Tugba Cosgun

Video-assisted thoracoscopic thymectomy for myasthenia gravis: where we are

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.

Robotic thymectomy—a new approach for thymus

Advancements in modern technology bring many evolutions in minimally invasive surgery such as robot assisted approaches. Because of complete resection is so important in thymectomy operations, they became a new era for robotic surgery as a result of its superiorities (intuitive movements, tremor filtration, more degrees of manipulative freedom, motion scaling, and high-definition stereoscopic vision).

Can the da Vinci robotic system be alternative to open surgery for schwannoma in posterior mediastinum

OBJECTIVE: In the present study, the outcomes and technical details of patients who underwent surgical resection for benign schwannoma with the da Vinci robotic system are presented. MATERIALS AND METHODS: In the scope of our robotic surgery program, 26 (8.7%) patients out of 296 patients were operated using the da Vinci robotic system. Five patients (19.2%) who underwent surgery of benign schwannoma were included in the study. Prospectively, collected data of these patients were retrospectively evaluated. Age, gender, robot docking and console times, length of hospital stay, anatomic localizations of the lesions, pathology results, blood infusion needs, and mortality and morbidity rates of the patients were recorded. RESULTS: All patients were male, and the mean age was 43.2 ± 12.1 years. The mean length of hospital stay was 3 ± 0.9 days. The mean console time was 27.6 ± 18.8 min, and the mean docking time was 12 ± 4 min. None of the patients received blood transfusion. Utility incision was made in only one patient. Postoperative ptosis was detected in two patients with tumors where located in the apical region, and no mortality occurred. CONCLUSION: Due to the advantages of robotic surgery to the surgeon, patients with schwannoma in extreme locations that would pose challenges in dissection could be operated with da Vinci system.

Robot-Assisted Thoracoscopic Surgery: Pros and Cons

Purpose of ReviewIn the last two decades, minimally invasive approaches for thoracic surgery have become the major challenge in the field of thoracic surgery. These techniques became preferable over open surgery (thoracotomy) in terms of reducing pain and having aesthetic advantages. However, patient selection is one of the most important factors for minimally invasive surgery because of related limitations and insufficiency of video-assisted thoracoscopic surgery (VATS).Recent FindingsRobot-assisted thoracoscopic surgery (RATS) has been developed to overcome the limitations of VATS. Better flexibility and transmission the surgeon’s convenient manoeuvrability in the thoracic cavity are some of the advantages of robotic surgery.SummaryThis paper focuses on the advantages and disadvantages of RATS in comparison to that of VATS and thoracotomy.