ObjectiveTo investigate the safety, feasibility and advantages of subxiphoid uni-portal thoracoscopic thymectomy.MethodsClinical data of 65 patients undergoing subxiphoid uni-portal thoracoscopic thymectomy in our hospital from September 2018 to March 2019 were retrospectively analyzed. They were treated as a subxiphoid surgery group, including 36 males and 29 females, aged 49.5 (29-71) years. The incision with the length of about 3 cm was located approximately 1 cm under the xiphoid process. From January 2016 to December 2017, 65 patients received intercostal uni-portal thoracoscopic thymectomy, who were treated as a control group, including 38 males and 27 females, aged 48.9 (33-67) years. All patients who were clinically diagnosed with thymic tumor before surgery were treated with total thymectomy. After surgery, expectoration and analgesia were used.ResultsThere was no statistically significant difference in general clinical data, lesion size, intraoperative blood loss, postoperative catheterization time, postoperative hospital stay and postoperative pathology between the two groups. All operations were successfully completed, and the patients in both groups recovered uneventfully after surgery. Visual analogue scale scores on the 1st, 3rd, 7th and 30th day after surgery in the subxiphoid surgery group were lower than those in the control group.ConclusionThe subxiphoid uni-portal thoracoscopic approach can achieve total thymectomy with less trauma and faster postoperative recovery.
Objective
To investigate the clinical outcomes of subxiphoid video-assisted thoracoscopic thymectomy for myasthenia gravis.
Methods
The clinical data of the 85 patients undergoing video-assisted thoracoscopic thymectomy for myasthenia gravis in Department of Cardiothoracic Surgery, Huashan Hospital affiliated to Fudan University between January 2014 and July 2016 were studied. Subxiphoid approach video-assisted thoracoscopic thymectomy (SXVT) and through traditional unilateral approach video-assisted thymectomy (TVAT) were compared. The clinical outcomes of SXVT and TVAT were compared.
Results
There was no surgical death and no statistical difference between the two groups in drainage time, postoperative volume of drainage, postoperative hospital stay and bleeding volume during operation (P>0.05). However, the acute chest pain after surgery, as well as the postoperative chest pain, and operative time were less in the the SXVT group than that in the TVAT group (P<0.05).
Conclusion
SXVT for myasthenia gravis is safe and executable. It can alleviate intercostal neuralgia and abnormal chest wall feeling. And it should be considered in the treatment of myasthenia gravis.
ObjectiveTo assess the long-term efficacy of extended thymectomy in the treatment of myasthenia gravis(MG) and the factors influencing the results.
MethodsWe retrospectively analyzed the clinical data of 45 MG patients who underwent extended thymectomy in our hospital from January 2005 through December 2010. There were 11males and 34 females at age of 32.6(16-50) years. The overall effective rate was calculated. Univariate analysis was used to analyze the risk factors including sex, age, Osserman classification, and pathological type for outcomes.
ResultsAll the patients were followed up for a mean of 58.3 months(ranged from 36 to 108 months). The overall effective rate was 80.0%(36/45) and rose with the extention of time. Age(P=0.019), pathological type(P=0.024) of thymus and Osserman classification(P=0.043) of MG were the main factors influencing the outcomes of the treatment except sex(P=0.666).
ConclusionExtended thymectomy in the treatment of MG has better outcomes. And the overall effective rate rises with the extention of time.
Thymectomy is the main treatment for thymoma and other thymic diseases. But the incidence of non-therapeutic thymectomy is high due to the difficulty in the differential diagnosis of anterior mediastinum lesions. Formerly, it was believed that the thymus gradually degraded and lost function with aging, and the preservation of the thymus was not valued. Recent studies have found that the removal of the thymus at all ages has adverse effects on overall health and leads to a significant increase in the risk of autoimmune diseases, malignancy, and all-cause mortality. Therefore, unnecessary thymectomy should be avoided. This article reviews the influence of thymectomy, including the changes of immunological indexes and clinical prognosis, and further discusses the current situation and avoidance methods of non-therapeutic thymectomy.
