Approaches to thymectomy in the minimally invasive era: a narrative review
Bibliographic record
Abstract
Background and Objective: Thymectomies have the potential to significantly improve quality of life, especially in patients with myasthenia gravis (MG) refractory to medical management and thymic malignancies. Initially performed as open surgeries requiring a thoracotomy, techniques for thymectomies have now evolved to include minimally invasive approaches such as transcervical, transthoracic, lateral intercostal, and subxiphoid techniques. The objective of this review is to summarize the evolution of surgical approaches to thymic resection. Methods: We conducted a search of the current literature regarding minimally-invasive surgical (MIS) approaches to thymectomy using the PubMed/Medline and Google Scholar databases. Articles were screened and included if they met one or more of the following criteria: (I) described the history and/or progression of MIS thymectomy; (II) described an approach to MIS thymectomy; (III) described the surgical outcomes of one or more of the MIS approaches to thymectomy; (IV) provided data comparing the outcomes and/or feasibility of MIS thymectomy. Key Content and Findings: Three approaches currently prevail in the realm of minimally invasive thymectomies: the transcervical, video-assisted thoracic surgery (VATS) transthoracic or lateral intercostal, and subxiphoid techniques. Results of our search revealed robust effectiveness of all three approaches with good patient outcomes and minimal post-operative complications. The transcervical approach is the oldest of the minimally invasive approaches to thymectomy and offers the shortest length of post-operative hospital stay as it does not require chest tube placement. The transthoracic approach is presently the most widely used both in MG and in thymic malignancies. This VATS technique has the potential to be performed robotically and recently has shown good outcomes using a single port. Finally, the subxiphoid approach is the newest technique. Like the transthoracic approach, it can be performed robotically and is most commonly approached through a single port. The subxiphoid approach has the advantage of avoiding the intercostal nerves which are inevitably damaged in the transthoracic approach, and this is reflected in the significantly better pain scores outcomes between both techniques. Conclusions: Overall, our search of the literature on minimally invasive thymectomies demonstrated significant progress of these techniques over the past two centuries with potential for continued improvement and incorporation of robotic techniques.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".