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Thoracoscopic thymectomy using a subxiphoid camera port
Thoracoscopic thymectomy is currently considered the approach of choice for the treatment of thymic conditions, including myasthenia gravis (MG). It has demonstrated advantages over open approaches, because it reduces postoperative pain, hospital stay, blood loss, promotes early patient discharge, and provides cosmetic improvement. The use of a subxiphoid access, either as a single port or camera-assistant port, grants even greater benefits as it allows the following: visualization of the phrenic nerve to the contralateral phrenic nerve, reaching all the thymus poles and the lower limit of the thyroid gland, peritracheal fat and aortopulmonary window, pericardial dissection and bilateral epiphrenic fat removal. In addition, it facilitates bilateral exploration through a pleural opening without the need to place another trocar on the left, and the use of carbon dioxide throughout the surgery, thereby avoiding sternal retraction. The dissection through the correct planes, and the systematization of the operative technique might reduce time and improve outcomes.
I Sastre, M España, R Ceballos, M Bustos
Хирургические операции
2 месяца назад
1090 просмотров
18 лайков
4 комментария
08:10
Thoracoscopic thymectomy using a subxiphoid camera port
Thoracoscopic thymectomy is currently considered the approach of choice for the treatment of thymic conditions, including myasthenia gravis (MG). It has demonstrated advantages over open approaches, because it reduces postoperative pain, hospital stay, blood loss, promotes early patient discharge, and provides cosmetic improvement. The use of a subxiphoid access, either as a single port or camera-assistant port, grants even greater benefits as it allows the following: visualization of the phrenic nerve to the contralateral phrenic nerve, reaching all the thymus poles and the lower limit of the thyroid gland, peritracheal fat and aortopulmonary window, pericardial dissection and bilateral epiphrenic fat removal. In addition, it facilitates bilateral exploration through a pleural opening without the need to place another trocar on the left, and the use of carbon dioxide throughout the surgery, thereby avoiding sternal retraction. The dissection through the correct planes, and the systematization of the operative technique might reduce time and improve outcomes.
Complex robotic resection of a large middle mediastinal thymoma
A 62-year-old man had an asymptomatic middle mediastinal tumor with a 4.5cm diameter, opposite to the superior vena cava and the azygos vein in the Barety’s space, which was discovered on thoracic CT-scan performed during an urothelial tumor follow-up.
Past history includes an urothelial carcinoma grade I treated with transurethral cystectomy, an ischemic cardiopathy with a single medical treatment, a prostate hypertrophy, and a sigmoid diverticulosis.
After a multidisciplinary review of the case, a mediastinoscopy was performed. It demonstrated the presence of a thymoma.
The patient was well informed of the operative risks and of the possibility of conversion, but thanks to our experience and national recommendations, we were able to perform a radical robotic assisted thymectomy.
The operation took during 3 hours with less than 100cc of bleeding.
The postoperative course was uneventful and the patient was discharged on postoperative day 3.
Histopathological analysis showed a type AB thymoma according to the OMS 2015 classification. The staging was IIb according to Masaoka. No adjuvant radiotherapy was indicated.
A Boutin, M Sarsam, M Lair, N Piton, C Peillon, JM Baste
Хирургические операции
3 года назад
982 просмотра
66 лайков
1 комментарий
07:38
Complex robotic resection of a large middle mediastinal thymoma
A 62-year-old man had an asymptomatic middle mediastinal tumor with a 4.5cm diameter, opposite to the superior vena cava and the azygos vein in the Barety’s space, which was discovered on thoracic CT-scan performed during an urothelial tumor follow-up.
Past history includes an urothelial carcinoma grade I treated with transurethral cystectomy, an ischemic cardiopathy with a single medical treatment, a prostate hypertrophy, and a sigmoid diverticulosis.
