Video-Assisted Thoracoscopic Thymectomy for Myasthenia Gravis (original) (raw)

Video-assisted thoracoscopic surgery or transsternal thymectomy in the treatment of myasthenia gravis?

Interactive CardioVascular and Thoracic Surgery, 2010

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was how video-assisted thoracoscopic surgery (VATS) compares to median sternotomy in the surgical management of patients with myasthenia gravis (MG)? Overall 74 papers were found using the reported search, of which 15 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results are tabulated. We conclude that VATS produces equivalent postoperative mortality and complete stable remission (CSR) rates, with superior results in terms of hospital stay, operative blood loss and patient satisfaction at the expense of a doubling of operative time. Six studies comparing VATS and transsternal sternotomy in non-thymomatous myasthenia gravis (NTMG) patients found VATS to have lower operative blood loss (73.8"70.7 vs. 155.3"91.7 ml; P-0.05), reduced total hospital stay (5.6"2.2 vs. 8.1"3.0 days; Ps0.008), whilst maintaining equivalent remission rates (33 vs. 44.7%; Ps0.16) and mass of thymic tissue resection (37 vs. 34 g; P)0.05). One study comparing video-assisted thoracoscopic extended thymectomy to transsternal thymectomy in only thymoma-associated myasthenia gravis (T-MG) patients found equivalent CSR (11.3 vs. 8.7%, Ps0.1090) at six-year follow-up. Thymoma recurrence rate (9.64%) was not significantly different (Ps0.1523) between the two groups. Eight studies comparing VATS and transsternal approach in mixed T-MG and NTMG patients found a lower hospital stay (1.9"2.6 vs. 4.6"4.2 days, P-0.001), reduced need for postoperative medication (76.5 vs. 35.7%, Ps0.022), lower intensive care unit stay (1.5 vs. 3.2 days, Ps0.018), greater symptom improvement (100 vs. 77.9%, Ps0.019) and better cosmetic satisfaction (100 vs. 83, Ps0.042) with VATS. In concordance with NTMG and T-MG alone patient groups, VATS and transsternal methods had equivalent complication rates (23 vs. 19%, Ps0.765) with no mortalities in either group. Even though VATS has a longer operative time (268"51 vs. 177"92 min, P-0.05), its improved cosmesis, reduced need for postoperative medication and equivalent disease resolution outcomes make it a preferable surgical option to the transsternal approach.

Video-Assisted Thoracoscopic Thymectomy vs "Maximal" Thymectomy for Myasthenia Gravis

CHEST Journal, 1996

Thymectomy vs "Maximal" Thymectomy Video-Assisted Thoracoscopic http://chestjournal.chestpubs.org/content/110/3/864.2.citation and services can be found online on the World Wide Web at: The online version of this article, along with updated information ISSN:0012-3692 ) http://chestjournal.chestpubs.org/site/misc/reprints.xhtml

Safety and feasibility of video assisted thoracoscopic thymectomy for myasthenia gravis: a single centre experience

International Surgery Journal

Background: Myasthenia gravis (MG) is an autoimmune disease affecting acetylcholine postsynaptic receptor of voluntary muscles. Thymectomy is a mainstay in the treatment for myasthenia gravis with or without thymoma. For many years transsternal and transcervical thymectomy had been the most common approaches used, video assisted thoracoscopic thymectomy is still not accepted as approach of choice. We intend to study the role of Video assisted thoracoscopic thymectomy for myasthenia gravis in central Indian population.Methods: Study was conducted in single tertiary care institute from January 2015 to November 2018. It is a prospective study. Aims of the study were to evaluate the safety and feasibility of video assisted thoracoscopic thymectomy for patients of myasthenia gravis. All patients of myasthenia gravis who underwent underwent video assisted thoracoscopic thymectomy (VATS) were included in the study. Intraoperative and postoperative details were studied to assess the safety ...

