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1.
Medicine (Baltimore) ; 98(51): e18359, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860993

RESUMO

BACKGROUND: The completeness of resection is an important prognostic factor for early resectable thymoma. Since its inception 2 decades ago, median sternotomy has been recognized as the gold standard method for the treatment of all types and stages of thyomas. Minimally invasive surgical techniques, including video-assisted and robot-assisted surgery, have been rapidly developed as an alternative to traditional open approach surgery. Compared with traditional open approach surgery, minimally invasive approach has better cosmetic effect, faster improvement of lung function, reduction of surgical trauma, length of stay, and complications. We believe that this is an appropriate time and there is a need for a systematic, comprehensive, and objective assessment of the 2 surgical modalities in order to provide reliable evidence for clinicians to determine the best treatment for patients with early resectable thymoma. METHODS: Pubmed (Medline), Web of Science, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar will be searched for relevant randomized controlled trials (RCTs), quasi-RCTs, and Hi-Q (high quality) prospective cohort trials published or unpublished in any language before March 1, 2020. Subgroup analysis will be performed in tumor pathological stage and ethnicity. PROSPERO registration number: CRD42019133724. RESULTS: The results of this study will be published in a peer-reviewed journal. CONCLUSION: This study will be the first to assess the efficacy and safety of median sternotomy recognized as the gold standard method for the treatment of all types and stages of thyomas and minimally invasive thymectomy for patients with early-stage thymoma. This study will assess whether minimally invasive thoracoscopic and robotic assisted thymectomy can be used as an alternative to traditional median sternotomy for patients with early resectable thymoma and provide high-quality and reliable evidence for clinicians' decision-making.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos , Esternotomia , Timectomia/métodos , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Humanos , Metanálise como Assunto , Revisão Sistemática como Assunto
2.
J Cardiothorac Surg ; 14(1): 182, 2019 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-31665049

RESUMO

BACKGROUND: The authors presented a 63-year old female synchronously complicated with a thymic tumor located at the left-side of the superior mediastinum, and a paravertebral tumor located at the right-side of the lower thorax. Conventional thoracoscopic surgical procedure using rigid instruments to simultaneously resect the two tumors via the same ports might be technically challenging. To our knowledge, the use of a surgical robot allowed the surgeon to perform precise dissection from extreme angles with the characteristic of articulating surgical instruments. CASE PRESENTATION: Two lesions were successfully dissected using the da Vinci Surgical System through the same four ports on the right side of the chest and two-step docking. Firstly, the patient cart came from the dorsal side of the patient and the paravertebral neoplasm was dissected. Afterwards, the patient cart was undocked and the operation table was rotated 180 degrees counterclockwise. The robot was re-introduced and the patient cart came from the ventral side of the patient and the whole thymus was resected. CONCLUSION: This case report suggests that two-step docking via the same four ports for these two tumors located at different directions of the thorax was safe and effective, demonstrating a clear advantage of the surgical robot.


Assuntos
Cisto Broncogênico/cirurgia , Neoplasias do Mediastino/cirurgia , Neoplasias Primárias Múltiplas/cirurgia , Neurilemoma/cirurgia , Neoplasias do Timo/cirurgia , Cisto Broncogênico/diagnóstico por imagem , Cisto Broncogênico/patologia , Feminino , Humanos , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/patologia , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Primárias Múltiplas/patologia , Neurilemoma/diagnóstico por imagem , Neurilemoma/patologia , Procedimentos Cirúrgicos Robóticos/métodos , Vértebras Torácicas , Toracoscopia/métodos , Timectomia/métodos , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/patologia , Tomografia Computadorizada por Raios X
3.
Magy Seb ; 72(3): 83-97, 2019 Sep.
Artigo em Húngaro | MEDLINE | ID: mdl-31544487