After a multidisciplinary review of the case, a mediastinoscopy was performed. It demonstrated the presence of a thymoma.
The patient was well informed of the operative risks and of the possibility of conversion, but thanks to our experience and national recommendations, we were able to perform a radical robotic assisted thymectomy.
The operation took during 3 hours with less than 100cc of bleeding.
The postoperative course was uneventful and the patient was discharged on postoperative day 3.
Histopathological analysis showed a type AB thymoma according to the OMS 2015 classification. The staging was IIb according to Masaoka. No adjuvant radiotherapy was indicated.
Robotic assisted resection of a complex thymoma
Our objective is to demonstrate the management of a very complex mediastinal tumor. To do so, a minimally invasive resection is used, highlighting the benefit of a robotic approach.
The present case is that of a 64-year-old patient diagnosed with an anterior mediastinal mass discovered during myasthenia assessment with positive antibodies.
The tumor was in contact with the aorta, pulmonary artery, and the innominate vein with probable pericardial invasion.
Given such a complex localization, the challenge was to propose a radical resection using minimally invasive surgery with robotic assistance.
As compared to a VATS approach, a robotic approach provides a better view and instruments to achieve complete resection in complex mediastinal tumor. What is important to first control on the CT-scan is the size of the tumor as compared to the thoracic cavity’s size which will allow robotic surgery with a good operative field.
Pericardial resection associated with a lateral plasty of the innominate vein were required to achieved complete R0 resection. The entire resection was performed using a bipolar forceps.
The postoperative course was uneventful. The patient is discharged on postopeartive day 3. The phrenic nerve was preserved.
Pathological analysis of the operative specimen is evocative of a B1 thymoma classified IIb on the Masaoka staging system with complete R0 resection (margins were clear).
The entire file was discussed at the Rhythmic meeting, which is the national meeting for thymoma tumor management held every two weeks. A simple survey was put forward without any adjuvant radiotherapy.
JM Baste, E Roussel, L Haddad, C Peillon
Хирургические операции
5 лет назад
1196 просмотров
26 лайков
0 комментариев
07:19
Robotic assisted resection of a complex thymoma
Our objective is to demonstrate the management of a very complex mediastinal tumor. To do so, a minimally invasive resection is used, highlighting the benefit of a robotic approach.
The present case is that of a 64-year-old patient diagnosed with an anterior mediastinal mass discovered during myasthenia assessment with positive antibodies.
The tumor was in contact with the aorta, pulmonary artery, and the innominate vein with probable pericardial invasion.
Given such a complex localization, the challenge was to propose a radical resection using minimally invasive surgery with robotic assistance.
As compared to a VATS approach, a robotic approach provides a better view and instruments to achieve complete resection in complex mediastinal tumor. What is important to first control on the CT-scan is the size of the tumor as compared to the thoracic cavity’s size which will allow robotic surgery with a good operative field.
Pericardial resection associated with a lateral plasty of the innominate vein were required to achieved complete R0 resection. The entire resection was performed using a bipolar forceps.
The postoperative course was uneventful. The patient is discharged on postopeartive day 3. The phrenic nerve was preserved.
Pathological analysis of the operative specimen is evocative of a B1 thymoma classified IIb on the Masaoka staging system with complete R0 resection (margins were clear).
The entire file was discussed at the Rhythmic meeting, which is the national meeting for thymoma tumor management held every two weeks. A simple survey was put forward without any adjuvant radiotherapy.
Robotic assisted thymectomy for the management of autoimmune myasthenia gravis
We present the case of a 16-year-old female patient who has had an autoimmune myasthenia gravis for 8 months.

