Marcin Zieliński1. 1. Department of the Thoracic Surgery, Pulmonary Hospital, Zakopane, Poland.
Abstract
BACKGROUND: The minimally invasive thoracic procedures are those performed through the intercostal, subxiphoid, subcostal or transcervical incisions. In most of these procedures (with exception of some transcervical procedures) the video-assisted thoracic surgery (VATS) technique is used for performance of an operation under guidance of a video monitor. METHODS: According to the definition the minimally invasive procedures do not include the sternal manubriotomy (upper sternal split), transverse sternotomy and subcutaneous longitudinal sternotomy. Currently, a minimally invasive extended thymectomy became a widespread procedure advised for nonthymomatous myasthenia gravis (MG) and early-stage thymomas. The definition of an extended thymectomy is a removal of the whole thymus with the surrounding adipose tissue. Instead of the term "extended thymectomy" some authors recommended a term "complete thymectomy", which means total removal of the whole thymus, without the adjacent fatty tissue. RESULTS: There are a lot of doubts about the definition of extended thymectomy. There have been no prospective randomized trials comparing the transsternal and minimally invasive approaches for MG or thymomas. Possible scenarios for such trials are analyzed in this paper. CONCLUSIONS: There are several issues of a minimally invasive thymectomy for MG and thymomas necessitating further clarifications.
BACKGROUND: The minimally invasive thoracic procedures are those performed through the intercostal, subxiphoid, subcostal or transcervical incisions. In most of these procedures (with exception of some transcervical procedures) the video-assisted thoracic surgery (VATS) technique is used for performance of an operation under guidance of a video monitor. METHODS: According to the definition the minimally invasive procedures do not include the sternal manubriotomy (upper sternal split), transverse sternotomy and subcutaneous longitudinal sternotomy. Currently, a minimally invasive extended thymectomy became a widespread procedure advised for nonthymomatous myasthenia gravis (MG) and early-stage thymomas. The definition of an extended thymectomy is a removal of the whole thymus with the surrounding adipose tissue. Instead of the term "extended thymectomy" some authors recommended a term "complete thymectomy", which means total removal of the whole thymus, without the adjacent fatty tissue. RESULTS: There are a lot of doubts about the definition of extended thymectomy. There have been no prospective randomized trials comparing the transsternal and minimally invasive approaches for MG or thymomas. Possible scenarios for such trials are analyzed in this paper. CONCLUSIONS: There are several issues of a minimally invasive thymectomy for MG and thymomas necessitating further clarifications.
Authors: Faiz Y Bhora; David J Chen; Frank C Detterbeck; Hisao Asamura; Conrad Falkson; Pier Luigi Filosso; Giuseppe Giaccone; James Huang; Jhingook Kim; Kazuya Kondo; Marco Lucchi; Mirella Marino; Edith M Marom; Andrew G Nicholson; Meinoshin Okumura; Enrico Ruffini; Paul Van Schil Journal: J Thorac Oncol Date: 2014-09 Impact factor: 15.609
Authors: J M Buckingham; F M Howard; P E Bernatz; W S Payne; E G Harrison; P C O'Brien; L H Weiland Journal: Ann Surg Date: 1976-10 Impact factor: 12.969