Video-Assisted Thoracic Surgery Thymectomy for Nonthymomatous Myasthenia Gravis

Chest, 2005

Study objectives: Minimal-access thymectomy has become increasingly popular as surgical treatment for patients with nonthymomatous myasthenia gravis (NTMG) because of its comparable efficacy, safety, and lesser degree of tissue trauma compared with conventional open surgery. We reviewed and analyzed our data on video-assisted thoracic surgery (VATS) thymectomy and present the clinical outcomes according to the Myasthenia Gravis Foundation of America classification. Design: A retrospective review of VATS thymectomy for NTMG in a university hospital over a 12-year period. Data were collected from the medical records and supplemented with telephone surveys. The impact of surgery and other variables potentially affecting complete stable remission (CSR) were calculated using Kaplan-Meier survival curves; comparisons between survival curves was performed using the log-rank test. Results: A total of 38 consecutive patients underwent VATS thymectomy for NTMG. Median postoperative stay was 3 days. Pathologic examination revealed thymic hyperplasia in 61.1% of cases, normal thymus in 22.2%, and thymic atrophy in 16.6%. There was no perioperative mortality; complications occurred in four patients. After a median follow-up of 69 months, 91.6% of patients experienced improvement, with crude CSR achieved in 22.2%. Kaplan-Meier survival curve demonstrated a 75% CSR rate at 10-year follow-up. On univariate analysis, only disease duration < 12 months (p ‫؍‬ 0.03) was associated with a statistically significant improvement in CSR. Conclusions: VATS thymectomy for NTMG results in symptomatic improvement in the vast majority of patients, with a high rate of CSR. The procedure is associated with low morbidity and no perioperative mortality. Future studies on thymectomy for myasthenia gravis should be reported in a standardized manner to allow accurate comparisons between results in the absence of randomized prospective trials.

Video-assisted thoracoscopic thymectomy for non-thymomatous myasthenia gravis: a right-sided or left-sided approach?

Interactive cardiovascular and thoracic surgery, 2017

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was in [patients undergoing video-assisted thoracoscopic thymectomy for myasthenia gravis (MG)] is a [left-sided approach] superior to a [right-sided approach] in terms of [clinical outcome]? Two hundred and fifty-nine papers were found using the reported search. In looking at both procedures, we selected studies with a sizeable number of patients performing or studying both procedures and comparing their outcome. Hence, only 4 studies represented the best evidence to answer the clinical question. The authors, journal, date, country, study type, patient group, relevant outcomes and results of these papers are tabulated. Two studies compared their clinical experience with a right-sided versus a left-sided video assisted thoracoscopic surgery thymectomy approach, while 1 study compared using a bilateral versus a unilateral right-sided approach in patients with non-thymomato...

Comparison of robotic and nonrobotic thoracoscopic thymectomy: A cohort study

The Journal of Thoracic and Cardiovascular Surgery, 2011

Objective: Radical thymectomy has become more popular in the comprehensive treatment of myasthenia gravis. Minimally invasive techniques are increasingly used for thymectomy. The most recent development in robotic thoracoscopic surgery has been successfully applied for mediastinal pathologies. To establish robotic technique as a standard, the results of high-volume centers and comparison with traditional surgery are mandatory. Methods: In a retrospective cohort study, the results of 79 thoracoscopic thymectomies (October 1994 to December 2002) were compared with the results of 74 robotic thoracoscopic thymectomies (January 2003 to August 2006). Data from both series were collected prospectively. In both groups, all patients had myasthenia gravis. Both cohorts were compared with respect to severity of disease, gender, age, histology, and postoperative morbidity. All patients were analyzed for quantification of improvement of disease according to the Myasthenia Gravis Foundation of America. Results: There were no differences in age distribution and severity of myasthenia gravis. The dominant histologic finding was follicular hyperplasia of the thymus in both groups with a significantly higher percentage in the thoracoscopic thymectomy series (68% vs 45%, P<.001). After a follow-up of 42 months, the cumulative complete remission rate of myasthenia gravis for robotic and nonrobotic thymectomy was 39.25% and 20.3% (P ¼ .01), respectively. Conclusions: There is an improved outcome for myasthenia gravis after robotic thoracoscopic thymectomy compared with thoracoscopic thymectomy.