Symptoms are generalized to her four arms. Anti-acetylcholine antibodies and the therapeutic test of Mestinon® (Pyridostigmine) are positive.
In recent months, her symptoms worsened with the onset of swallowing disorders.

Immunoglobulin treatment was poorly effective and was complicated by the appearance of jaundice. CT-scan showed a mediastinal thymic hyperplasia.
Thymectomy is indicated. To do so, a left thoracoscopy is performed and assisted by means of the Da Vinci™ robot.

Pathological findings demonstrated the presence of a lymphoid thymic hyperplasia.

The use of the Da Vinci® robot for this type of intervention has been recognized many years ago now with the works of Federico Rea and Jens Ruckert among others. The advantage of this technique is the possibility to proceed with a radical thymectomy enlarged to the mediastinal fat exactly in the same way as for a median sternotomy, which is the standard technique. When compared to thoracoscopy, the advantage stems from 3D vision, segmentation of the operator’s movements, and exceptional maneuverability of the instruments which have 7 degrees of freedom. These instruments allow for an access to the lower cervical area without the use of a cervicotomy. The choice of the left side is explained by the need to identify the phrenic nerve’s position, which is more difficult to predict than the right nerve’s position, which can be easily identified on the right lateral aspect of the superior vena cava.
N Santelmo, A Olland
Хирургические операции
7 лет назад
1883 просмотра
23 лайка
0 комментариев
11:26
Robotic assisted thymectomy for the management of autoimmune myasthenia gravis
We present the case of a 16-year-old female patient who has had an autoimmune myasthenia gravis for 8 months.

Symptoms are generalized to her four arms. Anti-acetylcholine antibodies and the therapeutic test of Mestinon® (Pyridostigmine) are positive.
In recent months, her symptoms worsened with the onset of swallowing disorders.

Immunoglobulin treatment was poorly effective and was complicated by the appearance of jaundice. CT-scan showed a mediastinal thymic hyperplasia.
Thymectomy is indicated. To do so, a left thoracoscopy is performed and assisted by means of the Da Vinci™ robot.

Pathological findings demonstrated the presence of a lymphoid thymic hyperplasia.

