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REVIEW PAPER
Surgical treatment of myasthenia gravis using a robotic system – a literature review and a description of the first surgery in Poland
 
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1
Wojskowy Instytut Medyczny – Państwowy Instytut Badawczy, Klinika Chirurgii Ogólnej, Onkologicznej, Metabolicznej i Torakochirurgii, Polska
 
2
Klinika Chirurgii Dziecięcej, Instytut Pediatrii Collegium Medicum, Uniwersytet Jagielloński, Polska
 
3
Wojskowy Instytut Medyczny – Państwowy Instytut Badawczy, Centrum Chirurgii Robotycznej, Polska
 
4
Oddział Chirurgii Klatki Piersiowej z Pododdziałem Chirurgii Onkologicznej, Szpital Chorób Płuc "Odrodzenie" im. Klary Jelskiej, Polska
 
 
Submission date: 2023-07-07
 
 
Acceptance date: 2023-09-04
 
 
Publication date: 2024-05-13
 
 
Corresponding author
Michał Wiłkojć   

Wojskowy Instytut Medyczny – Państwowy Instytut Badawczy, Klinika Chirurgii Ogólnej Onkologicznej, Metabolicznej i Torakochirurgii, Warszawa
 
 
LW 2024;102(1):12-16
 
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ABSTRACT
Introduction and objective: Surgical treatment of Myasthenia Gravis (MG) with a use of the robotic system has been applied worldwide foSurgical treatment of myasthenia gravis with a use of the robotic system has been applied worldwide over past 20 years. On February 22, 2022, for the first time in Poland, extended thymectomy using robot-assisted thoracoscopic surgery approach was performed at the Military Institute of Medicine – National Research Institute in Warsaw. Material and methods: Three port, left-sided approach with CO2 insufflation was performed. The left phrenic nerve was located and left lower pole of the thymus with fat of the left diaphragmatic angle was dissected. Further dissection of the thymus from the pericardial sac and along the left phrenic nerve with visualisation of the left brachiocephalic vein up to the level of the thyroid lobes was performed. Thymic veins were managed and the upper poles of the thymus were dissected. Right pleural cavity was opened and thymus was removed along right phrenic nerve with right lower pole of the thymus and surrounding fat tissue of right diaphragmatic angle. Specimen was removed and both pleural cavities were drained using single 24 Fr drain. Results: The operative time was 162 minutes, postoperative course was uneventful. The total postoperative drainage measured 50 ml and chest tube was removed on the first postoperative day. The amount of pain the patient suffered was moderate. The patient was discharged from the hospital on the second postoperative day. On the pathological study an atrophic thymus with mediastinal lymph nodes and fatty tissue were found. Conclusions: Robot-assisted thoracoscopic surgery extended thymectomy allowed for safe and radical resection of the thymus and surrounding fat tissue with a reduction in the time of hospitalization.
eISSN:1509-5754
ISSN:0024-0745
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