Non-intubated Uniportal Subxiphoid Video-Assisted Thoracoscopic Surgery for Extended Thymectomy in Myasthenia Gravis Patients: A Case Series (original) (raw)
Related papers
Annals of the New York Academy of Sciences, 1998
Myasthenia gravis (MG) is an autoimmune disease marked by weakness of voluntary musculature. Medical and surgical therapy of adult myasthenia is well documented. There is little pediatric surgical evidence, only a few case reports being available. The aim of this paper is to verify whether the surgical and anesthesiological techniques can warrant an early and safe discharge from the operating room. The secondary aim is to assess the presence of perioperative indicators that can eventually be used as predictors of postoperative care. During the years 2006-2009, 10 pediatric patients were treated according to a surgical approach based on video assisted thoracoscopic extended thymectomy (VATET). Standard preoperative evaluation is integrated with functional respiratory tests. Anesthetic induction was made with propofol and fentanyl/remifentanyl and maintenance was obtained with sevoflurane/desflurane/propofol ± remifentanyl. A muscle relaxant was used in only one patient. Right or left double-lumen bronchial tube (Rüsch Bronchopart ® Carlens) placement was performed. Six patients were transferred directly to the surgical ward while 4 were discharged to the intensive care unit (ICU); ICU stay was no longer than 24 h. Length of hospital stay was 4.4±0.51 days. No patient was readmitted to the hospital and no surgical complications were reported. Volatile and intravenous anesthetics do not affect ventilator weaning, extubation or the postoperative course. Paralyzing agents are not totally contraindicated, especially if short-lasting agents are used with neuromuscular monitoring devices and new reversal drugs. Perioperative evaluation of the myasthenic patient is mandatory to assess the need for postoperative respiratory support and also predict timely extubation with early transfer to the surgical department. Availability of new drugs and of reversal drugs, the current practice of mini-invasive surgical techniques, and the availability of post anesthesia care units are the keys to the safety and successful prognosis of patients affected by MG who undergo thymectomy.
Anesthetic implications for video assisted thoracoscopic thymectomy in myasthenia gravis
Middle East journal of anaesthesiology, 2005
Thymectomy is an established therapy in the management of generalized myasthenia gravis (MG). However, the optimal surgical approach to thymectomy has remained controversial. There are advocates for transternal, transcervical approaches for "maximal" thymectomy. Video-assisted thoracoscopic thymectomy (VATT) presents new approach to thymectomy. By minimizing chest wall trauma, VATT not only causes less postoperative pain, shortens hospital stay, gives better cosmetic results but also leads to wider acceptance by patients for earlier surgery. Anesthesia for thymectomy in MG is challenging. Currently we are using non-muscle relaxant technique (NMRT) which we adopted in 1994, for maximal thymectomy. In this paper, we present our limited experience with two cases of VATT using two different NMRTs. Two cases of MG underwent VATT under general anesthesia (GA) and one lung ventilation (OLV) using double lumen tube (DLT). In both cases NMRT was used which encompass, light GA plus ...
Journal of the Neurological Sciences, 2003
Myasthenia gravis (MG) is an autoimmune disease marked by weakness of voluntary musculature. Medical and surgical therapy of adult myasthenia is well documented. There is little pediatric surgical evidence, only a few case reports being available. The aim of this paper is to verify whether the surgical and anesthesiological techniques can warrant an early and safe discharge from the operating room. The secondary aim is to assess the presence of perioperative indicators that can eventually be used as predictors of postoperative care. During the years 2006-2009, 10 pediatric patients were treated according to a surgical approach based on video assisted thoracoscopic extended thymectomy (VATET). Standard preoperative evaluation is integrated with functional respiratory tests. Anesthetic induction was made with propofol and fentanyl/remifentanyl and maintenance was obtained with sevoflurane/desflurane/propofol ± remifentanyl. A muscle relaxant was used in only one patient. Right or left double-lumen bronchial tube (Rüsch Bronchopart ® Carlens) placement was performed. Six patients were transferred directly to the surgical ward while 4 were discharged to the intensive care unit (ICU); ICU stay was no longer than 24 h. Length of hospital stay was 4.4±0.51 days. No patient was readmitted to the hospital and no surgical complications were reported. Volatile and intravenous anesthetics do not affect ventilator weaning, extubation or the postoperative course. Paralyzing agents are not totally contraindicated, especially if short-lasting agents are used with neuromuscular monitoring devices and new reversal drugs. Perioperative evaluation of the myasthenic patient is mandatory to assess the need for postoperative respiratory support and also predict timely extubation with early transfer to the surgical department. Availability of new drugs and of reversal drugs, the current practice of mini-invasive surgical techniques, and the availability of post anesthesia care units are the keys to the safety and successful prognosis of patients affected by MG who undergo thymectomy.
Minimalist three-dimensional thoracoscopic extended thymomectomy in a patient with myasthenia gravis
Journal of Visualized Surgery
Thymoma represents a relatively rare slowly growing tumor of the thymic gland. Complete thymomectomy along with all thymic and peri-thymic tissue is recommended to reduce risks of recurrence and proved to be beneficial for patients with associated myasthenia gravis (MG). Various surgical approaches have been advocated for thymomectomy and in recent years, use of video-assisted thoracoscopic surgery (VATS) has become more and more popular. Moreover, combining minimally invasive approaches together will have an excellent impact on the very early post-operative outcome. We report on a patient with MG who underwent a minimalist uniportal three dimensional thoracoscopic extended thymomectomy under non intubated, spontaneous ventilation anaesthesia protocol.
Video-Assisted Thoracoscopic Thymectomy for Myasthenia Gravis
Chest, 1995
Thymectomy has long been considered one of the treatment modalities for myasthenia gravis (MG). The centre of debate has been the surgical technique for thymectomy, such as complete, extended and maximal thymectomies, and the surgical approach with the transsternal approach being the most common. Partial sternal splitting was the gold standard approach for many decades with less postoperative complications and safety. Transcervical thymectomy and video-assisted thoracoscopic surgery (VATS) thymectomy gained popularity for superior cosmesis, less invasive approach, shorter hospital stays and increased safety. Both techniques may provide a complete removal of the thymus gland. Now, different VATS techniques are preferred by different surgeons and clinics. The debate is shifting to the options of an extended thymectomy or a bigger thymus resection with minimally invasive techniques. Robotic thymectomy, which is considered a robot-assisted VATS thymectomy, became an important choice for surgical treatment in several centres. In this study, we aimed to study the role of thymectomy in the treatment of MG, including debatable indications and recently developed attitudes for the difficult decisions, and the effects of recent technology on the outcome of MG treatment.
Wideochirurgia I Inne Techniki Maloinwazyjne, 2018
Introduction: Thymectomy is the preferred standard treatment in younger non-thymoma patients with myasthenia gravis as well as in patients with early stage thymoma. Total thymectomy by median sternotomy has been the surgical approach since resection of the thymus with video-assisted thoracoscopic surgery (VATS). Aim: To compare the clinical outcomes of VATS thymectomy with conventional open thymectomy for neoplastic and non-neoplastic thymic diseases. Material and methods: Forty patients underwent thymectomy between October 2012 and January 2016. Fifteen patients were male and 25 patients were female. The mean age was 40.3 ±17.7 years. Seventeen (55%) patients underwent VATS thymectomy and 23 (45%) patients underwent an open procedure. We retrospectively reviewed the data of the patients and compared these two techniques. Results: The mean tumor size was 5.17 ±3.2 cm in the thymoma group (VATS 2.5 ±2.4 cm vs. open access 4.7 ±3.7 cm). None of the patients experienced a myasthenic crisis. Conversion to thoracotomy was required in 1 patient in the VATS group due to bleeding from the right internal mammary artery; therefore, the conversion rate was 2.5% among all the patients. No mortality occurred in either group. No significant difference was found in the perioperative blood loss, operative time or pain visual analogue scale scores. On the other hand, regarding postoperative drainage, duration of chest tube drainage and length of hospital stay, VATS thymectomy yielded better results and the differences were significant. Conclusions: Video-assisted thoracoscopic surgery thymectomy can be performed for both neoplastic and non-neoplastic thymic diseases with minimal morbidity and mortality.