The use of the Da Vinci® robot for this type of intervention has been recognized many years ago now with the works of Federico Rea and Jens Ruckert among others. The advantage of this technique is the possibility to proceed with a radical thymectomy enlarged to the mediastinal fat exactly in the same way as for a median sternotomy, which is the standard technique. When compared to thoracoscopy, the advantage stems from 3D vision, segmentation of the operator’s movements, and exceptional maneuverability of the instruments which have 7 degrees of freedom. These instruments allow for an access to the lower cervical area without the use of a cervicotomy. The choice of the left side is explained by the need to identify the phrenic nerve’s position, which is more difficult to predict than the right nerve’s position, which can be easily identified on the right lateral aspect of the superior vena cava.
Robot-assisted left video thoracoscopic partial thymectomy for mediastinal ectopic parathyroid adenoma
This film presents the case of an 85-year-old man who suffered from primary hyperparathyroidism diagnosed on a pathological cervical fracture and elevated laboratory values for parathyroid hormone and calcium. Preoperative localizing studies showed no anomalies on the parathyroid gland. However, a left anterior mediastinal ectopic parathyroid adenoma was found on 99m Tc-MIBI scintigraphy.
Mediastinal parathyroid adenomas can be resected in a minimally invasive fashion via a conventional transcervical approach, or using a video-assisted thoracoscopic resection, allowing for an access to the lower cervical area without the use of a cervicotomy. Robotic-assisted thoracic surgery (RATS) also allows for a better visualization and less instrument crowding, with no difference in clinical results.
Considering the good efficacy and the better chances not to leave tumor tissue missed out during surgery, and the impossibility to install the patient with cervical hyperextension, we decided to perform a robot-assisted thoracoscopy through a left-sided approach, instead of the conventional transcervical approach.
During the intraoperative period, the adenoma was identified, and we did not feel the need to perform PTH assay. There were no complications in the postoperative period. PTH levels reached a normal range after adenoma removal, and the patient was discharged on postoperative day 3. He remains asymptomatic at 3 months after the intervention.
The robotic resection of an intrathymic parathyroid adenoma is a safe and effective alternative to the conventional transcervical approach.
JM Baste, M Dazza, C Peillon
Хирургические операции
6 лет назад
1075 просмотров
29 лайков
1 комментарий
06:54
Robot-assisted left video thoracoscopic partial thymectomy for mediastinal ectopic parathyroid adenoma
This film presents the case of an 85-year-old man who suffered from primary hyperparathyroidism diagnosed on a pathological cervical fracture and elevated laboratory values for parathyroid hormone and calcium. Preoperative localizing studies showed no anomalies on the parathyroid gland. However, a left anterior mediastinal ectopic parathyroid adenoma was found on 99m Tc-MIBI scintigraphy.
Mediastinal parathyroid adenomas can be resected in a minimally invasive fashion via a conventional transcervical approach, or using a video-assisted thoracoscopic resection, allowing for an access to the lower cervical area without the use of a cervicotomy. Robotic-assisted thoracic surgery (RATS) also allows for a better visualization and less instrument crowding, with no difference in clinical results.
Considering the good efficacy and the better chances not to leave tumor tissue missed out during surgery, and the impossibility to install the patient with cervical hyperextension, we decided to perform a robot-assisted thoracoscopy through a left-sided approach, instead of the conventional transcervical approach.
During the intraoperative period, the adenoma was identified, and we did not feel the need to perform PTH assay. There were no complications in the postoperative period. PTH levels reached a normal range after adenoma removal, and the patient was discharged on postoperative day 3. He remains asymptomatic at 3 months after the intervention.
The robotic resection of an intrathymic parathyroid adenoma is a safe and effective alternative to the conventional transcervical approach.
Robotic thymectomy for autoimmune myasthenia gravis
We present the case of a 27-year-old woman who has had an autoimmune myasthenia gravis for 6 months. The current treatment essentially includes anticholinesterasics, but no use of corticosteroids. Thymectomy is indicated in the presence of thymic hyperplasia visible on a thorax CT-scan with contrast injection. The use of the da Vinci robot for this type of intervention has been recognized many years ago now with the work of Federico Rea and Jens Ruckert amongst others. The advantage of this technique is the possibility to proceed with a radical thymectomy enlarged to the mediastinal fat exactly in the same way as for a median sternotomy which is the standard technique. When compared with thoracoscopy, the advantage stems from 3D vision, segmentation of the operator’s movements and exceptional maneuverability of the instruments which have 7 degrees of freedom. These instruments allow for an access to the lower cervical area without the use of a cervicotomy. The choice of the left side is explained by the need to identify the phrenic nerve’s position, which is more difficult to predict than the right nerve’s position, which can be easily identified on the right lateral aspect of the superior vena cava.
The video is followed by an interview with Professor Marescaux (MD, FACS, Hon FRCS, Hon JSES) and Doctor Santelmo (MD, FETCS) about robotic thymectomy, comparing it with Novellino's procedure and discussing the ways in which this technique pushes robotic surgery forward.
N Santelmo, S Renaud, J Marescaux
Хирургические операции
8 лет назад
1981 просмотр
18 лайков
0 комментариев
12:14
Robotic thymectomy for autoimmune myasthenia gravis
We present the case of a 27-year-old woman who has had an autoimmune myasthenia gravis for 6 months. The current treatment essentially includes anticholinesterasics, but no use of corticosteroids. Thymectomy is indicated in the presence of thymic hyperplasia visible on a thorax CT-scan with contrast injection. The use of the da Vinci robot for this type of intervention has been recognized many years ago now with the work of Federico Rea and Jens Ruckert amongst others. The advantage of this technique is the possibility to proceed with a radical thymectomy enlarged to the mediastinal fat exactly in the same way as for a median sternotomy which is the standard technique. When compared with thoracoscopy, the advantage stems from 3D vision, segmentation of the operator’s movements and exceptional maneuverability of the instruments which have 7 degrees of freedom. These instruments allow for an access to the lower cervical area without the use of a cervicotomy. The choice of the left side is explained by the need to identify the phrenic nerve’s position, which is more difficult to predict than the right nerve’s position, which can be easily identified on the right lateral aspect of the superior vena cava.
The video is followed by an interview with Professor Marescaux (MD, FACS, Hon FRCS, Hon JSES) and Doctor Santelmo (MD, FETCS) about robotic thymectomy, comparing it with Novellino's procedure and discussing the ways in which this technique pushes robotic surgery forward.