Document Detail

Robotic-assisted thymectomy with Da Vinci II versus sternotomy in the surgical treatment of non-thymomatous myasthenia gravis: early results.
MedLine Citation:
PMID:  22682054     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The role of thymectomy in myasthenia gravis remains controversial. The remission rate 5years after surgery varies from 13 to 51% in the literature. Sternotomy is the standard technique, though unacceptable by patients because of significant esthetic sequelae. Our objective was to demonstrate that the robot-assisted technique using the Da Vinci Surgical Robot II is at least as efficient and leaves fewer scars than the standard surgical technique.
METHODS: We retrospectively reviewed the data of 31 consecutive patients suffering from myasthenia gravis who underwent surgery in our center from January 1998 to March 2010. Ten patients with thymoma were excluded from this study. Two groups were formed: group 1 corresponding to patients treated with sternotomy, group 2 patients with robot-assisted technique. The duration of the hospital stay, the pain on D1, the degree of improvement at 1year according to Myasthenia Gravis Foundation of America (MGFA) classification, the frequency of relapses, and perioperative treatment were studied.
RESULTS: Our sample consisted of 14 women and seven men. The mean age was 31.3years. The mean delay before surgery was 24months. Group 1 included 15 patients and group 2 had six patients. The complete remission rate at 1year was 9.5% (n=2). Surgery decreased the frequency of relapses after surgery (P=0.08) equally in the two groups. The duration of hospital stay and the pain level on D1 in group 2 were significantly lower than those in group 1 (P=0.02 and P<0.001). The degree of postoperative improvement was not significantly different between the two groups (P=0.31).
CONCLUSION: The results at 1year are fully comparable for sternotomy and the robot-assisted technique. The robot provides additional benefits of minimally invasive techniques: minimal esthetic sequelae in often young patients, less parietal morbidity (including pain), shorter hospital stays. Our complete remission rate, lower than those in the literature, must be considered taking into account the early nature of these results. The surgical robot, because of its many advantages, appears to be a promising technique and should facilitate the early management of these patients.
S Renaud; N Santelmo; M Renaud; M-C Fleury; J De Seze; C Tranchant; G Massard
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2012-06-06
Journal Detail:
Title:  Revue neurologique     Volume:  169     ISSN:  0035-3787     ISO Abbreviation:  Rev. Neurol. (Paris)     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-02-04     Completed Date:  2013-07-18     Revised Date:  2013-09-21    
Medline Journal Info:
Nlm Unique ID:  2984779R     Medline TA:  Rev Neurol (Paris)     Country:  France    
Other Details:
Languages:  eng     Pagination:  30-6     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Elsevier Masson SAS. All rights reserved.
Service de chirurgie thoracique, pôle de pathologie thoracique, hôpitaux universitaires de Strasbourg, Nouvel Hôpital Civil, 1, place de l'Hôpital, BP 426, 67091 Strasbourg cedex, France.
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MeSH Terms
Anesthesia, General
Length of Stay
Middle Aged
Myasthenia Gravis / surgery*
Neurosurgical Procedures / instrumentation*,  methods*
Postoperative Complications / epidemiology
Sternotomy / methods*
Thymectomy / methods*
Thymus Hyperplasia / surgery
Treatment Outcome
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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