Thoracoscopic thymectomy for myasthenia gravis: a case report

Annals of the Academy of Medicine, Singapore, 1998

Total thymectomy combined with medical therapy is currently the most effective therapeutic strategy for patients with myasthenia gravis. The standard approach for total thymectomy is that of a median sternotomy. Other approaches include the cervical approach and partial sternotomy. We report a patient who underwent video-assisted thoracoscopic thymectomy at our institution. There was no postoperative complications and the patient was discharged on the fifth postoperative day. Video-assisted thoracoscopic thymectomy has proved to be an effective surgical therapy for the treatment of myasthenia gravis. The long-term outcome awaits close follow-up of the patients operated using this technique.

Combined Transcervical and Unilateral-thoracoscopic Thymectomy for Myasthenia Gravis: 2 Years of Follow-up

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2008

Background: To investigate the efficacy of combined transcervical and unilateral-thoracoscopic thymectomy for myasthenia gravis. Methods: There were 36 patients with nonthymomatous myasthenia gravis, undergoing combined transcervical and unilateral-thoracoscopic thymectomy and who have been followed-up for more than 2 years. To achieve maximal benefit, a transverse cervical incision was performed to give access to remove fat in the neck, which may contain residual or ectopic thymus after all thymic tissue and mediastinal fat were completely removed by thoracoscopic thymectomy. Results: There were no perioperative deaths and no cases that required conversion to median sternotomy. The mean length of surgery was 162 minutes (range, 132 to 210 min). Three sustained myasthenic crisis. Seventeen patients had lymphadenitis and 4 had ectopic thymus in the neck. There were 2 cases in which the residual superior horns of thymus were found in the neck. Average specimen weights of the thymus, mediastinal fat, and cervical fat were 44.2, 32.5, and 3.6 g, respectively. The rate of complete stable remission was 16.7% at the end of the first year, and rose to 27.8% at the second year. The effective rate was 88.9% at the end of the second year. Conclusions: Thymectomy represents a safe and valid approach for patients with myasthenia gravis. Achieving a curative thymectomy and good cosmesis in myasthenic patients is possible with the combined transcervical and unilateral-thoracoscopic thymectomy as an effective alternative to open approaches.

Long-Term Follow-Up After Robotic Thymectomy for Nonthymomatous Myasthenia Gravis

The Annals of Thoracic Surgery, 2011

Background. Thymectomy is recognized as a significant component in the treatment of myasthenia gravis. However, controversy exists as to the optimal surgical approach. This investigation summarizes our experience performing extended thymectomy using a robotic technique in a large group of patients with significant follow-up.

Video-assisted Thoracoscopic Extended Thymectomy (VATET) in Myasthenia Gravis Two-Year Follow-up in 101 Patients and Comparison with the Transsternal Approach

Annals of the New York Academy of Sciences, 1998

Myasthenia gravis (MG) is an autoimmune disease marked by weakness of voluntary musculature. Medical and surgical therapy of adult myasthenia is well documented. There is little pediatric surgical evidence, only a few case reports being available. The aim of this paper is to verify whether the surgical and anesthesiological techniques can warrant an early and safe discharge from the operating room. The secondary aim is to assess the presence of perioperative indicators that can eventually be used as predictors of postoperative care. During the years 2006-2009, 10 pediatric patients were treated according to a surgical approach based on video assisted thoracoscopic extended thymectomy (VATET). Standard preoperative evaluation is integrated with functional respiratory tests. Anesthetic induction was made with propofol and fentanyl/remifentanyl and maintenance was obtained with sevoflurane/desflurane/propofol ± remifentanyl. A muscle relaxant was used in only one patient. Right or left double-lumen bronchial tube (Rüsch Bronchopart ® Carlens) placement was performed. Six patients were transferred directly to the surgical ward while 4 were discharged to the intensive care unit (ICU); ICU stay was no longer than 24 h. Length of hospital stay was 4.4±0.51 days. No patient was readmitted to the hospital and no surgical complications were reported. Volatile and intravenous anesthetics do not affect ventilator weaning, extubation or the postoperative course. Paralyzing agents are not totally contraindicated, especially if short-lasting agents are used with neuromuscular monitoring devices and new reversal drugs. Perioperative evaluation of the myasthenic patient is mandatory to assess the need for postoperative respiratory support and also predict timely extubation with early transfer to the surgical department. Availability of new drugs and of reversal drugs, the current practice of mini-invasive surgical techniques, and the availability of post anesthesia care units are the keys to the safety and successful prognosis of patients affected by MG who undergo thymectomy.