Left Side Robotic Approach for Extended Thymectomy: Surgical Technique and Preliminary Experience

Rapid Communication

Austin J Surg. 2016; 3(3): 1090.

Left Side Robotic Approach for Extended Thymectomy: Surgical Technique and Preliminary Experience

Pardolesi A* and Spaggiari L

Division of Thoracic Surgery, University of Milan School of Medicine, Italy

*Corresponding author: Pardolesi A, Division of Thoraci Surgery, European Institute of Oncology, University of Milan School of Medicine, Via Giuseppe Ripamonti 435, 20141 Milan, Italy

Received: September 14, 2016; Accepted: October 13, 2016; Published: October 19, 2016

Abstract

Background: Most published reports regarding minimally invasive approach for non invasive thymoma have focused on the right approach. In our early experience with robot-assisted thymectomies we adopted a left side three ports approach. We report our surgical technique for robotic extended thymectomy for early stage thymoma and early surgical outcome.

Method: We retrospectively reviewed all patients undergoing robotic thymectomy for clinical early-stage thymoma at the European Institute of Oncology, Milan Italy.

The preoperative work up included a Chest Computer Tomography scan and PET scan in all patients.

Results: From January 2010 to December 2015, 20 robotic extended thymectomies were performed. All patients were approached from the left side. There was no major post-operative complications only one case of atrial fibrillation (1 out of 20 patients).

Conclusion: The results of our initial experience showed that the left side robotic approach is a safe procedure and oncologically feasible for non-invasive thymomas.

Keywords: Human; Myasthenia gravis; Thymoma; Minimally invasive surgery; Robotic surgery; RATS

Introduction

Over the past 10 years video-assisted thoracoscopic approach, and more recently robot-assisted surgery, has replaced median sternotomy for resectable anterior mediastinal mass, including thymoma [1,2].

In our early experience with robot-assisted thymectomies we adopted a left side three ports approach. The left sided approach provide a clear view of the surgical field and the anatomical landmarks, phrenic nerves, in nominate vein and superior cava vein, are easily identifiable [3].

The aim of this “how to do it” is to describe our robotic extended thymectomy technique for early stage thymoma and to report early surgical outcome.

Surgical Technique

Patient selection

a. Nonthymomatous myasthenia gravis

b. Small (< 2cm) intrathymicthymoma

c. Large well encapsulated thymoma (preferably <4cm)

d. Minimally invasive thymoma

Patient positioning and port placement

Under general anesthesia with double lumen intubation, patient is positioned in a 30 degree semi-supine position, left side up, with a roll placed under the left shoulder for a better left chest exposition. The right arm is right extended on a padded board. This approach allows access to the right side in case of need (Figure 1).

Citation: Pardolesi A and Spaggiari L. Left Side Robotic Approach for Extended Thymectomy: Surgical Technique and Preliminary Experience. Austin J Surg. 2016; 3(3): 1090. ISSN : 2381-9030