Introduction:
The thymus gland is in the anterior portion of the chest, just before the breast bone. In the anterior position of the heart, a region called the anterior mediastinum, with parts of the lobes spreading into the neck region. The thymus is a part of the body's immune system and recreates its most significant role early in a person's development.
Thymectomy is the surgical extraction of the thymus gland, as they have an essential role in developing myasthenia gravis. Approximately ten percent of patients with myasthenia gravis have a thymoma or an abnormal growth-like tumor on the thymus gland.
Most of these tumors are slow-growing and benign. Few can be cancerous or malignant. Thymectomy is suggested for patients below the age of sixty with intermediate to intense liability from myasthenia gravis. It may be indicated for cases with reduced weakness if it affects respiration or consumption.
The process is also suggested for patients with a thymoma. The foremost thymectomized were conducted in concurrence with thyroidectomies for Grave disease by Garre and Sauerbruch. Still, it was not until Blalock and colleagues that numerous sequences were performed with satisfactory outcomes.
Myasthenia gravis is a neuromuscular disorder that impacts the muscles and nerves that manage them. It is generated by a condition in the immune system that induces the body to affect the location of the muscles where the nerves attach to them.
What Is Thymectomy?
Thymectomy is surgery to extract the thymus. It causes remission of myasthenia gravis with medication. Thus thymectomy is suggested if a thymoma is formed in the thymus.
Diverse surgical approaches can achieve thymectomy.
It includes
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Transsternal Thymectomy: The most typical procedure. It is an open surgical technique in which an incision is created in the skin over the breastbone, and the breastbone is diverged to reveal and extract the thymus.
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Transcervical Thymectomy: it is a surgical procedure in which the incision is created across the inferior portion of the neck, merely beyond the breastbone. The surgeon extract the thymus via this incision without splitting the sternum.
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Robotic Thymectomy and Video-Assisted Thoracoscopic Thymectomy is a minimally-invasive procedure utilizing numerous tiny cuts in the chest. First, the surgeon extracts the thymus using particular surgical tools in other amounts. Then, in a robotic-assisted process, the surgeon utilizes robotic arms to execute the procedure.
What Are the Preoperative Preparations Done for Thymectomy?
Before the thymectomy procedure, the preoperative evaluation includes the identical attributes familiar to all surgeries, including a complete history and bodily examination. The kind of procedure also relies on the disease type demanding thymectomy. If thymectomy is achieved for underlying myasthenia gravis, proper preoperative stabilization of the patient is required to bypass the myasthenia crisis. This comprises the anticholinesterase inhibitors group, intravenous immunoglobulin group, and plasmapheresis. Before the procedure, imaging involves a computerized tomography scan with intravenous contrast to assess nearby structures' involvement, implicating blood vessels in the innominate vein.
Magnetic resonance imaging (MRI) and Positron emission tomography (PET) or PET-CT scans may also help distinguish between thymic hyperplasia and thymoma and determine nodal metastases or distant metastases. Preoperative assessment should involve pulmonary and cardiac function tests. It should be done in cases where pulmonary resection is not suggested. There is a considerable respiratory load after median sternotomy or baseline from myasthenia gravis. Thus, a pulmonary function test, electrocardiogram, and cardiac stress test are suggested depending on the patient's condition.
How Is the Thymectomy Procedure Performed?
A thymectomy will generally take about one to three to finish. This process is usually conducted in the cardiothoracic operating space. Our thoracic surgeons are capable of delivering the robotic procedure.
Typically this procedure involves the following steps,
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Initially, a nurse will initiate the intravenous line into the arm.
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Generally, the surgeon will induce general anesthesia.
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After the patient is sedated, the surgeon will place a breathing line via the throat into the lungs and link it to a ventilator.
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The surgeon will then create three small cuts on each side of the patient's chest area.
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A camera and surgical tools are placed through the incisions.
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The components of the DaVinci robot are then connected to the tools.
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The surgeon controls every action of the robotic arms.
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The surgeon carefully splits the thymus gland from adjacent components and extracts it via any one of the cuts.
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After the procedure, the surgical tools are extracted, and the tiny incisions are sutured and sealed.
What Are the Indications of Thymectomy?
The typical indications of thymectomy are thymoma and myasthenia gravis. Rarely is it indicated that thymectomy involves cancerous tumors like thymus carcinoma, neuroendocrine tumors, and benign tumors such as thymic cysts. Ectopic parathyroid glands are there in the thymus and demand resection. The need for minimally invasive procedures, such as video-assisted thoracoscopic and robotic-assisted procedures, is equivalent to the open approach. Further need for this procedure comprises nonthymoma like juvenile or ocular and myasthenia gravis partial thymectomy secured for therapeutic lymphoma biopsy.
What Are the Contraindications of Thymectomy?
Contraindications for thymectomy involve those affected by surgery, like incapacity to accept general anesthesia, hemodynamic fluctuation, and coagulopathy. Notably, the great vessels would need an open surgical approach for thymectomy and a minimally invasive procedure in patients who are considered incompetent to handle single-lung ventilation.
What Are the Complications of Thymectomy?
Complications of thymectomy involve bleeding. It can occur due to injury to the thymic vessels. Others involve pneumothorax, chylothorax, recurrence of thymoma, pericardial injury, and incomplete thymectomy, done for myasthenia gravis.
Conclusion:
Thymectomy is a complicated surgery that demands infusion from a multi-professional group of healthcare people before, during, and after the procedure. Due to the numerous causes requiring thymectomy, this process mandates multiple specialties, from internal medicine to neurology, to cardiothoracic surgery.
Healthy communication between these groups can adequately support stage patients and supply preoperative assessment and risk stratification for impending procedures. In addition, during the procedure, there should be good communication between the anesthesiology doctors and the surgery doctors to handle patients with myasthenia gravis and observe cardiovascular function during these extensive procedures.
After the process, these patients are conducted on the thoracic surgery benefit and mandate cooperation from the intensive care team, involving intensivists, nurses, and respiratory therapists. By blending among these classes with solid contact, thymectomy can be a secure and practical approach for managing a myriad of illness procedures.
