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Subxiphoid robotic extended thymectomy - The first Indian report.
Belal Bin Asaf1, Harsh Vardhan Puri1, Sukhram Bishnoi1
1Centre for Chest Surgery, Institute of Robotic Surgery, Sir Ganga Ram Hospital, New Delhi, India.
Journal of Minimal Access Surgery
|April 30, 2019
Summary
Subxiphoid robotic thymectomy (SRT) offers a safe and effective minimally invasive approach for myasthenia gravis and thymoma, providing excellent visualization of phrenic nerves. This technique demonstrates comparable results to traditional methods with minimal post-operative pain and no mortality.
Area of Science:
- Thoracic surgery
- Minimally invasive surgery
- Robotic surgery
Background:
- Minimally invasive thymectomy is preferred for myasthenia gravis and thymoma.
- Lateral thoracic approach is common but can limit phrenic nerve visualization.
- Subxiphoid robotic thymectomy (SRT) is presented as an alternative technique.
Purpose of the Study:
- To describe the technique and initial experience of SRT.
- To evaluate the safety and efficacy of SRT for myasthenia gravis and thymoma.
- To assess the operative view and post-operative outcomes of SRT.
Main Methods:
- Retrospective analysis of 25 consecutive patients undergoing SRT from June 2017 to September 2018.
- Data collected included operative time, console time, blood transfusion, chest drainage duration, hospital stay, pain scores, and post-operative morbidity/mortality.
- All patients had myasthenia gravis; 4 also had thymoma.
Main Results:
- Mean console time was 102.85 min; mean total operative time was 199.14 min.
- Post-operative pain scores decreased from 5 on POD 1 to 2 at discharge.
- No 30-day or 90-day mortality was observed; all thymoma resections were complete (R0).
Conclusions:
- SRT provides a good operative view of the thymus and bilateral phrenic nerves.
- The subxiphoid approach allows for safe and effective thymectomy.
- SRT is a safe procedure with results comparable to other minimally invasive techniques.
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