International Society for Minimally Invasive Cardiothoracic Surgery

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Robotic Thymectomy In Myasthenic Patients: Single Center Experience
Gianmarco Elia1, Carmelina Cristina Zirafa2, Alessandra Lenzini1, Melania Guida3, Michelangelo Maestri3, Gaetano Romano4, Federico Davini4, Franca Melfi4
1Department of surgical, medical, molecular, and critical area pathology, University of Pisa - Division of Thoracic Surgery, Pisa, Italy, Pisa, Italy, PISA, Italy, 2Minimally invasive and robotic thoracic surgery - surgical, medical, molecular and critical car, University of Pisa, Pisa, Italy;, PISA, Italy, 3Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy., PISA, Italy, 4Minimally invasive and robotic thoracic surgery - surgical, medical, molecular and critical care, University of Pisa, Pisa, Italy;, PISA, Italy

BACKGROUND:Myasthenia gravis (MG) is a chronic autoimmune disease, classified into different stages, depending on ocular, bulbar and respiratory symptoms.Thymectomy is the only strategic intervention capable of modifying the natural history of the disease, in terms of reducing symptoms and specific therapy.In recent years, several studies have demonstrated its feasibility and effectiveness.This study aims to analyse the neurological outcomes of thymectomy, using an exclusive robotic approach, in patients suffering from MG , with exclusive ocular symptoms. METHODS:From January 2018 to December 2023, 25 thymectomy were performed at our center (4 patients with thymus involution and 21 with a thymic hyperplasia).The surgeries were performed under general anesthesia, using a left surgical approach, with selective orotracheal intubation. RESULTS:The average duration of surgery was 115.4 minutes, (range 65-290). No postoperative complications was observed in 24 cases (96%) , while in 1 (4%) case pneumonia occurred, treated with medical therapy. The average postoperative hospital stay was 3 days (range 2-5), while the average duration of drainage was 2 days (range 1-3). At an average follow-up of 48 months (range 3-72) all patients examined were alive, and 20 patients (80%) reduced the dosage of corticosteroid therapy, while 5 (20%) suspended it. In terms of persistence of ocular symptoms, in 23 patients (92%) there was a complete regression, while in 2 patients (8 %) there was a persistence of mild diplopia.
CONCLUSIONS:Robotic surgery appears to be a safe, feasible and accurate minimally invasive approach to thymectomy in the treatment of patients with exclusive ocular MG, providing satisfactory neurological outcomes, although limited to a small sample, allowing good disease control, reducing side effects due to steroid therapy, in line with what has been published in other studiesFurther studies with a larger series of cases will be necessary.


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