RESUMO

Introduction: Thymectomy became an important part of the treatment of myasthenia gravis, since Alfred Blalock reported about his first surgery 80 years ago. Despite of several different surgical techniques already accepted abroad, sternal approach was the almost exclusive exposure for thymectomy in Hungary till 2006. In this publication, we analyze the direct surgical consequences and complications of this method. Methods: At the Surgical Department of Budai MÁV Hospital, 1002 transsternal thymectomies were performed during 34 years on patients suffering from myasthenia gravis. Surgeries were performed for neurological indications, following careful medical investigations, involving specialists in neurology and internal medicine. In cases associated with thymoma, surgery was indicated for two reasons: removal of the thymus and the tumor at the same time. Neurological indications, patient preparation, perioperative treatment and surgical technique have considerably changed during these 34 years. We interpret the results according to the two eras based on the most frequently applied surgical techniques (simple and extended thymectomy); we publish the data separately of the patients with thymoma and those who underwent repeated surgery, focusing basically on breath-related complications. Results: The patients' age was 32 years on the average (8-73 years). Women/men ratio: 3.5:1. Myasthenia gravis was associated with thymoma in 12.7% of the patients. Repeated thymectomy was necessary in case of 11 patients; further two patients required repeated sternotomy after cardiac surgery. Respiratory failure occurred in 21,3% out of 525 myasthenic patients operated in the first 19-year-old era, emergency re-intubation and tracheostomy happened in 12,8% and in 11,2% as well. In the second 15-year-old period postoperative respiratory failure occurred in 12,7% with emergency re-intubation in 7,1% and tracheostomy only in 1,2% out of 338 myasthenic patients. Respiratory failure occurred in 19.1% out of 126 patients operated for thymoma; re-intubation was necessary in 12.8% of the cases and tracheostomy was performed in 20.6% of the patients. Respiratory failure occurred in 13 patients, who underwent repeated surgery (46.1%); the ratio of re-intubation was 15.4% and that of tracheostomies 46.1%. Serious surgical complications were infrequent also in the entire group of patients: 2 patients required repeated surgery due to sternal bleeding; one more patient underwent repeated surgery due to rupture of the drainage tube, 4 cases of mediastinitis in the first group, two cases of heart injury and one case of sternal disruption occurred in the second period. The overall mortality was 1.4%: 1.3% in the first period, 0.3% in the second period, 4% in the thymoma group and 7.7% after repeated surgeries. Conclusions: In a historical overview, the ratio of serious respiratory and airway complications and the mortality after transsternal thymectomies has considerably decreased, but the postoperative respiratory failure and the surgical risk of transsecting the sternum still pose a real risk.


Assuntos
Miastenia Gravis/cirurgia , Esterno/cirurgia , Timectomia/métodos , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Miastenia Gravis/patologia , Cuidados Pré-Operatórios , Timoma/patologia , Neoplasias do Timo/patologia , Resultado do Tratamento
4.
Medicine (Baltimore) ; 98(23): e15926, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169711

RESUMO

The normal distribution of parathyroid glands is well documented. However, this study aims to evaluate the efficacy of total parathyroidectomy (TPTx) and bilateral cervical thymectomy (BCTx) for the treatment of secondary hyperparathyroidism (SHPT) through identifying the location of parathyroid glands with attention to the pattern and frequency of orthotopic and ectopic glands.Between 2013 and 2018, sixty chronic hemodialysis patients with medically refractory SHPT underwent TPTx & BCTx. The adequacy of the operation was defined by the pathological confirmation of at least 4 parathyroid glands, accompanied by an intact parathormone (iPTH) value of <60 pg/mL on postoperative day 1(POD1). Based on their anatomical localizations, four distinct sites were identified for both the upper (Zone I-IV) and lower parathyroid glands (Zone V-VIII).The mean follow-up was 15.2 ±â€Š14.6 months. The mean iPTH values on POD1 were normal in 50 patients, with an average of 11.7 ±â€Š14.4 pg/mL. Ten patients (16.6%) had persistent HPT after the operation, three of whom underwent complementary parathyroidectomy. The surgical success rates after first and second operations were both 83.3%. A total of 235 parathyroid glands were detected. Ninety-two percent of the upper parathyroids were located in Zones I and II. However, almost 28% of the lower parathyroids were ectopic and located in Zones VII and VIII.At least one fourth of the lower parathyroids are ectopic; for this reason, Zones VII and VIII require careful investigation during surgery. For upper parathyroids not found in Zone I-III, total thyroidectomy on the same side is recommended.


