Video-assisted thoracoscopic thymectomy for myasthenia gravis

G M Wright, S Barnett, C P Clarke
Internal Medicine Journal 2002, 32 (8): 367-71

BACKGROUND: Thymectomy is an effective, but radical therapy for myasthenia. Video-assisted thoracic surgery (VATS) may allow a minimally invasive alternative to the standard sternotomy approach.

AIMS: To audit prospectively the outcome of VATS thymectomy for myasthenia gravis in a unit specializing in advanced VATS techniques.

METHODS: Twenty-six patients underwent VATS thymectomy between 1997 and 2001. Most underwent preoperative plasma exchange therapy. Seventeen women and nine men with a median age of 36 years (range 17-71 years) had a right-sided VATS approach to remove all anterior mediastinal fat and thymic tissue.

RESULTS: There was no perioperative mortality and all procedures were concluded successfully, with one patient requiring sternotomy. Twenty-five patients were extubated in theatre and one patient required 17 h of assisted ventilation. The other significant complication was a diathermy injury to the phrenic nerve, which recovered. Median postoperative stay was 4 days (range 2-6 days), with median postoperative chest drainage for 2 days (range 1-3 days). Three patients had progression of disease postoperatively. The remainder were asymptomatic (7), improved (14) or stable (2).

CONCLUSION: In a dedicated unit with neurological and intensive care support, VATS thymectomy is a safe, effective method of obtaining remission or improvement in myasthenia gravis (MG). While achieving the same surgical goal, this approach offers advantages of improved cosmesis, shorter recovery time and minimal chest wall disruption over the gold standard of sternotomy. Better patient acceptance of this minimally invasive technique may result in wider application of the benefits of thymectomy in MG.

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