Mid-term results of thoracoscopic thymectomy for myasthenia gravis

Context : Video-assisted thoracic surgery (VATS) has been proposed as a less invasive technique for treatment of myasthenia gravis.
Materials and Methods : A total of 31 patients underwent a right-sided VATS to remove all anterior mediastinal fat and thymic tissue during a 4-year period in our institution. None of the patients had associated thymoma.
Results : All procedures were performed successfully with no conversion to sternotomy. The mean operating time was 190 minutes. The median intubation time and assisted ventilation were 24 and 18 hours, respectively. The median ICU and hospital stays were 3 and 7 days, respectively. The median time for post-operative chest drainage was 48 hours. There was no perioperative mortality. Eight significant complications occurred. One patient had atelectasis, 1 patient had aspiration pneumonia, and 3 patients had postoperative myasthenic crisis and required prolonged mechanical ventilation. Other complications were granuloma of the vocal cord, right recurrent laryngeal nerve palsy, and temporary brachial plexus injury due to poor intraoperative positioning. The mean length of follow-up was 20 months (range: 3-42 months). Overall, 27 patients (87%) had improved clinically and 11 patients (35%) had complete remission. The resulting scars were cosmetically acceptable for all patients.
Conclusion : VATS provides an effective alternative approach to thymectomy and has several advantages over open techniques. VATS causes minimal postoperative complications, shortens hospital stay, and gives better cosmetic results.

Keywords
Myasthenia gravis, thoracoscopy, thymectomy, thymus gland, video-assisted thoracic surgery