Abstrakt Hrudní chirurgie Květen 2010

“Thoracoscopic robot-assisted extended thymectomy in the human cadaver.”

Ishikawa, N., Y. S. Sun, et al. (2010).

Surgical Endoscopy and Other Interventional Techniques 24(4): 965-967.


Methods Thoracoscopic robot-assisted extended thymectomy was performed in a human cadaver. The technique utilized the da VinciTM surgical system inserted through the subxiphoid approach with the sternum lifted upward (anteriorly). A small subxiphoid incision and two additional thoracoports were made in the chest wall, and the sternum was lifted by a new lifting retractor system. Results This method provided sufficient view and working space in the anterior mediastinum. A complete thymectomy was performed with facility. The robotic system provides superior optics and allows for enhanced dexterity. Conclusions Minimally invasive robotic-assisted thymectomy is an effective procedure and may add benefits for both surgeon and patients.




“Differences in postoperative outcomes, function, and cosmesis: open versus robotic thyroidectomy.”

Lee, J., K. Y. Nah, et al. (2010).

Surgical Endoscopy.


BACKGROUND: Robotic thyroidectomy using a gasless transaxillary approach, first described in 2008, has become popular. This study compared outcomes, including postoperative distress and patient satisfaction, for patients undergoing robotic thyroidectomy with those for patients treated by conventional open thyroidectomy. METHODS: Of 84 prospectively enrolled patients, 41 underwent robotic thyroidectomy (the robot group), and 43 received conventional open thyroidectomy (the open group). All the patients were followed up for at least 3 months after surgery. Videolaryngostroboscopic examinations were performed preoperatively and after 1 week and after 3 months postoperatively. Postoperative pain and discomfort were evaluated using a symptom scale. Subjective voice and swallowing changes were assessed by questionnaires; and satisfaction with cosmetic outcome was measured by verbal response at 3 months. RESULTS: The two groups were similar in age, gender, type of operation, and final pathologic diagnosis. Although the mean operating time was significantly longer with the robotic technique than with open surgery, there were no between-group differences in postoperative pain or duration of hospital stay. No patient in either group experienced any major postoperative complication. Postoperative discomfort in the neck and swallowing disturbances were significantly more frequent in the open group than in the robot group, both at 1 week and at 3 months after surgery. However, there was no significant between-group difference in subjective voice parameters. At 3 months, the mean cosmetic satisfaction score was significantly higher in the robotic than in the open group. CONCLUSION: Although postoperative pain levels and complications were comparable in the two groups, conventional open thyroidectomy requires a shorter operative time. The robotic technique, however, offers several distinct advantages including very good to excellent cosmetic results, reduced postoperative neck discomfort, and fewer adverse swallowing symptoms.




“Extended Transcervical Thymectomy: The Ultimate Minimally Invasive Approach.”

Shrager, J. B. (2010).

Annals of Thoracic Surgery 89(6).


The ideal operative technique for thymectomy in myasthenia gravis remains controversial. Most surgeons perform thymectomy through median sternotomy; more recently, thoracoscopic and robotic approaches have been described. “Extended transcervical thymectomy” is an out-patient procedure that appears less morbid and costly than other approaches. It allows a complete extracapsular thymic resection. Kaplan-Meier complete stable remission rates after transcervical thymectomy are 33% and 35% at 3 and 6 years (higher including patients remaining on single-drug immunosuppression). The major surgical complication rate is 0.7%. We believe that this less morbid and less costly operation is a very reasonable choice in the surgical treatment of myasthenia gravis. © 2010 The Society of Thoracic Surgeons.




“Robotic Surgery of the Mediastinum.”

Weissenbacher, A. and J. Bodner (2010).

Thoracic Surgery Clinics 20(2): 331-339.


Several different mediastinal procedures for benign and malignant diseases have been proved to be feasible and safe when performed by a robotic minimally invasive approach. This article reviews the published data on robotic mediastinal surgery, focusing on technical aspects and perioperative outcomes. These are evaluated for differences and potential benefits over open and conventional minimally invasive techniques. Is there a need for the robot in the mediastinum? Is its application justified?




“Comparison of open and minimally invasive thymectomies at a single institution.”

Youssef, S. J., B. E. Louie, et al. (2010).

American Journal of Surgery 199(5): 589-593.


Background: Most thymectomies are performed via sternotomy. Minimally invasive thymectomy (MIT) has been described but its potential benefits and drawbacks remain unclear. Methods: A retrospective chart review comparing thymectomies performed via sternotomy to MIT at a single institution between 2005 and 2009. Results: Eight patients underwent MIT and 8 patients underwent sternotomy in the management of myasthenia gravis, thymic hyperplasia, or small thymic tumors. There was 1 perioperative death unrelated to the surgical procedure and no morbidity. The surgical time, estimated blood loss, and chest tube output was similar in both groups. The average hospital stay for MIT was 2.4 days compared with 4.3 days for sternotomy. One MIT patient remained on narcotic pain medication 2 weeks after surgery compared with 6 in the open group. Conclusions: MIT can be performed with similar morbidity and efficacy as transsternal thymectomy. Patients require fewer narcotics and can be discharged earlier. © 2010 Elsevier Inc. All rights reserved.