Expert consensus on the safety of tubeless robotic thymectomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XU Wei ¹ , XU Shiguang ¹ , DIAO Yugang ² ,  WANG Shumin ¹ , The Committee of Thoracic Surgery, Doctor Society of Medical Robotics,Chinese Medical Doctor Association

1. Department of Thoracic Surgery, General Hospital of Northern Theater Command, Shenyang, 110000, P. R. China;
2. Department of Anesthesiology, General Hospital of Northern Theater Command, Shenyang, 110000, P. R. China;

Corresponding?author：

WANG Shumin, Email: sureman2003congo@163.com

Keywords：

Thymectomy; robotic surgery; nonintubated anesthesia; safety; expert consensus

DOI：

10.7507/1007-4848.202208051

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Thymectomy is an important treatment for thymoma and myasthenia gravis. The application of minimally invasive surgery to complete thymectomy and rapid recovery of patients after surgery is a developmental goal in thoracic surgery technology. Surgical robots have many technical advantages and are applied for many years in mediastinal tumor resections, a process that has led to its recognition. We published this consensus with the aim of examining how to ensure surgical safety based on the premise that better use of surgical robots achieving rapid recovery after surgery. We invited multiple experts in thoracic surgery to discuss the safety and technical issues of thymectomy under nonintubated anesthesia, and the consensus was made after several explorations and modifications.

Citation： XU Wei, XU Shiguang, DIAO Yugang, WANG Shumin, The Committee of Thoracic Surgery, Doctor Society of Medical Robotics,Chinese Medical Doctor Association. Expert consensus on the safety of tubeless robotic thymectomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(12): 1554-1561. doi: 10.7507/1007-4848.202208051 Copy

