The comparison of modified minimally invasive and open surgical approaches in the treatment of epithelial thymic tumours.

OBJECTIVES: Exploring the efficacy of a modified combined minimally invasive approach in patients with thymoma regardless of myasthenia gravis involvement in contrast to open surgery as the mainstay of treatment. BACKGROUND: Primary epithelial thymic tumours are rare malignancies of the anterior mediastinum, often present with myasthenia gravis, and with good prognosis when assuming complete surgical resection. We present a modified mini-invasive technique (MIT) that is unique in its extent. METHODS: Fifty-two patients were included in this retrospective study. Two groups of patients who had undergone different types of surgery were compared using the Mann-Whitney test (ordinal variables) and Fisher's exact test (binary variables). Changes after completing the surgical learning curve were observed. RESULTS: There was a statistical difference when comparing early Masaoka stages (I‒II) with later stages in favour of the mini-invasive method (p=0.013). The duration of surgery was longer in the mini­invasive group with a median value of 260 vs 133 min (p=0.001). The analysis of operation times revealed that after overcoming the learning curve period, the duration of surgery decreased (2008‒2012: 297 min; 2013‒2018: 199 min; p=0.005). The systemic complication rate was lower in the mini­invasive method (26.1 % vs 3.4 %; p=0.035). CONCLUSION: Our results showed the modified maximal minimally invasive thymectomy to be an effective and safe method, and after overcoming the learning curve, even superior to open surgery in cases with lower tumour stages in terms of its extent (Tab. 3, Fig. 1, Ref. 49).

Management of oesophageal anastomosis dehiscence after oesophagectomy for oesophageal cancer.

Oesophagectomy is being used in treatment of several oesophageal diseases, most commonly in treatment of oesophageal cancer. It is a major surgical procedure that may result in various complications. One of the most severe complications is anastomotic dehiscence between the gastric conduit and the oesophageal remnant. Anastomotic dehiscence after esophagectomy is directly linked to high morbidity and mortality. We propose a therapeutic algorithm of this complication based on published literature and our experience by retrospective evaluationof 164 patients who underwent oesophagectomy for oesophageal cancer. Anastomotic dehiscence was present in 29 cases.

“Maximal” minimally invasive thymectomy in patients with Nonthymomatous Myasthenia Gravis - short-term results over a 10year period - retrospective study.

INTRODUCTION: Thymectomy has always been considered an important treatment modality for patients with Myasthenia Gravis (MG). Because of the absence of randomized trials, its exact role was not clear and was even questioned by some. Indications for surgery were made on empirical basis. It was not until the results of the first randomized double- blinded multicentric study were published, where the combined surgical treatment of patients with nonthymomatous MG was proved superior to conservative treatment alone. In this study the technique of extensive thymectomy via longitudinal sternotomy was used as a mainstay of surgical treatment. In the advent of minimally invasive techniques a variety of options were presented for minimally invasive surgical treatment of thymic pathology. METHODS: The authors present a retrospective analysis of short term results using the slightly modified method of “Minimally Invasive Maximal Thymectomy” developed by Zielinski over a 10 year period (20082018). Besides the demographics, we assessed the peri- and postoperative results such as the length of surgery, blood loss, the need for conversion, learning curve impact, the lengths of drainage and hospital stay and the complication rate, both surgical and systemic. RESULTS: 48 patients underwent surgery using the above mentioned method for non-thymomatous MG. 81.25% (n=39) of patients were diagnosed with a seropositive generalized form of MG, 6 (12.5%) had seropositive ocular form and 3 patients (6.25%) had seronegative form of the disease. The sex ratio profoundly favored females (89.5%; n=43). The median value of the length of surgery was 186,5 minutes, the mean LOS and length of drainage were 4 and 3 days, respectively. CONCLUSION: According to our results and experience with Minimally Invasive Maximal Thymectomy, we found it to be an effective and safe method for MG patients after conquering the learning curve.

Unexpected finding of an ablation catheter during thoracoscopic exploration for a spontaneous hemothorax - case report.

Varicose veins of lower extremities represent a common medical condition with minimally invasive percutaneous endovenous ablation techniques as a treatment of choice. A very rare complication is a catheter migration in the deep venous system. In the literature only 7 cases have been published so far, with only 2 cases with migration to the systemic circulation and heart involvement. In this paper we present an interesting case report from the perspective of a thoracic surgeon with the finding of a laser ablation catheter remnant in the left pleural cavity during thoracoscopic exploration for a spontaneous hemothorax in a 47-year old male patient after collapse. A similar complication affecting the pleural cavity has not been published before. In this paper we discuss possible routes of the cathether migration into the left pleural cavity, impending complications when a part of the catheter is left behind in the body and the means of prevention of these serious potentially fatal complications even after many years following the initial treatment.