Assuntos
Coristoma/patologia , Hiperparatireoidismo Secundário/cirurgia , Glândulas Paratireoides/patologia , Paratireoidectomia/métodos , Timectomia/métodos , Adulto , Idoso , Feminino , Humanos , Hiperparatireoidismo Secundário/patologia , Hiperparatireoidismo Secundário/fisiopatologia , Masculino , Pessoa de Meia-Idade , Pescoço , Glândulas Paratireoides/fisiopatologia , Período Pós-Operatório , Adulto Jovem
5.
Pediatr Surg Int ; 35(7): 749-757, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31119357

RESUMO

BACKGROUND: Thymectomy in pediatric patients is an effective treatment for myasthenia gravis (MG), thymic neoplasms, and other rarer pathologies. It is an uncommon procedure in children and studies have focused on small, single-institution cohorts. We sought to better characterize its use by utilizing a national database. METHODS: The Kids' Inpatient Database was used to identify hospital discharge records of patients ≤ 20 years old who underwent thymectomy. A retrospective cross-sectional analysis for 2003, 2006, 2009, and 2012 was performed. Trends in patient characteristics, diagnosis, surgical approach, and short-term outcomes were analyzed. Risk factors were identified using univariate and multivariate analyses. RESULTS: There were 600 thymectomies identified. MG was the most common indication. Thoracoscopy is being used increasingly for all diagnoses except malignancy. The overall morbidity rate was 14.0%, with respiratory complications representing the largest group. No in-hospital deaths were identified. Private insurance was associated with shorter hospital stays and lower costs. Hispanic race was associated with more complications, longer stays, and higher costs. Thoracoscopic thymectomies had shorter stays than open procedures. CONCLUSION: Thymectomy in the pediatric population is being performed safely, with low morbidity and no identified mortalities. Thoracoscopy results in reduced length of stay and is being used increasingly. Of note, socioeconomic and racial factors impact outcomes.


Assuntos
Miastenia Gravis/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Timectomia/métodos , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Adolescente , Criança , Estudos Transversais , Feminino , Humanos , Tempo de Internação/tendências , Masculino , Estudos Retrospectivos , Resultado do Tratamento
6.
Khirurgiia (Mosk) ; (3): 84-87, 2019.
Artigo em Russo | MEDLINE | ID: mdl-30938362

RESUMO

The experience of video-assisted thoracoscopic interventions for thymus tumors in the Research Institute of Oncology of Tomsk National Research Medical Center is presented. We also evaluate the features of postoperative management of these patients.


Assuntos
Cirurgia Torácica Vídeoassistida/métodos , Timectomia/métodos , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Humanos , Cuidados Pós-Operatórios , Resultado do Tratamento
7.
Thorac Surg Clin ; 29(2): 159-164, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30927997

RESUMO

The effectiveness of thymectomy for nonthymomatous myasthenia gravis is analyzed with regard to extensiveness of removal of the adipose tissue of the mediastinum and the lower neck region with various techniques of thymectomy. The approach necessary to achieve maximal radicality must include access to both pleural cavity and the lower neck area up to the thyroid gland. Surgical techniques include extended transsternal approach, which might be combined with separate transcervical incision, bilateral videothoracoscopic (VATS) approach combined with transcervical incision, and extended subxiphoid approach, either uniportal or combined with bilateral VATS. Anatomic aspects of maximally extensive thymectomy are described in detail.


Assuntos
Miastenia Gravis/cirurgia , Timectomia , Tecido Adiposo/cirurgia , Humanos , Cirurgia Torácica Vídeoassistida , Timectomia/métodos , Timo/anatomia & histologia , Timo/cirurgia
8.
Thorac Surg Clin ; 29(2): 165-175, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30927998

RESUMO

We describe the various video-assisted thoracic surgery approaches to the thymus currently adopted in nonthymomatous and thymomatous myasthenic patients. Despite several controversies, video-assisted thoracic surgery thymectomy gained worldwide popularity. Classic 3-port approaches proved safe and effective. Uniportal video-assisted thoracic surgery requires consolidated experience, whereas the bilateral approach is considered more extensive. Subxiphoid represents the ultimate and exciting challenge. As an effect of video-assisted thoracic surgery approach, thymectomy is performed earlier; both patients and neurologists are more prone to accept the procedure given the quicker recovery, lesser pain, and better cosmesis. Outcomes are equivalent to those achieved by sternotomy.