1.	Detterbeck FC, Zeeshan A. Thymoma: Current diagnosis and treatment. Chin Med J(Engl), 2013, 126(11): 2186-2191.
2.	NCCN clinical practice guidelines in oncology: Thymomas and thymic carcinomas (version2.2022). https://www.nccn.org/professionals/physician_gls/pdf/thymic.pdf.
3.	Jaretzki A 3rd, Penn AS, Younger DS, et al. "Maximal" thymectomy for myasthenia gravis. Results. J Thorac Cardiovasc Surg, 1988, 95(5): 747-757.
4.	Ashton RC Jr, McGinnis KM, Connery CP, et al. Totally endoscopic robotic thymectomy for myasthenia gravis. Ann Thorac Surg, 2003, 75(2): 569-571.
5.	高長青. 探索的腳步: 解放軍總醫院機器人外科手術探索實踐紀實. 中華腔鏡外科雜志(電子版), 2017, 10(5): 257-259.
6.	黃佳, 羅清泉, 趙曉菁, 等. 胸腺瘤切除術中機器人輔助胸腔鏡技術的應用. 腫瘤, 2009, 29(8): 796-798.
7.	Ruffini E, Filosso PL, Guerrera F, et al. Optimal surgical approach to thymic malignancies: New trends challenging old dogmas. Lung Cancer, 2018, 118: 161-170.
8.	劉星池, 李博, 徐惟, 等. 達芬奇機器人手術系統行縱隔腫瘤切除術后不放置引流管的病例對照研究. 中國胸心血管外科臨床雜志, 2015, 22(10): 940-943.
9.	中國醫師協會醫學機器人醫師分會胸外科專業委員會籌備組, 譚群友, 陶紹霖, 等. 機器人輔助縱隔腫瘤手術中國專家共識(2019版). 中國胸心血管外科臨床雜志, 2020, 27(2): 117-125.
10.	李劍濤, 羅清泉. 微創外科時代達芬奇機器人在胸外科的應用經驗與思考. 中華腔鏡外科雜志(電子版), 2020, 13(5): 260-264.
11.	宋世源, 吳子恒, 徐惟, 等. 機器人輔助非氣管插管縱隔腫瘤切除術后住院時間影響因素分析及流程優化. 中國胸心血管外科臨床雜志, 2022. [Epub ahead of print].
12.	劉博, 汪明敏, 許世廣, 等. 達芬奇機器人縱隔腫瘤切除術的學習曲線. 中國胸心血管外科臨床雜志, 2017, 24(2): 127-131.
13.	Ternovykh I, Kreis O, Gavrilov Y, et al. Diagnosis of anxiety and depression in patients with myasthenia gravis. J Neurol Sci, 2021, 429(S): 19769.
14.	王圣中, 劉晨熙, 胡玉川, 等. 胸腺增生的影像學研究進展. 國際醫學放射學雜志, 2021, 44(4): 438-441.
15.	Strange CD, Ahuja J, Shroff GS, et al. Imaging evaluation of thymoma and thymic carcinoma. Front Oncol, 2022, 11: 810419.
16.	Assuncao CM, Grein HT. The importance of single-fiber electromyography in myasthenia gravis diagnosis and prognosis: A systematic review. J Neurol Sci, 2021, 429(S): 118508.
17.	Enkhtuya S, Khutagbaatar D, Rentsenbat M. Repetitive nerve stimulation test in patients with myasthenia gravis. J Neurol Sci, 2021, 429(S): 118357.
18.	Chimedregzen O, Jambal S, Rentsenbat M, et al. Thymus characteristics in seropositive and seronegative myasthenia gravis. J Neurol Sci, 2021, 429(S): 118396.
19.	周怡, 趙衛國, 保鵬濤, 等. 重癥肌無力患者胸腺切除手術前后呼吸肌功能變化. 中國神經精神疾病雜志, 2011, 37(11): 679-682.
20.	姜格寧, 張雷, 朱余明, 等. 肺切除手術患者術前肺功能評估肺科共識. 中國胸心血管外科臨床雜志, 2020, 27(1): 1-9.
21.	Tonev D, Georgieva R, Vavrek E. Our clinical experience in the treatment of myasthenia gravis acute exacerbations with a novel nanomembrane-based therapeutic plasma exchange technology. J Clin Med, 2022, 11(14): 4021.
22.	Kondo K, Monden Y. Therapy for thymic epithelial tumors: A clinical study of 1, 320 patients from Japan. Ann Thorac Surg, 2003, 76(3): 878-84.
23.	Hamaji M, Allen MS, Cassivi SD, et al. The role of surgical management in recurrent thymic tumors. Ann Thorac Surg, 2012, 94(1): 247-254.
24.	Zielinski M, Hauer L, Hauer J, et al. Comparison of complete remission rates after 5 year follow-up of three different techniques of thymectomy for myasthenia gravis. Eur J Cardiothorac Surg, 2010, 37(5): 1137-143.
