Robotic thymectomy for myasthenia gravis

Abstract

Thymectomy is an effective treatment option for the management of myasthenia gravis, as demonstrated by a recent multicenter randomized clinical trial. Complete removal of all thymic tissue, including ectopic foci, increases the chance of achieving a remission or a substantial improvement of the disease; therefore, extended transsternal thymectomy was long considered the procedure of choice. Over the years, several minimally invasive approaches have been proposed, with the aim to reduce perioperative morbidity and to improve aesthetics; however, concerns exist that through such approaches, it may not be possible to achieve a complete resection. Robotic thymectomy seems to overcome many of the limitations associated with other minimally invasive approaches. The available evidence suggests that robotic thymectomy for myasthenia gravis is a safe procedure, and that long-term neurological outcomes are satisfactory.

Keywords

Thymectomy / robot / myasthenia gravis

References

[1] Gwathmey KG.Myasthenia gravis..Semin Neurol2015;35:327-39

[2] Blalock A,Morgan HJ.Myasthenia gravis and tumors of the thymic region: report of a case in which the tumor was removed..Ann Surg1939;110:544-61 PMCID:PMC1391425

[3] Oosterhuis HJ.Observations of the natural history of myasthenia gravis and the effect of thymectomy..Ann N Y Acad Sci1981;377:678-90

[4] Gronseth GS.Practice parameter: thymectomy for autoimmune myasthenia gravis (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology..Neurology2000;55:7-15

[5] Wolfe GI,Aban IB,Kuo HC.Randomized Trial of Thymectomy in Myasthenia Gravis..N Engl J Med2016;375:511-22 PMCID:PMC5189669

[6] Sonett JR,Gorenstein L.Thymectomy and myasthenia gravis: A history of surgical passion and scientific excellence..J Thorac Cardiovasc Surg2017;154:306-9

[7] Magee MJ.Surgical approaches to the thymus in patients with myasthenia gravis..Thorac Surg Clin2009;19:83-9

[8] Qi K,Wang B,Chu XY.Video-assisted thoracoscopic surgery thymectomy versus open thymectomy in patients with myasthenia gravis: a meta-analysis..Acta Chir Belg2016;116:282-8

[9] Zielinski M,Hauer J,Nabialek T.Comparison of complete remission rates after 5 year follow-up of three different techniques of thymectomy for myasthenia gravis..Eur J Cardiothorac Surg2010;37:1137-43

[10] Jaretzki A.‘‘Maximal’’ thymectomy for myasthenia gravis. Surgical anatomy and operative technique..J Thorac Cardiovasc Surg1988;96:711-6

[11] Masaoka A,Kotake Y.Distribution of thymic tissue at the anterior mediastinum. Current procedures in thymectomy..J Thorac Cardiovasc Surg1975;70:747-54

[12] Rea F,Bortolotti L,Zuin A.Experience with the “da Vinci” robotic system for thymectomy in patients with myasthenia gravis: report of 33 cases..Ann Thorac Surg2006;81:455-9

[13] Rückert JC,Ismail M.Comparison of robotic and nonrobotic thoracoscopic thymectomy: a cohort study..J Thorac Cardiovasc Surg2011;141:673-7

[14] Jun Y,Demin L,Hua J.Da Vinci robot-assisted system for thymectomy: experience of 55 patients in China..Int J Med Robot2014;10:294-9

[15] Augustin F,Sieb M,Bodner J.Video-assisted thoracoscopic surgery versus robotic-assisted thoracoscopic surgery thymectomy..Ann Thorac Surg2008;85:S768-71

[16] Melfi F,Davini F,Lucchi M.Ten-year experience of mediastinal robotic surgery in a single referral centre..Eur J Cardiothorac Surg2012;41:847-51

[17] Marulli G,Melfi F,Ismail M.Robot-aided thoracoscopic thymectomy for early-stage thymoma: a multicenter European study..J Thorac Cardiovasc Surg2012;144:1125-30

[18] Sanders DB,Benatar M,Gilhus NE.International consensus guidance for management of myasthenia gravis: executive summary..Neurology2016;87:419-25 PMCID:PMC4977114

[19] Ismail M,Rückert JC.State of the art of robotic thymectomy..World J Surg2013;37:2740-6

[20] Freeman RK,Van Woerkom JM,Robison RJ.Long-term follow-up after robotic thymectomy for nonthymomatous myasthenia gravis..Ann Thorac Surg2011;92:1018-22discussion 1022-3

[21] Marulli G,Perissinotto E,Di Chiara F.Surgical and neurologic outcomes after robotic thymectomy in 100 consecutive patients with myasthenia gravis..J Thorac Cardiovasc Surg2013;145:730-5discussion 735-6

[22] Keijzers M,Hochstenbag M,Zur Hausen A.Robotic thymectomy in patients with myasthenia gravis: neurological and surgical outcomes..Eur J Cardiothorac Surg2015;48:40-5

[23] Kumar A,Asaf BB,Sood J.Robotic thymectomy for myasthenia gravis with or without thymoma-surgical and neurological outcomes..Neurol India2017;65:58-63

[24] Weksler B,Newhook TE,Diehl JT.Robot-assisted thymectomy is superior to transsternal thymectomy..Surg Endosc2012;26:261-6

[25] Ye B,Ge XX,Ji CY.Surgical treatment of early-stage thymomas: robot-assisted thoracoscopic surgery versus transsternal thymectomy..Surg Endosc2014;28:122-6

[26] Seong YW,Choi JW,Jeon JH.Early clinical outcomes of robot-assisted surgery for anterior mediastinal mass: its superiority over a conventional sternotomy approach evaluated by propensity score matching..Eur J Cardiothorac Surg2014;45:e68-73

[27] Orsini B,Pages PB,Dahan M.Comparative study for surgical management of thymectomy for non-thymomatous myasthenia gravis from the French national database EPITHOR..Eur J Cardiothorac Surg2016;50:418-22

[28] Fok M,Harky A,DiMartino M.Video-assisted thoracoscopic versus robotic-assisted thoracoscopic thymectomy: systematic review and meta-analysis..innovations (Phila)2017;12:259-64

[29] Daniel VC.Extended transsternal thymectomy..Thorac Surg Clin2010;20:245-52

[30] Masaoka A,Niwa H,Kondo S.Extended thymectomy for myasthenia gravis patients: a 20-year review..Ann Thorac Surg1996;62:853-9

[31] Zielinski M,Hauer J,Nabialek T.Comparison of complete remission rates after 5 year follow-up of three different techniques of thymectomy for myasthenia gravis..Eur J Cardiothorac Surg2010;37:1137-43

[32] Hess NR,Pennathur A,Christie NA.Minimally invasive versus open thymectomy: a systematic review of surgical techniques, patient demographics, and perioperative outcomes..Ann Cardiothorac Surg2016;5:1-9 PMCID:PMC4740099