Abstrakt Hrudní chirurgie Březen 2010

“Robot-assisted excision of ectopic mediastinal parathyroid adenoma.”

Chan, A. P., I. Y. Wan, et al. (2010).

Asian cardiovascular & thoracic annals 18(1): 65-67.


Robot-assisted excision of an ectopic parathyroid adenoma in the superior mediastinum was performed in a 57-year-old man. The mass was located by methoxyisobutylisonitrile scan and computed tomography. Identification of the ectopic parathyroid adenoma was facilitated by the 3-dimensional images of the da Vinci robotic system, and resection was achieved using EndoWrist instruments. Robot-assisted excision of parathyroid adenoma located in the relatively inaccessible superior mediastinum proved to be feasible.




“Assessment of robotic thymectomy using the Myasthenia Gravis Foundation of America Guidelines.”

Goldstein, S. D. and S. C. Yang (2010).

Annals of Thoracic Surgery 89(4): 1080-1085; discussion 1085-1086.


BACKGROUND: Robotic thymectomy is an emerging treatment for myasthenia gravis. However, the Myasthenia Gravis Foundation of America clinical research standards have been infrequently adopted in the surgical literature. METHODS: Twenty-six patients underwent robotic thymectomy for myasthenia gravis between 2003 and 2008, performed by a single surgeon using the da Vinci system (Intuitive Surgical; Sunnyvale, CA) through a four-port right-sided approach. RESULTS: Mean operative times were 68+/-25 minutes of robotic system activation and 127+/-35 minutes from incision to closure. There were no intraoperative or postoperative mortalities; the most common intraoperative complication was desaturation after single-lung ventilation, for which four procedures were converted to open. On histologic examination, there were five thymomas. The average follow-up after surgery was 26 months. Median preoperative and postoperative Myasthenia Gravis Foundation of America disease classifications were 2 and 0, respectively, reflecting a statistically significant decrease in symptoms (p<0.01). Additionally, the average daily dose of cholinesterase inhibitor decreased by 63% postoperatively. Overall, 82% of patients improved and 18% were unchanged; no worsening disease was observed. CONCLUSIONS: Robotic thymectomy is a safe and efficacious treatment option for myasthenia gravis. There were no notable differences in patient demographics compared with previously published reports of open thymectomies. Furthermore, surgical and neurologic outcomes in this series compare favorably with conventional approaches in the literature. Of those with follow-up greater than 6 months, 82% of patients undergoing robotic thymectomy demonstrated significant clinical improvement postoperatively, indicating that this approach in concert with optimized medical management is an effective treatment for myasthenia gravis.




“Resection of ectopic mediastinal parathyroid glands with the da Vinci robotic system.”

Ismail, M., S. Maza, et al. (2010).

British Journal of Surgery 97(3): 337-343.


BACKGROUND: Mediastinal ectopic parathyroid adenoma is a frequent cause of persistent or recurrent hyperparathyroidism, traditionally treated by open surgery. Thoracoscopic access is associated with reduced morbidity in mediastinal surgery. The aim of this study was to evaluate the feasibility and effectiveness of robot-assisted dissection for mediastinal ectopic parathyroid glands. METHODS: Two patients with recurrent secondary hyperparathyroidism and three with complicated primary hyperparathyroidism were operated on between July 2004 and August 2008 for ectopic mediastinal parathyroid glands. Fusion of single-photon emission computed tomography and computed tomography led to an exact identification of the culprit glands. Surgery was performed thoracoscopically with the da Vinci robotic system using a three-trocar approach. RESULTS: All procedures were completed successfully with the robotic system. No perioperative morbidity or mortality was noted. Median operating time was 58 (range 42-125) min. Intraoperative parathyroid hormone reduction indicated complete resection. Median hospital stay was 3 (range 2-4) days. CONCLUSION: Robot-assisted dissection is a promising approach for resection of ectopic parathyroid glands in remote narrow anatomical locations such as the mediastinum.




“Total port-access robot-assisted pulmonary lobectomy without utility thoracotomy.”

Ninan, M. and M. R. Dylewski 

European Journal of Cardio-thoracic Surgery.


Robot-assisted lobectomy has been reported elsewhere as a feasible technique for lobectomy. We report a modification of the previously reported technique using a complete port-access approach without utility thoracotomy. © 2010 European Association for Cardio-Thoracic Surgery.




“Robot-assisted thoracoscopic thymectomy: perianaesthetic concerns.”

Pandey, R., R. Garg, et al. (2010).

European Journal of Anaesthesiology.


BACKGROUND: Robot-assisted thoracoscopic thymectomy has brought new challenges to the anaesthesiologists. Here we present a study of 17 patients undergoing robotic thymectomy. PATIENTS AND METHODS: The present study was a prospective study, which included 17 patients with myasthenia gravis scheduled for robot-assisted thoracoscopic thymectomy. Preoperatively, all scheduled medications were continued along with incentive spirometry.In the operating room, routine monitors were attached. Radial artery cannula and central venous catheter were inserted. Anaesthesia was induced with fentanyl, propofol and sevoflurane in oxygen and nitrous oxide. The neuromuscular blockade was achieved with atracurium. Airway was secured with double lumen tube. The capnography, entropy, neuromuscular junction and temperature monitoring were initiated. After patient positioning, one-lung ventilation was initiated prior to insertion of trocar. Thereafter, the robot was docked and surgery was started. During the surgical dissection, capnomediastinum was created. At the end of the surgery, double lumen tube was changed to single lumen endotracheal tube size. After extubation in ICU, continuous positive airway pressure of 5 mmHg was administered. RESULTS: Intraoperatively, all patients had transient episodes of arrhythmias and hypotension. The airway pressure increased from 23.7 +/- 2 to 28 +/- 2.7 cmH2O and central venous pressure increased from 12.9 +/- 1 to 19.2 +/- 1.6 mmHg after creation of capnomediastinum. The accidental rent in the right-sided pleura occurred in two patients. Intraoperatively, ventilatory difficulty was encountered in another two patients. One patient had brachial plexus injury. Two patients had hoarseness of voice. SUMMARY: Refinement of the surgical technique is required to avoid compression by robotic arms on any portion of the patient, particularly the upper extremities. The use of beanbag for positioning of the ipsilateral arm needs to be evaluated further. The double lumen tube is to be positioned in such a way as to avoid any obstacle in the movement of robotic arm. We suggest pulse oximeter and arterial blood pressure monitoring in the abducted arm ipsilateral to the surgical approach. The airway pressure and capnography are to be monitored continuously for detection of capnothorax. Patient of robot-assisted thoracoscopic thymectomy should be observed for any nerve injury.