Assuntos
Miastenia Gravis/cirurgia , Cirurgia Torácica Vídeoassistida , Timectomia/métodos , Humanos , Posicionamento do Paciente , Seleção de Pacientes , Cuidados Pós-Operatórios
9.
Thorac Surg Clin ; 29(2): 177-186, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30927999

RESUMO

Robotic-assisted thoracoscopic surgery (RATS) creates an extended approach for thymectomy in terms of locating contralateral phrenic nerve and upper poles of the thymus. RATS thymectomy is indicated in all non-thymomatous myasthenia gravis (MG) patients and thymomatous MG patients with resectable thymoma, typically Masaoka-Koga I and II. Left-sided RATS thymectomy is superior for anatomic reasons and in the special care patients with MG. Up to now, left-sided three-trocar RATS thymectomy is the perfect combination of radical resection and minimal invasiveness among various approaches for thymectomy.


Assuntos
Miastenia Gravis/cirurgia , Procedimentos Cirúrgicos Robóticos , Timectomia/métodos , Humanos , Obesidade/complicações , Posicionamento do Paciente , Reoperação
10.
Thorac Surg Clin ; 29(2): 187-194, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30928000

RESUMO

Surgery has proven superiority over medical management for patients with nonthymomatous myasthenia gravis. The key is complete resection of the gland, which can be achieved with various techniques. The uniportal video-assisted transcervical technique allows minimally invasive surgery with a low complication rate, a good cosmetic result, and a short length of recovery.


Assuntos
Miastenia Gravis/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Timectomia/métodos , Humanos , Seleção de Pacientes
11.
Thorac Surg Clin ; 29(2): 195-202, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30928001

RESUMO

Kido and colleagues in 1999 used for the first time the subxiphoid approach. Recently, video-assisted thoracoscopic surgery (VATS) thymectomy has been improved for the advancement of surgical materials and new instruments. The most important aspect regarding the subxiphoid approach is the possibility to avoid the intercostal nerve damage with the consequence of a decreased use of postoperative analgesics, quite short surgical duration, fast discharge from hospital and a guarantee of successful cosmetics results.


Assuntos
Miastenia Gravis/cirurgia , Timectomia/métodos , Humanos , Posicionamento do Paciente , Cuidados Pré-Operatórios , Cirurgia Torácica Vídeoassistida/métodos
12.
Ann Thorac Surg ; 108(2): 405-411, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30953650

RESUMO

BACKGROUND: Minimally invasive thymectomy (MIT) has demonstrated improved short-term outcomes compared with open thymectomy (OT). Although adoption of MIT for thymoma is increasing, oncologic outcomes have not been well characterized. METHODS: This was a retrospective cohort study of adult patients from the National Cancer Database who underwent MIT or OT for Masaoka stage I to II thymoma between 2010 and 2014. The primary outcome was R0 resection. Secondary outcomes included MIT use, perioperative mortality, and length of stay. RESULTS: Nine hundred forty-three patients from 395 hospitals underwent thymectomy for stage I to II thymoma. MIT was performed in 31.3% (59.7% robotic, 40.3% thoracoscopic). Over the study period MIT utilization increased from 21.0% to 40.2% (trend test, p < 0.001). R0 resection was achieved in 83.1% of MITs (86.6% stage I, 72.7% stage II) and 79% of OTs (85.5% stage I, 65.8% stage II). In multivariable analyses, the likelihood of incomplete resection (R1/2) was associated with stage II tumors (odds ratio, 2.51) and World Health Organization B3 histology (odds ratio, 3.66). R0 resection was not associated with surgical approach (p = 0.17) and did not vary with tumor size (trend test, p = 0.90). Mortality rates at 30 and 90 days were 0% and 0.5%, respectively. MIT was associated with significantly shorter lengths of stay than OT (-1.03 days [95% confidence interval, -1.68 to -0.38]). CONCLUSIONS: The use of MIT for resection of early-stage thymoma is increasing and is not associated with lower rates of R0 resection than OT. Reasons for the relatively low rates of R0 resection among all thymectomies requires further investigation, and long-term outcomes data are needed to better define the oncologic effectiveness of MIT.


Assuntos
Margens de Excisão , Estadiamento de Neoplasias/métodos , Robótica/métodos , Timectomia/métodos , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Timoma/diagnóstico , Timoma/mortalidade , Neoplasias do Timo/diagnóstico , Neoplasias do Timo/mortalidade , Estados Unidos/epidemiologia , Adulto Jovem
13.
Allergol. immunopatol ; 47(2): 141-151, mar.-abr. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-180802

