State of the Art of Robotic Thymectomy
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State of the Art of Robotic Thymectomy Mahmoud Ismail • Marc Swierzy • Jens C. Ru¨ckert
Published online: 24 October 2013 Ó Socie´te´ Internationale de Chirurgie 2013
Abstract Background Thymectomy is a widely accepted treatment for most cases of myasthenia gravis and essential for the treatment of thymoma. The development of a minimally invasive procedure for thymectomy resulted in a variety of approaches for surgery on the thymic gland. The use of thoracoscopy-based techniques has continued to increase, including the latest advance in this field, robotic thymectomy. Methods We review the rapid development and actual use of this approach by examining published reports, worldwide registries, and personal communications and by analyzing our database, which is the largest single-center experience and contains 317 thymectomies until 12/2012. The technical modifications of robotic thymectomy are also described. Results Since 2001, approximately 3,500 robotic thymectomies have been registered worldwide. Meanwhile, the results of approximately 500 thymectomy cases have been published. Robotic thymectomy is performed most frequently through a standardized unilateral three-trocar approach. All reports describe promising and satisfactory results for myasthenia gravis. For early-stage thymoma, robotic thymectomy is a technically sound and safe procedure with a very low complication rate and short hospital stay. Oncological outcome without recurrences is promising, but a longer follow-up is needed. Conclusion The unilateral robotic technique can be considered an adequate approach for thymectomy, even with
M. Ismail M. Swierzy J. C. Ru¨ckert (&) Department of General, Visceral, Vascular and Thoracic Surgery, Universita¨tsmedizin Berlin - Charite` Campus Mitte, Charite´platz 1, 10117 Berlin, Germany e-mail: [email protected]
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demanding anatomical configurations. Robotic thymectomy has spread worldwide over the last decade because of the promising results in myasthenia gravis and thymoma patients.
Introduction Complete thymectomy is essential in the complex treatment of myasthenia gravis (MG) [1]. It is required for all patients with thymoma, although for patients requiring thymectomy due to the anatomical distribution of the gland, debate continues regarding the optimal surgical approach [2–4]. Because ectopic thymic tissue can be located at various locations throughout the anterior mediastinum [5], the radicality of thymectomy is crucial for tumor resection and complete remission of MG [6]. Traditionally, thymectomy has been performed through a median sternotomy [7, 8]. While this approach is considered essential for radical thymectomy by many authors [6–8], more than 14 other approaches have been developed [9], including the minimally invasive approach, which decreases morbidity and mortality when compared to open surgery [10]. However, the radicality of hybrid thoracoscopic operations for challenging anatomical configurations remains under discussion. With the improved da Vinci robot technology and its cl
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