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J Chest Surg

Published online July 13, 2022

Copyright © Journal of Chest Surgery.

Non-intubated Uniportal Subxiphoid Video-Assisted Thoracoscopic Surgery for Extended Thymectomy in Myasthenia Gravis Patients: A Case Series

Marc Hartert, M.D. 1, Jan Tripsky, M.D. 1, Andreas Brandt, M.D. 2, Martin Huertgen, M.D. 1

Departments of 1Thoracic Surgery and 2Anesthesiology, Katholisches Klinikum Koblenz-Montabaur, Koblenz, Germany

Correspondence to:Marc Hartert
Tel 49-261-496-3590
Fax 49-261-496-3599
E-mail m.hartert@kk-km.de
ORCID
https://orcid.org/0000-0003-1217-1555

Received: January 28, 2022; Revised: March 26, 2022; Accepted: May 4, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Minimally invasive strategies are increasingly popular in patients with myasthenia gravis (MG)-associated thymomas. Within the context of video-assisted thoracoscopic surgery (VATS) as a widely known minimally invasive option, the most recent achievement is uniportal subxiphoid VATS. In MG patients, it is mandatory (1) to minimize perioperative interference with administered anesthetics to avoid complications and (2) to achieve a complete surgical resection, as the prognosis essentially depends on radical tumor resection. In order to fulfill these criteria, we merged this surgical technique with its anesthesiologic counterpart: regional anesthesia with the maintenance of spontaneous ventilation via a laryngeal mask. Non-intubated uniportal subxiphoid VATS for extended thymectomy allowed radical thymectomy in all MG patients with both rapid symptom control and fast recovery.

Keywords: Non-intubated surgery, Uniportal video-assisted thoracoscopic surgery, Subxiphoid approach, Thymectomy, Myasthenia gravis, Case report

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J Chest Surg

Published online July 13, 2022

Copyright © Journal of Chest Surgery.

Non-intubated Uniportal Subxiphoid Video-Assisted Thoracoscopic Surgery for Extended Thymectomy in Myasthenia Gravis Patients: A Case Series

Marc Hartert, M.D. 1, Jan Tripsky, M.D. 1, Andreas Brandt, M.D. 2, Martin Huertgen, M.D. 1

Departments of 1Thoracic Surgery and 2Anesthesiology, Katholisches Klinikum Koblenz-Montabaur, Koblenz, Germany

Correspondence to:Marc Hartert
Tel 49-261-496-3590
Fax 49-261-496-3599
E-mail m.hartert@kk-km.de
ORCID
https://orcid.org/0000-0003-1217-1555

Received: January 28, 2022; Revised: March 26, 2022; Accepted: May 4, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Minimally invasive strategies are increasingly popular in patients with myasthenia gravis (MG)-associated thymomas. Within the context of video-assisted thoracoscopic surgery (VATS) as a widely known minimally invasive option, the most recent achievement is uniportal subxiphoid VATS. In MG patients, it is mandatory (1) to minimize perioperative interference with administered anesthetics to avoid complications and (2) to achieve a complete surgical resection, as the prognosis essentially depends on radical tumor resection. In order to fulfill these criteria, we merged this surgical technique with its anesthesiologic counterpart: regional anesthesia with the maintenance of spontaneous ventilation via a laryngeal mask. Non-intubated uniportal subxiphoid VATS for extended thymectomy allowed radical thymectomy in all MG patients with both rapid symptom control and fast recovery.

Keywords: Non-intubated surgery, Uniportal video-assisted thoracoscopic surgery, Subxiphoid approach, Thymectomy, Myasthenia gravis, Case report

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