title: Experience with the "da Vinci" robotic system for thymectomy in patients with myasthenia gravis: report of 33 cases.
abstract: BACKGROUND
  Our initial experience in applying robotic-assisted technologies for the treatment of myasthenia gravis (MG) in patients without thymoma is reported.
  
  
  METHODS
  from April 2002 to October 2004, 33 patients (24 females and 9 males; mean age, 41 years), with clinical nonthymomatous myasthenia gravis, underwent robotic thoracoscopic thymectomy using the "da Vinci" (Intuitive Surgical, Inc, Mountain View, CA) system and adopting a 3 port, left-sided approach.
  
  
  RESULTS
  Mean operative time was 120 minutes. No intraoperative complications or surgical mortality is reported and postoperative complications occurred in two patients (6%). Mean hospital stay was 2.6 days (range, 2-14 days). Histologic analysis of surgical specimens revealed 23 hyperplasia, 4 normal thymus, 4 atrophy, and 2 thymomas; in 12 patients (36.3%) ectopic thymic tissue was found. Follow-up evaluation of the first 24 patients (mean, 23.8 months; range, 12-31 months) showed that 4 patients (16.7%) had complete remission and 18 (75%) had significant clinical improvement for a global benefit rate of 91.7%.
  
  
  CONCLUSIONS
  In patients with MG, robot-assisted thymectomy can be performed safely and efficiently. The improved visualization and dexterity of this instrument and its advanced technology may facilitate the minimally invasive approach to the thymus. We prefer to use the left-sided approach because it provides an enhanced visualization of the aortic window and it reduces the probability of phrenic nerves injury. A longer follow-up is necessary to verify long-term clinical results.
authors.affiliation: Division of Thoracic Surgery, University of Padua, Padua, Italy. federico.rea@unipd.it
authors.forename: Federico
authors.initials: F
authors.lastname: Rea
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Marulli
authors.forename: Luigi
authors.initials: L
authors.lastname: Bortolotti
authors.forename: Paolo
authors.initials: P
authors.lastname: Feltracco
authors.forename: Andrea
authors.initials: A
authors.lastname: Zuin
authors.forename: Francesco
authors.initials: F
authors.lastname: Sartori
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D012371:Robotics; D013934:Thymectomy / Q000379:methods*; D016896:Treatment Outcome