RESUMO

Background: The del22q11 syndrome patients present immunological abnormalities associated to thymus alterations. Up to 75% of them present cardiopathies and thymus is frequently removed during surgery. The thymectomy per se has a deleterious effect concerning lymphocyte subpopulations, and T cell function. When compared to healthy controls, these patients have higher infections propensity of variable severity. The factors behind these variations are unknown. We compared immunological profiles of del22q11.2 Syndrome patients with and without thymectomy to establish its effect in the immune profile. Methods: Forty-six del22q11.2 syndrome patients from 1 to 16 years old, 19 of them with partial or total thymectomy were included. Heart disease type, heart surgery, infections events and thymus resection were identified. Immunoglobulin levels, flow cytometry for lymphocytes subpopulations and TREC levels were determined, and statistical analyses were performed. Results: The thymectomy group had a lower lymphocyte index, both regarding total cell count and when comparing age-adjusted Z scores. Also, CD3+, CD4+ and CD8+ lower levels were observed in this group, the lowest count in those patients who had undergone thymus resection during the first year of life. Their TREC level median was 23.6/μL vs 16.1 miL in the non-thymus group (p = 0.22). No differences were identified regarding immunoglobulin levels or infection events frequencies over the previous year. Conclusion: Patients with del22q11.2 syndrome subjected to thymus resection present lower lymphocyte and TREC indexes when compared to patients without thymectomy. This situation may be influenced by the age at the surgery and the time elapsed since the procedure


No disponible


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Linfócitos T/fisiologia , Subpopulações de Linfócitos T/fisiologia , Timectomia/métodos , Timo/cirurgia , Cromossomos Humanos Par 22/imunologia , Deleção Cromossômica , Citometria de Fluxo , Receptores de Antígenos de Linfócitos T/genética
14.
Ann Thorac Surg ; 108(3): 912-919, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30885848

RESUMO

BACKGROUND: Data are limited on the safety and efficacy of robotic thymectomy in patients with myasthenia gravis (MG) older than 60 years at onset. METHODS: Patients older than 60 years at MG onset who underwent robotic thymectomy in Charite Universitaetsmedizin Berlin between 2003 and 2017 were potentially eligible for inclusion. The main outcomes were perioperative complications and clinical outcome according to the Myasthenia Gravis Foundation of America Post-Intervention Status. RESULTS: Sixty-eight (25 women, 43 men) of 580 patients with MG who underwent robotic thymectomy were eligible for perioperative analyses (median age at MG onset 67 years, range: 61 to 85 years). The perioperative morbidity rate was 13.2%, and the only perioperative death was due to aortic dissection. Fifty-one patients were available for further analysis with a median follow-up time of 60 months (range: 12 to 263 months). The complete stable remission rate was 7.8%, the improvement rate was 68.6%, and the overall mortality rate was 11.8%. Compared with preoperative use, the mean daily dose of corticosteroid agents was significantly reduced at the last follow-up (17.6 ± 23.6 mg versus 2.6 ± 6.1 mg, p = 0.0001) without increased use of azathioprine (35.9 ± 61.9 mg versus 42.7 ± 59 mg, p = 0.427). After excluding 2 patients seronegative for the anti-acetylcholine receptor antibody, 10 of 49 seropositive patients achieved "good outcome" (including four complete stable remissions, three pharmacologic remissions, and three minimal manifestations 0) which was predicted by being free of concomitant disease (odds ratio 7.307, 95% confidence interval: 1.188 to 44.937, p = 0.032) and Myasthenia Gravis Foundation of America classification I before thymectomy (odds ratio 6.696, 95% confidence interval: 1.259 to 35.620, p = 0.026). CONCLUSIONS: Robotic thymectomy seems to be safe and effective in patients with MG older than 60 years at onset with a statistically significant steroid-sparing effect.


Assuntos
Miastenia Gravis/cirurgia , Segurança do Paciente , Procedimentos Cirúrgicos Robóticos/métodos , Timectomia/métodos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Bases de Dados Factuais , Feminino , Avaliação Geriátrica , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Miastenia Gravis/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Prognóstico , Estudos Retrospectivos , Medição de Risco , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Índice de Gravidade de Doença , Fatores Sexuais , Timectomia/efeitos adversos , Resultado do Tratamento , Reino Unido
15.
Pediatr Surg Int ; 35(5): 603-610, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30729982

