): 305-308.
3. Kamel M, Villena J, Rahouma M, et al. National trends and perioperative outcomes of robotic resection of thymic tumours in the United States: A propensity matching comparison with open and video-assisted thoracoscopic approaches. Eur J Cardiothorac Surg, 2019, 56(4): 762-769.
4. Agatsuma H, Yoshida K, Yoshino I, et al. Video-assisted thoracic surgery thymectomy versus sternotomy thymectomy in patients with thymoma. Ann Thorac Surg, 2017, 104(3): 1047-1053.
5. Liu CW, Luo M, Mei JD, et al. Perioperative and long-term outcome of thymectomy for myasthenia gravis: Comparison of surgical approaches and prognostic analysis. Chin Med J, 2013, 126(1): 34-40.
6. Melfi F, Fanucchi O, Davini F, et al. Ten-year experience of mediastinal robotic surgery in a single referral centre. Eur J Cardiothorac Surg, 2012, 41(4): 847-851.
7. Keijzers M, de Baets M, Hochstenbag M, et al. Robotic thymectomy in patients with myasthenia gravis: neurological and surgical outcomes. Eur J Cardiothorac Surg, 2015, 48(1): 40-45.
8. 张含露, 刘伦旭, 陈龙奇, 等. 机器人辅助经剑突下胸腺 (扩大)切除手术的临床应用. 中国胸心血管外科临床杂志, 2017, 24(10): 9-13.
9. Mineo TC, Ambrogi V. Moving around the thymus: More technology, more safety, more efficiency. J Thorac Cardiovasc Surg, 2016, 152(1): 280-281.
10. Davenport E, Malthaner RA. The role of surgery in the management of thymoma: A systematic review. Ann Thorac Surg, 2008, 86(2): 673-684.
11. Friedant AJ, Handorf EA, Su S, et al. Minimally invasive versus open thymectomy for thymic malignancies: Systematic review and meta-analysis. J Thorac Oncol, 2016, 11(1): 30-38.
12. Suda T, Hachimaru A, Tochii D, et al. Video-assisted thoracoscopic thymectomy versus subxiphoid single-port thymectomy: Initial results. Eur J Cardiothoracic Surg, 2015, 49(Suppl 1): i54-i58.
13. Toker A, Sone J, Zielinski M, et al. Standard terms, definitions, and policies for minimally invasive resection of thymoma. J Thorac Oncol, 2011, 6(7 Suppl 3): S1739-S1742.
14. Odaka M, Tsukamoto Y, Shibasaki T, et al. Thoracoscopic thymectomy is a feasible and less invasive alternative for the surgical treatment of large thymomas. Interact Cardio Vasc Thorac Surg, 2017, 25(1): 103-108.
15. Seong YW, Kang CH, Choi JW, et al. Early clinical outcomes of robot-assisted surgery for anterior mediastinal mass: its superiority over a conventional sternotomy approach evaluated by propensity score matching. Eur J Cardiothorac Surg, 2014, 45(3): e68-e73.
16. Yoshino I, Hashizume M, Shimada M, et al. Thoracoscopic thymomectomy with the da Vinci computer-enhanced surgical system. J Thorac Cardiovasc Surg, 2001, 122(4): 783-785.
17. Ashrafian H, Clancy O, Grover V, et al. The evolution of robotic surgery: surgical and anaesthetic aspects. Br J Anaesth, 2017, 119(suppl_1): i72-i84.
18. Rückert JC, Swierzy M, Ismail M. Comparison of robotic and nonrobotic thoracoscopic thymectomy: A cohort study. J Thorac Cardiovasc Surg, 2011, 141(3): 673-677.
19. Ye B, Li W, Ge XX, et al. Surgical treatment of early-stage thymomas: robot-assisted thoracoscopic surgery versus transsternal thymectomy. Surg Endosc, 2014, 28(1): 122-126.
20. Ye B, Tantai JC, Ge XX, et al. Surgical techniques for early stage thymoma: video-assisted thoracoscopic thymectomy versus transsternal thymectomy. J Thorac Cardiovasc Surg, 2014, 147(5): 1599-1603.
21. Şehitogullari A, Nasır A, Anbar R, et al. Comparison of perioperative outcomes of video thoracoscopy and robotic surgical techniques in thymoma. Asian J Surg, 2020, 43(1): 244-250.
22. Suda T, Tochii D, Tochii S, et al. Trans-subxiphoid robotic thymectomy. Interact Cardiovasc Thorac Surg, 2015, 20(5): 669-671.
23. Suda T, Kaneda S, Hachimaru A, et al. Thymectomy via a subxiphoid approach: single-port and robot-assisted. J Thorac Dis, 2016, 8(Suppl 3): S265-S271.
24. Zhang H, Chen L, Zheng Y, et al. Robot-assisted thymectomy via subxiphoid approach: technical details and early outcomes. J Thorac Dis, 2018, 10(3): 1677-1682.

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Comparison of perioperative outcomes of robotic trans-subxiphoid and video-assisted thoracoscopic extended thymectomy in the treatment of myasthenia gravis complicated with thymoma

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