Objective To explore the clinical efficacy and learning curve of robot-assisted thymectomy via subxiphoid approach. MethodsThe clinical data of patients with robot-assisted thymectomy surgery via subxiphoid approach performed by the same surgical team in the Department of Thoracic Surgery of Shanghai Pulmonary Hospital from February 2021 to August 2022 were retrospectively analyzed. The cumulative sum (CUSUM) analysis and best fit curve were used to analyze the learning curve of this surgery. The general information and perioperative indicators of patients at different learning stages were compared to explore the impact of different learning stages on clinical efficacy of patients. ResultsA total of 67 patients were enrolled, including 31 males and 36 females, aged 57.10 (54.60, 59.60) years. The operation time was 117.00 (87.00, 150.00) min. The best fitting equation of CUSUM learning curve was y=0.021 2x3–3.192 5x2 +120.17x–84.444 (x was the number of surgical cases), which had a high R2 value of 0.977 8, and the fitting curve reached the top at the 25th case. Based on this, the learning curve was divided into a learning period and a proficiency period. The operation time and intraoperative blood loss in the proficiency stage were significantly shorter or less than those in the learning stage (P＜0.001), and there was no statistical difference in thoracic drainage time and volume between the two stages (P＞0.05). ConclusionThe learning process of robot-assisted thymectomy via subxiphoid approach is safe, and this technique can be skillfully mastered after 25 cases.
ObjectiveTo analyze the risk factors of myasthenia gravis crisis after thymectomy with myasthenia gravis (MG).MethodsSixty-five myasthenia gravis patients who had myasthenia crisis after thymectomy in Xuanwu Hospital, Capital Medical University from June 2006 to June 2019 were retrospectively enrolled, including 31 males and 34 females, aged 15-78 (45.7±17.8) years. The relationship between myasthenia crisis after thymectomy and surgical option, operation time, pathological type, et al. were anylyzed.ResultsOperation time and pathological type were the predictive factors of postoperative myasthenic crisis. The area under receiver operating characteristic curve (AUC) of MG type (Osserman) was 0.676, the cut-off value wasⅡB type, the sensitivity was 37.5%, the specificity was 90.5%, and the Youden’s index was 0.280. The AUC of thymoma stage (Masaoka) was 0.682, cut-off value was stageⅡ, sensitivity was 62.5%, specificity was 66.7%, and Youden’s index was 0.292. The AUC of blood loss was 0.658, the cut-off value was 90 mL, the sensitivity was 87.5%, the specificity was 69.6%, and the Youden’s index was 0.304.ConclusionPreoperative MG classification, pathological type, operation time and blood loss are the risk factors of postoperative myasthenic crisis. Therefore, adequate preoperative preparation, rapid and careful intraoperative operation and active postoperative management can reduce the occurrence of postoperative myasthenic crisis.
ObjectiveTo compare the efficacy and safety of video-assisted thoracoscopic surgery (VATS) thymectomy for the treatment of thymoma through subxiphoid uniportal approach using double sternum retractors, and subxiphoid and subcostal arch approach. Methods We retrospectively analyzed the clinical data of the patients diagnosed with thymoma who underwent VATS thymectomy from June 2023 to June 2024 in West China Hospital. Patients were categorized based on the surgical approach into two groups: a subxiphoid uniportal VATS thymectomy (SUVT) group and a subxiphoid and subcostal arch VATS thymectomy (SASAT) group. Comparisons were made between the two groups regarding surgical duration, intraoperative blood loss, postoperative drainage, thymoma size and location, and postoperative pain assessed using the visual analogue scale (VAS). ResultsThe SUVT group consisted of 20 patients, including 11 males and 9 females, with an average age of (51.5±14.3) years. The SASAT group comprised 40 patients, including 26 males and 14 females, with an average age of (50.0±13.0) years. Compared to the SASAT group, the SUVT group had significantly larger thymomas [ (5.9±2.7) cm vs. (4.2±2.1) cm, P=0.010] and a higher proportion of neoplasms located in the superior mediastinum (30.0% vs. 2.5%, P=0.007). Additionally, the VAS pain scores on postoperative days 3, 7, and 30 were significantly lower in the SUVT group compared to the SASAT group (P<0.05). There were no statistical differences between the two groups in demographic characteristics, operative time, intraoperative blood loss, duration and volume of postoperative drainage, length of postoperative hospital stay, or the VAS pain score on the first postoperative day. Conclusion SUVT using double sternum retractors significantly reduces postoperative pain and provides superior efficacy in the resection of larger thymomas or those situated in the superior mediastinum.
