International Society For Minimally Invasive Cardiothoracic Surgery

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Unilateral Transthoracic Two Port Approach For Robotic Thymectomy
Kook Nam Han, Hyun Koo Kim, Jeong In Hong.
Korea University Guro Hospital, Seoul, Korea, Republic of.

OBJECTIVE: Robotic surgery for thymic tumors is becoming increasingly popular in recent era. We performed robotic extended thymectomy for early stage thymoma using two-port technique with three-robotic arms. We evaluated its feasibility and safety or technical limitations during procedure.
METHODS: The patient was a 51-year old female with anterior mediastinal tumor suspecting thymic tumor. She has no neurologic symptoms such as myasthenia gravis. For two-ports approach, the patient was positioned in left semi-lateral decubitus (30 degree) with arm elevation and one lung ventilation anesthesia. We made a 3-cm incision at 5th intercostal space and another 8-mm incision at 4th intercostal space. A Multi-hole port device combined with wound retractor was applied to 3-cm incisional wound and we infused CO2 gas to insufflation port.
RESULTS: Complete extended thymectomy was performed including mediastinal fat tissue from medial side of phrenic nerve and bilateral upper and lower cervical from right unilateral approach. We could approach to the contralateral thorax with wristed robotic devices. However, we could not identify the left phrenic nerve from right unilateral approach. Operation time was 145 minutes and there was no operative morbidity. The chest drain was removed at postoperative 2 days and the patients discharged at postoperative 3 days.
CONCLUSIONS: Two-port approach for robot thymectomy might be feasible option for minimal invasive thoracic surgery with the use of multi-hole port device.


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