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An early series of patients undergoing simultaneous bilateral thoracoscopy during robotic-assisted thymectomy
Inderpal Sarkaria, MD1, Nicholas Hess, BS2, Neil Christie, MD1, Ryan Levy, MD1, James Luketich, MD1.
1University of Pittsburgh Medical Center, Pittsburgh, PA, USA, 2University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.

OBJECTIVE: : Visualization of the contralateral phrenic nerve can present a challenge during thoracoscopic thymectomy. The purpose of this study was to assess the feasibility of simultaneous ipsilateral and contralateral mediastinal visualization during robotic-assisted thymectomy.
METHODS: This was a retrospective review of our early series of patients undergoing robotic-assisted thymectomy with simultaneous bilateral visualization of the mediastinum using dedicated software available on current robotic platforms
RESULTS: From June 2014 to December 2015, 18 sequential patients underwent robotic-assisted thymectomy with simultaneous ipsilateral and contralateral thoracoscopy. Contralateral mediastinal visualization was achieved through one or two contralateral ports. Thymectomy was most commonly performed for thymoma and thymic cyst/hyperplasia. In one case, ipsilateral en bloc resection of the phrenic nerve was required due to direct tumor invasion. There was one instance of persisted elevation of the ipsilateral hemidiaphragm occurring during nerve separation and skeletonization from a closely adherent tumor. Complete visualization of the bilateral phrenic nerves was achieved in all cases. Patient demographics and perioperative outcomes are reported in Table 1.
CONCLUSIONS: Simultaneous ipsilateral and contralateral mediastial visualization during robotic-assisted thymectomy is feasible and may improve visualization of key structures. Larger studies are needed to evaluate any potential incremental decrease in rates of contralateral nerve injury during these cases.
Patient demographics and preoperative outcomes
Histology; no. (%)
Thymoma; no.8 (44.4%)
Thymic cyst/hyperplasia6 (33.3%)
Other4 (22.2%)
Age; median (IQR), years60 (53-69)
Operating time; median (IQR), min187 (174-210)
Estimated blood loss; median (IQR), mL25 (20-50)
Hospital LOS; median (IQR), days2.5 (2-3)
Phrenic nerve resection1 (5.6%)
Ipsilateral phrenic nerve palsy; no. (%)1 (5.6%)

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