25.	Masaoka A, Yamakawa Y, Niwa H, et al. Extended thymectomy for myasthenia gravis patients: A 20-year review. Ann Thorac Surg, 1996, 62(3): 853-859.
26.	Nakagawa K, Asamura H, Sakurai H, et al. Does the mode of surgical resection affect the prognosis/recurrence in patients with thymoma? J Surg Oncol, 2014, 109(3): 179-183.
27.	Voulaz E, Perroni G, Russo A, et al. Thymomectomy versus complete thymectomy in early-stage non-myasthenic thymomas: A multicentric propensity score-matched study. Interact Cardiovasc Thorac Surg, 2022, 35(1): ivac167.
28.	井淼, 蔡文涵, 溫佳新, 等. 全胸腺切除與胸腺瘤切除治療早期非重癥肌無力胸腺瘤的圍術期指標和預后比較. 解放軍醫學院學報, 2022, 43(5): 502-506.
29.	Papadimas E, Tan YK, Luo H, et al. Partial versus complete thymectomy in non-myasthenic patients with thymoma: A systematic review and meta-analysis of clinical outcomes. Heart Lung Circ, 2022, 31(1): 59-68.
30.	Jarrar E, Naija S, Amara N, et al. Prognosis of thymectomy in myasthenia gravis patients, in a Tunisan cohort. J Neurol Sci, 2021, 429(S): 118831.
31.	Pulle MV, Asaf BB, Puri HV, et al. Meta-analysis of limited thymectomy versus total thymectomy for masaoka stage Ⅰ and Ⅱ thymoma. J Chest Surg, 2021, 54(2): 127-136.
32.	Rückert JC, Zhang H, Li F, et al. Complete thymectomy for myasthenia gravis. J Vis Surg, 2021. [Epub ahead of print].
33.	Huang Y, Su L, Zhang Y, et al. Risk factors for postoperative myasthenic crisis after thymectomy in patients with myasthenia gravis. J Surg Res, 2021, 262: 1-5.
34.	Chu XY, Xue ZQ, Wang RW, et al. Predictors of postoperative myasthenic crisis in patients with myasthenia gravis after thymectomy. Chin Med J (Engl), 2011, 124(8): 1246-1250.
35.	譚群友, 陶紹霖, 劉寶東, 等. 重癥肌無力外科治療中國臨床專家共識. 中國胸心血管外科臨床雜志, 2022, 29(5): 529-541.
36.	Beckers PAJ, Mercelis R, Heyman S, et al. Myasthenia gravis appearing after thymectomy heralding recurrent thymoma. Acta Chir Belg, 2019, 119(3): 195-197.
37.	中國醫師協會腫瘤多學科診療專業委員會. 中國胸腺上皮腫瘤臨床診療指南(2021版). 中華腫瘤雜志, 2021, 43(4): 395-404.
38.	Kiss G, Castillo M. Non-intubated anesthesia in thoracic surgery-technical issues. Ann Transl Med, 2015, 3(8): 109.
39.	陳凜, 陳亞進, 董海龍, 等. 加速康復外科中國專家共識及路徑管理指南(2018版). 中國實用外科雜志, 2018, 38(1): 1-20.
40.	譚潮, 吳浩, 王嘉華, 等. 全身麻醉下喉罩通氣并發癥的研究進展. 國際麻醉學與復蘇雜志, 2021, 12: 1325-1329.
41.	Bussières JS, Somma J, Del Castillo JL, et al. Bronchial blocker versus left double-lumen endotracheal tube in video-assisted thoracoscopic surgery: A randomized-controlled trial examining time and quality of lung deflation. Can J Anaesth, 2016, 63(7): 818-827.
42.	Campos JH. Update on selective lobar blockade during pulmonary resections. Curr Opin Anaesthesiol, 2009, 22(1): 18-22.
43.	鄧小明, 姚尚龍, 于布為, 等. 主編. 現代麻醉學. 第 5 版. 北京: 人民衛生出版社, 2020. 2127.
44.	朱勇, 施舜繽, 張林, 等. 2種徑路胸腔鏡全胸腺切除術的對比研究. 中國微創外科雜志, 2019, 19(2): 121-123.
45.	王維, 李川, 林琳, 等. 經劍突下達芬奇機器人手術與傳統胸腔鏡手術治療重癥肌無力合并胸腺瘤的對比研究. 中國胸心血管外科臨床雜志, 2020, 27(11): 1287-1291.
46.	徐建國, 吳新民, 羅愛倫, 等. 成人術后疼痛處理專家共識. 臨床麻醉學雜志, 2010, 26(36): 190-196.

