Approaches to thymectomy in the minimally invasive era: a narrative review
Why this work is in the frame
A frame that forgets how it found something cannot be audited. These are the routes that admitted this work.
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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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.006 | 0.002 |
| Bibliometrics | 0.001 | 0.005 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.000 | 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 it