Jens C. Ruckert1, Marc Swierzy1, Mahmoud Ismail1, Patrik Rogalla2, Ralph I. Ruckert3, Andreas Meisel4.
1Universitätsmedizin Berlin-Departments of Surgery, Berlin, Germany, 2Universitätsmedizin Berlin-Departments of Radiology, Berlin, Germany, 3University Medicine Berlin (Charité), Berlin, Germany, 4Universitätsmedizin Berlin- Department of Neurology, Berlin, Germany.
OBJECTIVE:
Complete thymectomy (Thx) is necessary for all cases of thymoma and for most patients with myasthenia gravis (MG), a muscle-debilitating autoimmune disease. More than 14 different surgical approaches for Thx have been developed due to the anatomical distribution of thymic tissue in both compartments of neck and thoracic cavity. Since January 2003, we are able to proceed with the minimally- invasive approach using the da Vinci-robotic system. We are presenting the largest single centre study.
METHODS:
A prospective study analyzed 129 consecutive robotic-asstisted thymectomies (rThx) (01/2003-12/2007) by a 3-trocar left-sided technique using the da Vinci- robotic system (Intuitive Surgical, Sunnyvale, CA, USA). Technical refinements of rThx were compared to conventional thoracoscopic technique, median sternotomy, and cervical approach. All patients with MG (118 of 129) were analyzed for quantification of improvement of MG and postoperative morbidity according to the Myasthenia Gravis Foundation of America (MGFA) classification. Furthermore, the worldwide development of rThx was analysed.
RESULTS:
Complete rThx required 184 +/-52 minutes (90-360). The conversion rate was 2.3% (3 of 129, all with thymoma). With zero mortality the overall postoperative morbidity rate was 1.2%. The dominant histological finding was follicular hyperplasia of the thymus (55/129, 47%). The cumulative complete stable remission rate of MG is > 40% with a median follow up of 16 months (0-58). There was no recurrence after rThx for thymoma (14/129). Until 11/2006, 608 rThx had been carried out by 39 institutions. These numbers are increasing rapidly. The present series represents the largest single-center experience to date.
CONCLUSIONS:
Advantages of rThx for mediastinal dissection in 118 patients with MG translated into improved outcome for MG, as compared with conventional thoracoscopic Thx. Therefore rThx proved to be the most promising technique for minimally-invasive Thx.
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