Postoperative myasthenic crisis with respiratory failure is a potentially lethal complication, warranting careful perioperative planning and extended postoperative surveillance of patients. Data on the incidence of postoperative respiratory failure and optimal management of patients after robotic-assisted thymectomy are limited.
The objective of this study was to evaluate the incidence of respiratory complications and the need for intensive care unit (ICU) capacities after robotic-assisted thymectomy in patients with myasthenia gravis.
Retrospective cohort study.
Single University hospital in Vienna, Austria, from January 2014 to December 2019.
The authors included adult patients who underwent robotic-assisted thymectomy due to myasthenia gravis.
Of 72 patients, 4 patients (5.6%) developed postoperative respiratory failure, needing noninvasive ventilation/intubation. Respiratory failure occurred within the first hours after extubation when patients still were under surveillance in the recovery room or in the ICU. One patient (1.4%) suffered from worsened myasthenic symptoms several days after surgery, and was treated with plasmapheresis. Sixty-five patients (90.3%) were extubated in the operating room, 35 of these (48.6%) were transferred to the ICU, and 30 patients (41.7%) primarily were transferred to the recovery room. Fourteen patients (19.4%) were transferred to the surgical ward after extended observation in the recovery room. Furthermore, after implementation of a standardized perioperative algorithm in 2020, a reduction of ICU admissions was achieved.
After careful patient selection, planning, and postoperative patient evaluation, robotic-assisted thymectomy can be performed safely without postoperative surveillance in an ICU.
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Published online: May 22, 2022
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- A New Postthymectomy Care Algorithm—Postanesthesia Care Unit Versus Intensive Care Unit After Robotic-Assisted Thoracoscopic Surgery: Does It Make a Difference?Journal of Cardiothoracic and Vascular AnesthesiaVol. 36Issue 10
- PreviewMYASTHENIA GRAVIS (MG) is a rare autoimmune disease that is characterized by fluctuating muscle weakness due to autoantibodies against the acetylcholine receptor or other related functional molecules at the neuromuscular junction.1 Thymoma frequently is associated with several types of diseases, of which MG is the most common. It is diagnosed in 10% to 15% of these patients.2 Resection of the thymoma remains the main therapeutic strategy. In recent years, focus has shifted from thoracotomy and transsternal thymectomy toward minimally invasive approaches, including video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS).