Article

A comparison of outcomes after robotic open extended thymectomy for myasthenia gravis

University of Innsbruck, Innsbruck, Tyrol, Austria
European Journal of Cardio-Thoracic Surgery (Impact Factor: 2.81). 04/2007; 31(3):501-4; discussion 504-5. DOI: 10.1016/j.ejcts.2006.12.016
Source: PubMed

ABSTRACT The aim of this study was to analyze the effect of the surgical approach on surgical and neurologic outcomes after extended thymectomy for myasthenia gravis.
A retrospective analysis of the institutional extended thymectomies for myasthenia gravis within the last decade was performed. Patients of group A (open access by total median sternotomy; n=10; 1996-2002) and of group B (video assisted thoracoscopic surgery approach with the da Vinci robotic system; n=9; 2003-2006) did not differ with regard to gender distribution, age, body mass index, American Association of Anaesthetists score and Osserman classification of myasthenia gravis. Primary endpoints were surgical complications and the symptomatic/neurologic outcome of the extended thymectomy. Secondary endpoints were operating times and hospital stay.
Median follow-up was 74+/-23 months in group A and 13+/-10 months in group B. Surgical complications occurred in 4 patients in group A (requiring 2 re-interventions) and in 1 patient in group B (p<0.05). The median dose of Pyridostigminbromid was reduced 3 and 6 months postoperatively in group A to 80% and 60% of the preoperative level and in group B to 66% and 60% of the preoperative level, respectively. Within the first postoperative year all patients of group B had an improvement of their disease whereas 2 patients of group A did not benefit from thymectomy or had a worsening of symptoms. Operating times were significantly shorter in group A (110 (42-152) min vs 154 (94-312) min, p<0.05), hospital stay was significantly shorter in group B (5 (4-15) vs 10 (10-23) days, p<0.05).
The results of this small series favour the robotic approach for extended thymectomy for myasthenia gravis in respect of both surgical and early neurologic outcome. However, prospective randomized trials are required to prove a general validity.

Full-text

Available from: Philipp Werner, Jun 13, 2014
0 Followers
 · 
96 Views
  • Source
    12/2009; 24(4):269-282.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Robotic thymectomy has been well described for the management of myasthenia gravis and thymic masses. Both short- and long-term safety and efficacy have been demonstrated. Surgical approaches vary, but the technique for thymic dissection and excision is universal.
    Thoracic Surgery Clinics 05/2014; 24(2):197-201. DOI:10.1016/j.thorsurg.2014.02.005 · 0.77 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of the present study was to explore the treatment and outcomes of bilateral craniomaxillofacial post-traumatic deformities with surgical planning, 3-dimensional (3D) model surgery, and preshaped implants. We analyzed the preoperative computed tomography (CT) data and designed preliminary surgical plans for 3 patients with bilateral craniomaxillofacial post-traumatic deformities. 3D resin skull models were produced using rapid prototyping technology, and 3D model surgery was performed to determine the location, reduction direction, and shift distance of the osteotomy and to optimize the surgical plans. Titanium plates or mesh were preshaped on the models and then implanted into the patients. The complications, symmetry of the maxillofacial regions, mouth opening, and occlusion were observed 1 month postoperatively. The patients had good recovery of their facial contour, occlusion, and mouth opening and acceptable symmetry of the bilateral maxillofacial regions. No complications were observed. The combination of surgical planning, 3D model surgery, and preshaped implants can provide surgical accuracy and efficiency and good therapeutic outcomes in the treatment of bilateral craniomaxillofacial post-traumatic deformities.
    Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons 02/2014; DOI:10.1016/j.joms.2014.02.023 · 1.28 Impact Factor