RESUMO

PURPOSE: A randomized controlled trial of thymectomy in myasthenia gravis demonstrated improved clinical outcomes in adults, but data surrounding juvenile cases, especially those treated with minimally invasive approaches, are limited. Here, we review our experience with thoracoscopic thymectomy for juvenile myasthenia gravis (JMG) in the largest cohort to date. METHODS: All cases of thymectomy for JMG in a single tertiary referral center between 2007 and 2018 were reviewed (N = 50). Patients underwent left thoracoscopic approach with extended dissection and without use of monopolar energy. Demographics, diagnostic criteria, and clinical classification, as well as surgical data were collected. Clinical status and medications were reviewed in follow-up. RESULTS: The mean age at surgery was 10.5 ± 0.8 years. Ocular disease and generalized disease each comprised half of the cohort. No patients suffered complications or increased risk of morbidity or mortality with thymectomy. At any interval of follow-up through 3.5 years, 49.8% of patients were improved compared to their pre-operative presentation, and there was a significant trend towards decreased steroid use. CONCLUSION: Thoracoscopic thymectomy is a safe treatment for juvenile myasthenia gravis in pediatric patients over a wide range of ages, body masses, and symptoms. Our experience adds evidence that pediatric patients likely benefit from thymectomy with improved clinical status and reduced medications.


Assuntos
Miastenia Gravis/cirurgia , Toracoscopia/métodos , Timectomia/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Tempo de Internação , Masculino , Estudos Retrospectivos , Centros de Atenção Terciária , Resultado do Tratamento
16.
Semin Thorac Cardiovasc Surg ; 31(3): 614-619, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30796955

RESUMO

Compared to the intercostal approach, subxiphoid uniportal video-assisted thoracoscopic surgery (VATS) is considered to be less invasive as it may cause minimal postoperative pain. Besides, it provides an excellent view of the bilateral pleural cavities. In this paper, we describe our technique and overview a 2-year experience results in this approach for the surgical treatment of anterior mediastinal and pulmonary lesions. In a retrospective study of data collected prospectively between October 2014 and December 2016, 38 patients underwent surgery for an anterior mediastinal tumor or myasthenia gravis at our institution. Intraoperative factors like duration of operation and amount of blood loss were analyzed as well as postoperative ones, including duration of chest drains, amount of postoperative fluid drainage, and length of hospital stay. The median age of patients was 59 years (36-80 years) with 19 females (50%). Overall, 28 patients (74%) underwent extended thymectomy. Seven patients (19%) experienced a combined lung resection and extended thymectomy, 3 (7%) a resection of pericardial (2) or bronchogenic (1) cysts. The median diameter of the lesions was 2.93 cm (1.2-7.7 cm). Postoperatively, 30-day mortality was 0%. Subxiphoid uniportal VATS is a convenient approach for minimally invasive mediastinal surgery. The excellent exposure of the anterior mediastinum and the possibility of conducting complex procedures, such as extended thymectomies and combined mediastinal and pulmonary resections with good results of minimal morbidity, represent the strong points of this technique. Thoracic surgeons experienced in VATS can safely perform subxiphoid uniportal VATS for mediastinal surgery.


Assuntos
Miastenia Gravis/cirurgia , Pneumonectomia/métodos , Neoplasias Torácicas/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Timectomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Miastenia Gravis/diagnóstico , Duração da Cirurgia , Pneumonectomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Neoplasias Torácicas/diagnóstico por imagem , Neoplasias Torácicas/patologia , Cirurgia Torácica Vídeoassistida/efeitos adversos , Timectomia/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
17.
Int J Surg ; 67: 13-17, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30677529

RESUMO

BACKGROUND: Thymectomy is increasingly being performed via minimally invasive approaches. The present study aimed to assess the safety and feasibility of the subxiphoid approach to video-assisted thoracic surgery (VATS) compared with the lateral intercostal approach VATS. METHODS: Patients who underwent VATS thymectomy via subxiphoid and lateral intercostal approaches in our hospital between 2015 and 2018 were retrospectively analyzed. A series of perioperative outcomes, including clinical and surgical results, postoperative pain scores and cosmetic results, was compared in a propensity score matching analysis. RESULTS: A total of 98 patients diagnosed with non-myasthenic early-stage thymoma underwent complete thymectomy by VATS. Propensity score analysis revealed that 28 patients treated with the subxiphoid approach and 28 patients treated with the lateral intercostal approach had the same baseline characteristics. Compared with those in the lateral intercostal approach group, patients in the subxiphoidapproach group yielded lower pain scores and shorter postoperative hospital stays. Other advantages of the subxiphoid approach included decreased inflammatory cytokine response and superior cosmesis. There were no significant differences in postoperative complications between the two groups. All these patients recovered well when discharged. There were no perioperative deaths. CONCLUSIONS: Our data suggest that subxiphoid and subcostal arch thoracoscopic radical thymectomy is a less invasive procedure for the treatment of non-myasthenic early-stage thymoma and provides a satisfactory cosmetic effect. Owing to the limitation ofour retrospective study, further prospective studies are needed to evaluate long-term and oncologic outcomes of subxiphoid approach VATS thymectomy.