1. Detterbeck FC, Zeeshan A. Thymoma: Current diagnosis and treatment. Chin Med J(Engl), 2013, 126(11): 2186-2191.
2. NCCN clinical practice guidelines in oncology: Thymomas and thymic carcinomas (version2.2022). https://www.nccn.org/professionals/physician_gls/pdf/thymic.pdf.
3. Jaretzki A 3rd, Penn AS, Younger DS, et al. "Maximal" thymectomy for myasthenia gravis. Results. J Thorac Cardiovasc Surg, 1988, 95(5): 747-757.
4. Ashton RC Jr, McGinnis KM, Connery CP, et al. Totally endoscopic robotic thymectomy for myasthenia gravis. Ann Thorac Surg, 2003, 75(2): 569-571.
5. 高長青. 探索的腳步: 解放軍總醫院機器人外科手術探索實踐紀實. 中華腔鏡外科雜志(電子版), 2017, 10(5): 257-259.
6. 黃佳, 羅清泉, 趙曉菁, 等. 胸腺瘤切除術中機器人輔助胸腔鏡技術的應用. 腫瘤, 2009, 29(8): 796-798.
7. Ruffini E, Filosso PL, Guerrera F, et al. Optimal surgical approach to thymic malignancies: New trends challenging old dogmas. Lung Cancer, 2018, 118: 161-170.
8. 劉星池, 李博, 徐惟, 等. 達芬奇機器人手術系統行縱隔腫瘤切除術后不放置引流管的病例對照研究. 中國胸心血管外科臨床雜志, 2015, 22(10): 940-943.
9. 中國醫師協會醫學機器人醫師分會胸外科專業委員會籌備組, 譚群友, 陶紹霖, 等. 機器人輔助縱隔腫瘤手術中國專家共識(2019版). 中國胸心血管外科臨床雜志, 2020, 27(2): 117-125.
10. 李劍濤, 羅清泉. 微創外科時代達芬奇機器人在胸外科的應用經驗與思考. 中華腔鏡外科雜志(電子版), 2020, 13(5): 260-264.
11. 宋世源, 吳子恒, 徐惟, 等. 機器人輔助非氣管插管縱隔腫瘤切除術后住院時間影響因素分析及流程優化. 中國胸心血管外科臨床雜志, 2022. [Epub ahead of print].
12. 劉博, 汪明敏, 許世廣, 等. 達芬奇機器人縱隔腫瘤切除術的學習曲線. 中國胸心血管外科臨床雜志, 2017, 24(2): 127-131.
13. Ternovykh I, Kreis O, Gavrilov Y, et al. Diagnosis of anxiety and depression in patients with myasthenia gravis. J Neurol Sci, 2021, 429(S): 19769.
14. 王圣中, 劉晨熙, 胡玉川, 等. 胸腺增生的影像學研究進展. 國際醫學放射學雜志, 2021, 44(4): 438-441.
15. Strange CD, Ahuja J, Shroff GS, et al. Imaging evaluation of thymoma and thymic carcinoma. Front Oncol, 2022, 11: 810419.
16. Assuncao CM, Grein HT. The importance of single-fiber electromyography in myasthenia gravis diagnosis and prognosis: A systematic review. J Neurol Sci, 2021, 429(S): 118508.
17. Enkhtuya S, Khutagbaatar D, Rentsenbat M. Repetitive nerve stimulation test in patients with myasthenia gravis. J Neurol Sci, 2021, 429(S): 118357.
18. Chimedregzen O, Jambal S, Rentsenbat M, et al. Thymus characteristics in seropositive and seronegative myasthenia gravis. J Neurol Sci, 2021, 429(S): 118396.
19. 周怡, 趙衛國, 保鵬濤, 等. 重癥肌無力患者胸腺切除手術前后呼吸肌功能變化. 中國神經精神疾病雜志, 2011, 37(11): 679-682.
20. 姜格寧, 張雷, 朱余明, 等. 肺切除手術患者術前肺功能評估肺科共識. 中國胸心血管外科臨床雜志, 2020, 27(1): 1-9.
21. Tonev D, Georgieva R, Vavrek E. Our clinical experience in the treatment of myasthenia gravis acute exacerbations with a novel nanomembrane-based therapeutic plasma exchange technology. J Clin Med, 2022, 11(14): 4021.
22. Kondo K, Monden Y. Therapy for thymic epithelial tumors: A clinical study of 1, 320 patients from Japan. Ann Thorac Surg, 2003, 76(3): 878-84.
23. Hamaji M, Allen MS, Cassivi SD, et al. The role of surgical management in recurrent thymic tumors. Ann Thorac Surg, 2012, 94(1): 247-254.
24. Zielinski M, Hauer L, Hauer J, et al. Comparison of complete remission rates after 5 year follow-up of three different techniques of thymectomy for myasthenia gravis. Eur J Cardiothorac Surg, 2010, 37(5): 1137-143.
25. Masaoka A, Yamakawa Y, Niwa H, et al. Extended thymectomy for myasthenia gravis patients: A 20-year review. Ann Thorac Surg, 1996, 62(3): 853-859.
