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Minimally invasive thymectomy: the Mayo Clinic experience
Phillip G Rowse1, Anja C Roden1, Frank M Corl1
11 Division of General Thoracic Surgery, 2 Department of Laboratory Medicine and Pathology, 3 Department of Medical Illustration/Animation, Mayo Clinic, Rochester, MN, USA.
Background:
The prevalence of minimally invasive thymectomy (MIT) is increasing and may have significant benefit to patients in terms of morbidity and post-operative recovery. Our aim was to review the Mayo Clinic experience of MIT.
Methods:
We reviewed data from all MIT cases collected in a prospectively maintained database from January 1995 to February 2015. Data were collected regarding patient demographics, perioperative management and patient outcomes.
Results:
A total of 510 thymectomies were performed in 20 years. Fifty-six patients underwent MIT (45 video-assisted thoracoscopy, 11 robotic-assisted). The median age was 55 years (range, 23-87 years) with male to female ratio of 25:31. Thymoma was the main pathologic diagnosis in 27/56 patients (48%), with 11/27 (41%) associated with myasthenia gravis (MG), and 16/27 (59%) non-MG. Other pathologies included 1/56 (2%) of each teratoma, lymphoma, lymphangioma, carcinoma and thymolipoma. There were 3/56 (5%) atrophic glands, 4/56 (7%) cysts, 6/56 (11%) benign glands and 11/56 (20%) hyperplastic. Mean blood loss (mL) and operative time (min) were significantly lower in the video-assisted thoracoscopic surgery (VATS) group compared to robotic (65±41 vs. 160±205 mL, P=0.04 and 102±39 vs. 178±53 min, P=0.001, respectively). There was no 30-day mortality. Post-operative morbidity occurred in 7/45 (16%) VATS patients (phrenic nerve palsy 7%, pericarditis 4%, atrial fibrillation 2%, pleural effusion 2%) and 1/11 (9%) robotic (urinary retention requiring self-catheterization). Reoperation was required in 1/3 of VATS patients with phrenic nerve palsy. There was no significant difference in length of hospital stay [VATS 1.5 days (range, 1-4 days) and robotic 2 days (range, 1-5 days) VATS; P=0.05]. Mean follow-up was 18.4 months (range, 1-50.4 months) with no tumor recurrences.
Conclusions:
MIT can be performed with low morbidity and mortality. VATS is associated with reduced blood loss, operative times and earlier hospital discharge compared to robotic MIT.
Insights
Minimally invasive thymectomy (MIT) offers low morbidity and mortality. Video-assisted thoracoscopic surgery (VATS) shows reduced blood loss and operative times compared to robotic approaches for thymectomy.
Area of Science:
- Thoracic Surgery
- Minimally Invasive Procedures
- Oncology
Background:
- Increasing prevalence of minimally invasive thymectomy (MIT).
- MIT offers potential benefits in patient morbidity and recovery.
- Review of Mayo Clinic's MIT experience.
Purpose of the Study:
- To review the Mayo Clinic's experience with minimally invasive thymectomy (MIT).
- To evaluate patient demographics, perioperative management, and outcomes of MIT.
- To compare video-assisted thoracoscopic surgery (VATS) and robotic-assisted MIT.
Main Methods:
- Retrospective review of MIT cases from a prospectively maintained database (1995-2015).
- Data collection included patient demographics, perioperative management, and outcomes.
- Analysis of 56 MIT procedures (45 VATS, 11 robotic).
Main Results:
- Thymoma was the most common diagnosis (48%), often associated with myasthenia gravis (MG).
- Video-assisted thoracoscopic surgery (VATS) demonstrated significantly lower blood loss and operative times than robotic-assisted MIT.
- Low 30-day mortality and comparable hospital stay between VATS and robotic approaches; no tumor recurrences observed.
Conclusions:
- Minimally invasive thymectomy (MIT) can be performed with low morbidity and mortality.
- Video-assisted thoracoscopic surgery (VATS) is associated with improved perioperative outcomes compared to robotic MIT.
- MIT is a safe and effective procedure for thymic pathologies.