Assuntos
Músculos Intercostais/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Timectomia/métodos , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Estudos de Viabilidade , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Pontuação de Propensão , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida/efeitos adversos , Timectomia/efeitos adversos , Resultado do Tratamento , Adulto Jovem
18.
Ann Thorac Surg ; 107(5): e369-e370, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30610853

RESUMO

The transsubxiphoid thoracoscopic approach is an ideal method for thoracoscopic thymectomy. This report introduces a simple method to establish the subxiphoid approach. The surgeon made an incision and inserted a homemade gasbag into the retrosternal space. The gasbag was inflated with 600 to 800 mL of air. The inflated gasbag was maintained for 5 minutes and removed. This technique was performed in 20 cases. This method provides the surgeon with a good field of view, rare thoracoscope contamination, and a smoother surgical procedure. Therefore, the method described in this study is a powerful option to establish the subxiphoid approach during thoracoscopic thymectomy.


Assuntos
Toracoscopia/métodos , Timectomia/métodos , Humanos , Estudos Retrospectivos , Toracoscopia/instrumentação , Timectomia/instrumentação , Processo Xifoide
19.
Ann Thorac Surg ; 107(3): 878-884, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30336118

RESUMO

BACKGROUND: Phrenic nerve infiltration has been described in as many as 33% of advanced thymomas; en bloc resection causes diaphragmatic loss of function, with detrimental effects on pulmonary function. We report the outcomes of selected patients operated on for invasive thymoma with a nerve-sparing technique. METHODS: From 1990 to 2015 we used nerve-sparing surgery with the intention to treat all patients with advanced stage thymomas without preoperative evidence of hemidiaphragmatic palsy, but with macroscopic evidence of phrenic nerve involvement. All patients underwent adjuvant radiotherapy (45 to 60 Gy) with or without chemotherapy. Long-term outcomes and the pattern of recurrence were retrospectively analyzed. RESULTS: Among 140 patients with stage III and IVa operated on during the study period, 19 women and 18 men with a median age of 52 years received a nerve-sparing resection. Myasthenia gravis was associated in 25 cases. In 12 patients, phrenic palsy was observed postoperatively, and eventually 4 of them recovered. Recurrence was found in 10 patients (7 stage IVa, 3 stage III) requiring additional therapies. Three patients died of cancer-related causes, with an overall survival of 265.4 months and a disease-free survival of 233.2 months. CONCLUSIONS: Phrenic nerve preservation in cases of invasive thymomas is feasible and may warrant an acceptable local control of disease, if associated with radiotherapy. According to these results, this technique could be proposed to all patients with invasive thymoma, especially in those affected by severe comorbidities or with a poor performance status.


Assuntos
Previsões , Estadiamento de Neoplasias , Nervo Frênico/cirurgia , Paralisia Respiratória/prevenção & controle , Timectomia/métodos , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Timoma/diagnóstico , Neoplasias do Timo/diagnóstico , Resultado do Tratamento
20.
Ann Thorac Surg ; 107(6): e415-e416, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30444992

RESUMO

Postoperative chylothorax is a rare but potentially life-threatening complication. Conservative treatment is usually unsuccessful in patients with high-output chylothorax, for whom early surgical thoracic duct ligation has been advocated to minimize morbidity and mortality. This report describes left uniportal thoracoscopic closure of persistent high-output chylothorax through Poirier's triangle in a patient undergoing thoracoscopic thymectomy. After resection of pleural adhesions, the mediastinal pleura was resected at the level of the aortic arch, left subclavian artery, and vertebral column, the anatomic limits of Poirier's triangle. The thoracic duct was then isolated from the esophagus and successfully clipped along its path.


Assuntos
Quilotórax/cirurgia , Complicações Pós-Operatórias/cirurgia , Ducto Torácico/cirurgia , Toracoscopia , Timectomia/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Toracoscopia/métodos
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