Robotic vs. Transsternal Thymectomy: A Single Center Experience over 10 Years

Introduction: Thymomas are the most common tumors of the mediastinum. Traditionally, thymectomies have been performed through a transsternal (TS) approach. With the development of robot-assisted thoracic surgery (RATS), a promising, minimally invasive, alternative surgical technique for performing a...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Luis Filipe Azenha, Robin Deckarm, Fabrizio Minervini, Patrick Dorn, Jon Lutz, Gregor Jan Kocher
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	RATS robotic thymectomy anterior mediastinal tumor resection Medicine R
Acceso en línea:	https://doaj.org/article/e41e0727af6146389eecacb0bc1eee5a
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:e41e0727af6146389eecacb0bc1eee5a
record_format	dspace
spelling	oai:doaj.org-article:e41e0727af6146389eecacb0bc1eee5a2021-11-11T17:37:17ZRobotic vs. Transsternal Thymectomy: A Single Center Experience over 10 Years10.3390/jcm102149912077-0383https://doaj.org/article/e41e0727af6146389eecacb0bc1eee5a2021-10-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/21/4991https://doaj.org/toc/2077-0383Introduction: Thymomas are the most common tumors of the mediastinum. Traditionally, thymectomies have been performed through a transsternal (TS) approach. With the development of robot-assisted thoracic surgery (RATS), a promising, minimally invasive, alternative surgical technique for performing a thymectomy has been developed. In the current paper, the oncological and surgical outcomes of the TS vs. RATS thymectomies are discussed. Methods: For the RATS thymectomy, two 8 mm working ports and one 12 mm camera port were used. In the transsternal approach, we performed a median sternotomy and resected the thymic tissue completely, in some cases en bloc with part of the lung and/or, more frequently, a partial pericardiectomy with consequent reconstruction using a bovine pericardial patch. The decisions for using the TS vs. RATS methods were mainly based on the suspected tumor invasion of the surrounding structures on the preoperative CT scan and tumor size. Results: Between January 2010 and November 2020, 149 patients were submitted for an anterior mediastinal tumor resection at our institution. A total of 104 patients met the inclusion criteria. One procedure was performed through a hemi-clamshell incision. A total of 81 (78%) patients underwent RATS procedures, and 22 (21.1%) patients were treated using a transsternal (TS) tumor resection. Thymoma was diagnosed in 53 (51%) cases. In the RATS group, the median LOS was 3.2 ± 2.8 days and the median tumor size was 4.4 ± 2.37 cm compared to the TS group, which had a median LOS of 9 ± 7.3 days and a median tumor size of 10.4 ± 5.3 cm. Both differences were statistically significant (<i>p</i> < 0.001). Complete resection was achieved in all patients. Conclusion: While larger and infiltrating tumors (i.e., thymic carcinomas) were usually resected via a sternotomy, the RATS procedure is a good alternative for the resection of thymomas of up to 9.5 cm, and the thymectomy is a strong approach for myasthenia gravis. The oncological outcomes and survival rates were not influenced by the chosen approach.Luis Filipe AzenhaRobin DeckarmFabrizio MinerviniPatrick DornJon LutzGregor Jan KocherMDPI AGarticleRATSroboticthymectomyanterior mediastinal tumor resectionMedicineRENJournal of Clinical Medicine, Vol 10, Iss 4991, p 4991 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	RATS robotic thymectomy anterior mediastinal tumor resection Medicine R
spellingShingle	RATS robotic thymectomy anterior mediastinal tumor resection Medicine R Luis Filipe Azenha Robin Deckarm Fabrizio Minervini Patrick Dorn Jon Lutz Gregor Jan Kocher Robotic vs. Transsternal Thymectomy: A Single Center Experience over 10 Years
description	Introduction: Thymomas are the most common tumors of the mediastinum. Traditionally, thymectomies have been performed through a transsternal (TS) approach. With the development of robot-assisted thoracic surgery (RATS), a promising, minimally invasive, alternative surgical technique for performing a thymectomy has been developed. In the current paper, the oncological and surgical outcomes of the TS vs. RATS thymectomies are discussed. Methods: For the RATS thymectomy, two 8 mm working ports and one 12 mm camera port were used. In the transsternal approach, we performed a median sternotomy and resected the thymic tissue completely, in some cases en bloc with part of the lung and/or, more frequently, a partial pericardiectomy with consequent reconstruction using a bovine pericardial patch. The decisions for using the TS vs. RATS methods were mainly based on the suspected tumor invasion of the surrounding structures on the preoperative CT scan and tumor size. Results: Between January 2010 and November 2020, 149 patients were submitted for an anterior mediastinal tumor resection at our institution. A total of 104 patients met the inclusion criteria. One procedure was performed through a hemi-clamshell incision. A total of 81 (78%) patients underwent RATS procedures, and 22 (21.1%) patients were treated using a transsternal (TS) tumor resection. Thymoma was diagnosed in 53 (51%) cases. In the RATS group, the median LOS was 3.2 ± 2.8 days and the median tumor size was 4.4 ± 2.37 cm compared to the TS group, which had a median LOS of 9 ± 7.3 days and a median tumor size of 10.4 ± 5.3 cm. Both differences were statistically significant (<i>p</i> < 0.001). Complete resection was achieved in all patients. Conclusion: While larger and infiltrating tumors (i.e., thymic carcinomas) were usually resected via a sternotomy, the RATS procedure is a good alternative for the resection of thymomas of up to 9.5 cm, and the thymectomy is a strong approach for myasthenia gravis. The oncological outcomes and survival rates were not influenced by the chosen approach.
format	article
author	Luis Filipe Azenha Robin Deckarm Fabrizio Minervini Patrick Dorn Jon Lutz Gregor Jan Kocher
author_facet	Luis Filipe Azenha Robin Deckarm Fabrizio Minervini Patrick Dorn Jon Lutz Gregor Jan Kocher
author_sort	Luis Filipe Azenha
title	Robotic vs. Transsternal Thymectomy: A Single Center Experience over 10 Years
title_short	Robotic vs. Transsternal Thymectomy: A Single Center Experience over 10 Years
title_full	Robotic vs. Transsternal Thymectomy: A Single Center Experience over 10 Years
title_fullStr	Robotic vs. Transsternal Thymectomy: A Single Center Experience over 10 Years
title_full_unstemmed	Robotic vs. Transsternal Thymectomy: A Single Center Experience over 10 Years
title_sort	robotic vs. transsternal thymectomy: a single center experience over 10 years
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/e41e0727af6146389eecacb0bc1eee5a
work_keys_str_mv	AT luisfilipeazenha roboticvstranssternalthymectomyasinglecenterexperienceover10years AT robindeckarm roboticvstranssternalthymectomyasinglecenterexperienceover10years AT fabriziominervini roboticvstranssternalthymectomyasinglecenterexperienceover10years AT patrickdorn roboticvstranssternalthymectomyasinglecenterexperienceover10years AT jonlutz roboticvstranssternalthymectomyasinglecenterexperienceover10years AT gregorjankocher roboticvstranssternalthymectomyasinglecenterexperienceover10years
_version_	1718432093168467968

Robotic vs. Transsternal Thymectomy: A Single Center Experience over 10 Years

Ejemplares similares