Research Article
Volume 6 Issue 7 - 2020
Anaesthesia in Robotic Myasthenic Thymectomy: Evaluation of Our 8-Year Experience
C Cariello1,2, C Zirafa1, G Romano1, F Davini1, R Ricciardi3, F Guarracino4 and F Melfi5*
1Minimally Invasive and Robotic Thoracic Surgery, Robotic Multispecialty Center of Surgery, University Hospital of Pisa, Pisa, Italy
2Anaesthesia and Intensive Care Unit, Cardiothoracic Surgery Department, University Hospital of Pisa, Pisa, Italy
3Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy
4Head of Department of Anaesthesia and Critical Care Medicine, Head of Anaesthesia and Intensive Care Unit, Cardiothoracic Surgery Department, University Hospital of Pisa, Pisa, Italy
5Head of Robotic Multispecialty Center for Surgery, Minimally Invasive and Robotic Thoracic Surgery, University Hospital of Pisa, Pisa, Italy
*Corresponding Author: F Melfi, Head of Robotic Multispecialty Center for Surgery, Minimally Invasive and Robotic Thoracic Surgery, University Hospital of Pisa, Pisa, Italy.
Received: April 27, 2020; Published: June 29, 2020


Robotic thymectomy in myasthenic patients is rapidly gaining more widespread interest, albite only a few centres use this approach, although only recently it has been established as a routine procedure performed in various centres. The use of minimally invasive techniques to perform thymectomies ensures minor trauma. In particular, the robotic approach allows safely performing radical thymectomy, providing good clinical outcomes to the patients, similar to an open approach. We present a retrospective analysis of our experience during the last 8 years in performing robotic thymectomy in myasthenic patients. We strongly believe that a dedicated team prepared to follow and guide the myasthenic patients in the perioperative period is paramount; this empathy together with the reduced traumatism and radicality ensured by the robotic approach can contribute to obtaining the best therapeutic result.

Keywords: Myasthenia; Robotic Thymectomy; Thoracic Anaesthesia; Human Factors


  1. Blobner M and Mann R. “Anesthesia in patients with myasthenia gravis”. Anaesthesist 50 (2001): 484-493.
  2. Naguib M. “Sugammadex: another milestone in clinical neuromuscular pharmacology”. Anesthesia and Analgesia 104 (2007): 575-581.
  3. Marx A., et al. “The different roles of the thymus in the pathogenesis of the various myasthenia gravis subtypes”. Autoimmunity Reviews 2 (2013): 875-884.
  4. Jaretzki A 3rd. “Thymectomy for myasthenia gravis: analysis of controversies-patient management”. Neurologist 9 (2003): 77-92.
  5. Mussi A., et al. “Extended thymectomy in myasthenia gravis: a team-work of neurologist, thoracic surgeon and anaesthesist may improve the outcome”. European Journal of Cardio-Thoracic Surgery 19 (2001): 570-575.
  6. Tp con anticolinester.
  7. Lauriola L., et al. “Thymus changes in anti-MuSK-positive and -negative myasthenia gravis”. Neurology 64 (2005): 536-538.
  8. Marulli G and Rea F. “Myasthenia gravis and thymectomy: many doubts and few certainties”. European Journal of Cardio-Thoracic Surgery 48 (2015): 46-47.
  9. Rea F., et al. “Experience with the “da Vinci” robotic system for thymectomy in patients with myasthenia gravis: report of 33 cases”. The Annals of Thoracic Surgery 81 (2006): 455-459.
  10. Melfi F., et al. “Ten-year experience of mediastinal robotic surgery in a single referral centre”. European Journal of Cardio-Thoracic Surgery 41 (2012): 847-851.
  11. Mussi A., et al. “Robotic extended thymectomy for early-stage thymomas”. European Journal of Cardio-Thoracic Surgery 41 (2012): e43-e46.
  12. Marulli G., et al. “Robot-aided thoracoscopic thymectomy for early-stage thymoma: a multicenter European study”. The Journal of Thoracic and Cardiovascular Surgery 144 (2012): 1125-1130.
  13. Ricciardi R., et al. “Endoscopic thymectomy: a neurologist’s perspective”. Annals of Cardiothoracic Surgery 1 (2015): 38-44.
  14. Cardone A., et al. “Perioperative evaluation of myasthenia gravis”. Annali Italiani di Chirurgia 78 (2007): 359-365.
  15. Ng JM. “Total intravenous anesthesia with propofol and remifentanil for video-assisted thoracoscopic thymectomy in patients with myasthenia gravis”. Anesthesia and Analgesia 1 (2006): 256-257.
  16. Gritti P., et al. “The use of desflurane or propofol in combination with remifentanil in myasthenic patients undergoing a video- assisted thoracoscopic-extended thymectomy”. Acta Anaesthesiologica Scandinavica 53 (2009): 380-389.
  17. Tugrul M., et al. “Comparison of volume controlled with pressure controlled ventilation during one-lung anaesthesia”. British Journal of Anaesthesia 79 (1997): 306-310.
  18. Heimberg C., et al. “Pressure-controlled versus volume-controlled one-lung ventilation for MIDCAB”. The Journal of Thoracic and Cardiovascular Surgery 54 (2006): 516-520.
  19. Rozé H., et al. “Pressure-controlled ventilation and intrabronchial pressure during one-lung ventilation”. British Journal of Anaesthesia 105 (2010): 377-381.
  20. Zhang Y., et al. “Anesthesia of robotic thoracic surgery”. Annals of Translational Medicine 5 (2015): 71.
  21. Campos JH. “An up date on robotic thoracic surgery and anaesthesia”. Current Opinion in Anesthesiology 23 (2010): 1-6.
  22. Campos J and Ueda K. “Update on anesthetic complications of robotic thoracic surgery”. Minerva Anestesiologica1 (2014): 83-88.
  23. Pauli H., et al. “Anesthesia for robotic thoracic surgery”. Annals of Cardiothoracic Surgery 2 (2019): 263-268.
  24. Sessler DI. “Perioperative thermoregulation and heat balance”. The Lancet10038 (2016): 2655-2664.
  25. Naguib M. “Sugammadex: another milestone in clinical neuromuscular pharmacology”. Anesthesia and Analgesia 104 (2007): 575-581.
  26. Romano G., et al. “Robotic approach for early stage thymic tumors-surgical and oncologic outcomes”. Shanghai Chest (2019).
Citation: F Melfi., et al. “Anaesthesia in Robotic Myasthenic Thymectomy: Evaluation of Our 8-Year Experience”. EC Anaesthesia 6.7 (2020): 03-08.

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