26. Nakagawa K, Asamura H, Sakurai H, et al. Does the mode of surgical resection affect the prognosis/recurrence in patients with thymoma? J Surg Oncol, 2014, 109(3): 179-183.
27. Voulaz E, Perroni G, Russo A, et al. Thymomectomy versus complete thymectomy in early-stage non-myasthenic thymomas: A multicentric propensity score-matched study. Interact Cardiovasc Thorac Surg, 2022, 35(1): ivac167.
28. 井淼, 蔡文涵, 溫佳新, 等. 全胸腺切除與胸腺瘤切除治療早期非重癥肌無力胸腺瘤的圍術期指標和預后比較. 解放軍醫學院學報, 2022, 43(5): 502-506.
29. Papadimas E, Tan YK, Luo H, et al. Partial versus complete thymectomy in non-myasthenic patients with thymoma: A systematic review and meta-analysis of clinical outcomes. Heart Lung Circ, 2022, 31(1): 59-68.
30. Jarrar E, Naija S, Amara N, et al. Prognosis of thymectomy in myasthenia gravis patients, in a Tunisan cohort. J Neurol Sci, 2021, 429(S): 118831.
31. Pulle MV, Asaf BB, Puri HV, et al. Meta-analysis of limited thymectomy versus total thymectomy for masaoka stage Ⅰ and Ⅱ thymoma. J Chest Surg, 2021, 54(2): 127-136.
32. Rückert JC, Zhang H, Li F, et al. Complete thymectomy for myasthenia gravis. J Vis Surg, 2021. [Epub ahead of print].
33. Huang Y, Su L, Zhang Y, et al. Risk factors for postoperative myasthenic crisis after thymectomy in patients with myasthenia gravis. J Surg Res, 2021, 262: 1-5.
34. Chu XY, Xue ZQ, Wang RW, et al. Predictors of postoperative myasthenic crisis in patients with myasthenia gravis after thymectomy. Chin Med J (Engl), 2011, 124(8): 1246-1250.
35. 譚群友, 陶紹霖, 劉寶東, 等. 重癥肌無力外科治療中國臨床專家共識. 中國胸心血管外科臨床雜志, 2022, 29(5): 529-541.
36. Beckers PAJ, Mercelis R, Heyman S, et al. Myasthenia gravis appearing after thymectomy heralding recurrent thymoma. Acta Chir Belg, 2019, 119(3): 195-197.
37. 中國醫師協會腫瘤多學科診療專業委員會. 中國胸腺上皮腫瘤臨床診療指南(2021版). 中華腫瘤雜志, 2021, 43(4): 395-404.
38. Kiss G, Castillo M. Non-intubated anesthesia in thoracic surgery-technical issues. Ann Transl Med, 2015, 3(8): 109.
39. 陳凜, 陳亞進, 董海龍, 等. 加速康復外科中國專家共識及路徑管理指南(2018版). 中國實用外科雜志, 2018, 38(1): 1-20.
40. 譚潮, 吳浩, 王嘉華, 等. 全身麻醉下喉罩通氣并發癥的研究進展. 國際麻醉學與復蘇雜志, 2021, 12: 1325-1329.
41. Bussières JS, Somma J, Del Castillo JL, et al. Bronchial blocker versus left double-lumen endotracheal tube in video-assisted thoracoscopic surgery: A randomized-controlled trial examining time and quality of lung deflation. Can J Anaesth, 2016, 63(7): 818-827.
42. Campos JH. Update on selective lobar blockade during pulmonary resections. Curr Opin Anaesthesiol, 2009, 22(1): 18-22.
43. 鄧小明, 姚尚龍, 于布為, 等. 主編. 現代麻醉學. 第 5 版. 北京: 人民衛生出版社, 2020. 2127.
44. 朱勇, 施舜繽, 張林, 等. 2種徑路胸腔鏡全胸腺切除術的對比研究. 中國微創外科雜志, 2019, 19(2): 121-123.
45. 王維, 李川, 林琳, 等. 經劍突下達芬奇機器人手術與傳統胸腔鏡手術治療重癥肌無力合并胸腺瘤的對比研究. 中國胸心血管外科臨床雜志, 2020, 27(11): 1287-1291.
46. 徐建國, 吳新民, 羅愛倫, 等. 成人術后疼痛處理專家共識. 臨床麻醉學雜志, 2010, 26(36): 190-196.

Previous Article
Application of extended radical surgery in hilar cholangiocarcinoma
Next Article
Application of extended radical surgery in hilar cholangiocarcinoma

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Expert consensus on the safety of tubeless robotic thymectomy

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content