Video-Assisted Thoracoscopic Thymectomy vs "Maximal" Thymectomy for Myasthenia Gravis
CHEST Journal, 1996
Thymectomy vs "Maximal" Thymectomy Video-Assisted Thoracoscopic http://chestjournal.chestpubs.org/content/110/3/864.2.citation and services can be found online on the World Wide Web at: The online version of this article, along with updated information ISSN:0012-3692 ) http://chestjournal.chestpubs.org/site/misc/reprints.xhtml
Catastrophes during video-assisted thoracoscopic thymus surgery for myasthenia gravis
Interactive CardioVascular and Thoracic Surgery, 2016
OBJECTIVES: Several series have demonstrated that video-assisted thoracoscopic (VAT) thymectomy is feasible and safe. However, VAT thymectomy is an operation that could invite catastrophes, such as major vascular injuries. We aimed to analyse the events and define the management and outcomes of these serious complications. METHODS: All patients who underwent VAT thymectomy/thymothymectomy recorded in our clinical database were evaluated. A catastrophic complication was defined as any situation that resulted in an additional unplanned major surgical procedure other than the planned closed thymic surgery. Operations were performed by two surgeons: one experienced and one junior. The order of catastrophes in each surgeon's experience was recorded. RESULTS: A total of 441 VAT thymectomy/thymothymectomy operations were performed. Catastrophic complications were identified in 7 (1.5%) patients. These cases included 3 major innominate vein injuries, 1 superior vena cava injury, 1 aortic injury, 1 sudden cardiac arrest and 1 diaphragmatic injury. The first catastrophe for the experienced surgeon was his 96th case. The mean age was 37.1 ± 11.5 (minimum: 21, maximum: 53). There were 5 (71.4%) male and 2 (28.6%) female patients. Two (28.6%) of the patients had thymoma and the mean body mass index was 23.9 ± 2.8. A mean of 1.7 ± 1.4 (minimum: 0, maximum: 3) units of blood were transfused; a postoperative intensive care unit stay of 20.6 ± 25.7 h and a hospital stay of 8.4 ± 7.9 days were recorded. There were no deaths. CONCLUSIONS: Catastrophic intraoperative complications of VAT thymectomy are very rare. They may not only occur in the learning curve period but also after a large experience. Experience in converting to open surgery within seconds is important to reduce morbidity and mortality.
Thoracoscopic Thymectomy for Myasthenia Gravis With and Without Thymoma: A Single-Center Experience
The Annals of Thoracic Surgery, 2012
Background. The treatment of patients with myasthenia gravis (MG) may include thymectomy. The objective of this study was to analyze the outcome of videoassisted thoracoscopic surgical (VATS) extended thymectomy and to compare characteristics of patients with MG with and without thymoma. Methods. Between 2002 and 2009, 247 patients with MG underwent VATS thymectomy in our department and were subdivided into 2 groups: MG without thymoma (n ؍ 176) and MG with thymoma (n ؍ 71). Complete stable remission (CSR) was the primary endpoint for efficacy. Results. There were no intraoperative deaths and 4 cases required conversion to median sternotomy. There was a significant difference between the 2 groups regarding preoperative and postoperative myasthenic crisis. Two hundred nineteen patients were followed for 4 months to 9 years: 152 had thymoma and 67 did not have thymoma. The cumulative probabilities of reaching CSR were 37.5% in patients with MG without thymoma and 28.3% in patients with thymoma, respectively. Forty months after surgery there was no significant difference in CSR between the 2 groups. Two years after surgery, 30 patients without thymoma achieved CSR and disease was exacerbated in 2 patients after CSR had been achieved. Ten patients with thymoma achieved CSR, and exacerbation occurred in 5 patients with thymoma. Two patients without thymoma died of myasthenic crisis, whereas 3 of 4 patients with thymoma died of myasthenic crisis, and 1 death was attributable to recurrent disease. Conclusions. Video-assisted thoracoscopic surgery thymectomy can produce a satisfactory long-term result. MG with thymoma seems more severe and its prognosis after thymectomy is not as optimistic as that of MG without thymoma. Special perioperative attention should be paid to patients with MG and thymoma to decrease the possibility of postoperative myasthenic crisis and reduce postoperative death.