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Primary Exploration Of Tubeless Robot-assisted Thymectomy For Myasthenia Gravis
Minghui Zhu1, Yujun Lian2, Jinglong Li1, Dazhi Pang1, Rutaiyang Liu1, Yanan Liang1, Zhihai Liu1, Guangqiang Shao1, Jianguo Lu1, Jitian Zhang1.
1Department of Thoracic Surgery, The University of Hong Kong-Shenzhen hospital, Shenzhen, China, 2Department of Anesthesiology, The University of Hong Kong-Shenzhen hospital, Shenzhen, China.

BACKGROUND: In order to accelerate recovery of myasthenia gravis (MG) patients, and avoid the adverse effects of muscle relaxants on them, we explored and evaluated a new tubeless (general anesthesia without endotracheal intubation, urinary catheterization and thoracic drainage tube) approach to perform robot-assisted thoracoscopic thymectomy for MG.
METHODS: The clinical characteristics of 13 patients who were diagnosed as MG and underwent a tubeless RATS thymectomy in our center from February 2022 to September 2022 were collected. All included patients were required these criterias:16-60 years old, American Society of Anesthesiologists (ASA) grade ≤ II, no history of thoracic surgery and no coexisting urinary diseases, etc.
RESULTS: All patients (Myasthenia Gravis Foundation of America (MGFA) Classification I:4, II A:1, II B:2, III A:1 and III B:5, median [interquartile range] age: 25[19-40] years old) underwent operation uneventfully without muscle relaxants, tracheal intubation, urinary catheterization and thoracic drain. No significant complications were seen, and none of them converted to a median thoracotomy approach intraoperatively. The anesthesia and operating time were 27[25-33] and 129[114-148] min, respectively. The blood loss was 10[10-10] ml. The awakening time was 2[1-8] min and the Post-anesthesia Care Unit (PACU) stay time was 41[36-56] min. None of patients complained of significant pain and the pain Visual Analog Scale (VAS) scores were 1.9 0.2, 1.8 0.1, and 1.8 0.1 on the operative day, 1st postoperative day and 2nd postoperative day, respectively. The difference value in Quantitative Myasthenia Gravis (QMG) scores between the preoperative and 2nd postoperative day was 2[1.5-3.5], and the one in Myasthenia Gravis-Activities of Daily Living (MG-ADL) scores was 1[0-1]. All patients had no need for chest drainage in general ward and they were discharged on the 2nd-6th day (postoperative hospitalization was 4[2-5] days) respectively after surgery.
CONCLUSIONS: The tubeless RATS thymectomy for MG is feasible in partial selected patients. Muscle relaxants, tracheal intubation, urinary catheterization and thoracic drain are not crucial in all MG cases.

Perioperative clinical characteristics
VariableTubeless RATS group
Anesthetic induction duration (min)27 (25-33)
Operative time (min)129 (114-148)
Intraoperative blood loss (ml)10 (10-10)
Awakening time (min)2 (1-8)
Stay in PACU (min)41 (36-56)
Postoperative hospital stay (day)4 (2-5)
D-value of QMG score2 (1.5-3.5)
D-value of MG-ADL score1 (0-1)
Postoperative pain VAS score1.9 0.2


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