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2015 ; 4
(6
): 519-26
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Minimally invasive thymectomy: the Mayo Clinic experience
#MMPMID26693147
Rowse PG
; Roden AC
; Corl FM
; Allen MS
; Cassivi SD
; Nichols FC
; Shen KR
; Wigle DA
; Blackmon SH
Ann Cardiothorac Surg
2015[Nov]; 4
(6
): 519-26
PMID26693147
show ga
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.