Preface: minimally invasive VATS thymectomy for myasthenia gravis

Objective Video-assisted thoracoscopic (VATS) thymectomy has been practiced in Australia for nearly two decades. Our aim was to assess the complete stable remission and asymptomatic disease rates after VATS thymectomy in nonthymomatous myasthenia gravis. There remains doubt that minimally invasive techniques achieve equal remission rates to open maximal operations. Therefore, we report our outcomes using the Myasthenia Gravis Foundation of America (MGFA) Clinical Classification and Kaplan-Meier analysis and compare the results to the literature. Methods A retrospective analysis of 78 consecutive patients undergoing right VATS thymectomy between April 1994 and March 2007 at two Thoracic Surgery Units in Melbourne, Australia, was undertaken. Patients with thymoma were excluded. Therefore, 57 patients were followed-up for a minimum of 12 months to apply the MGFA Clinical Classification. VATS thymectomy was performed by a three-port right side technique. Results The complete stable remission rate was 15% at 3 years and 28% at 5 years. The asymptomatic disease rate was 59% at 5 years. Median follow-up was 32 months. No prognostic factors for remission were identified. The overall morbidity rate was 14% (8/57). Conclusions Right VATS thymectomy achieves comparable remission and asymptomatic disease rates to other minimally invasive and open techniques when compared with studies using either MGFA or older criteria.

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Thymectomy for Nonthymomatous Myasthenia Gravis

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000490 ◽

2018 ◽

Vol 13 (2) ◽

pp. 77-80 ◽

Cited By ~ 1

Author(s):

Reza Bagheri ◽

Reza Boonstani ◽

Ali Sadrizadeh ◽

Maryam Salehi ◽

Reza Afghani ◽

...

Keyword(s):

Minimally Invasive ◽

Myasthenia Gravis ◽

Thoracoscopic Surgery ◽

Standard Procedure ◽

Operation Technique ◽

Traditional Methods ◽

Number Of Patients ◽

Duration Of Hospitalization ◽

Vats Thymectomy ◽

Video Assisted Thoracoscopic Surgery

Objective Thymectomy considered as a standard procedure in treatment of all the steps of myasthenia gravis. Video-assisted thoracoscopic surgery (VATS) thymectomy is one of the minimally invasive procedures that because of the short duration of hospitalization, less postoperative pain, and scar after surgery, nowadays it is replaced the traditional methods of surgery for patients with myasthenia gravis, but there are still differences and concerns. The aim of this study was to compare outcomes of two different techniques of surgery, VATS versus transsternal (TS) in the treatment of myasthenia gravis. Methods In this pilot study, 42 patients with myasthenia gravis and without a thymus tumor were evaluated based on Myasthenia Gravis Foundation of America classification and drug consumption. Then, they randomly underwent two different techniques of surgery: VATS versus TS. Patients were evaluated based on preoperative and postoperative variables. Results Duration of intensive care unit stay and hospitalization has been reduced in patients who underwent VATS thymectomy operation technique. In addition, duration of surgical procedure has been reduced significantly in these patients. These patients have less blood loss during surgery compared with TS group. The Myasthenia Gravis Foundation of America postoperative status in VATS thymectomy revealed that the number of patients with complete stable remission was higher and number of persons remained unchanged was lower in this group. Conclusions VATS thymectomy is a safe and appropriate approach comparing with traditional methods such as TS thymectomy for patients with myasthenia gravis. This method has better results after surgery and can be used as a minimally invasive alternative method instead of TS thymectomy.

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Influence of Minimally Invasive Thymectomy on the Subsequent Clinical Course of Myasthenia Gravis

Case Medical Research ◽

10.31525/ct1-nct04158661 ◽

2019 ◽

Author(s):

Keyword(s):

Minimally Invasive ◽

Myasthenia Gravis ◽

Clinical Course

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VATS thymectomy for myasthenia gravis

Heart Lung and Circulation ◽

10.1046/j.1443-9506.2000.09387.x ◽

2000 ◽

Vol 9 (3) ◽

pp. A185

Author(s):

Gavin M. Wright ◽

Stephen Barnett ◽

C.Peter Clarke

Keyword(s):

Myasthenia Gravis ◽

Vats Thymectomy

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Difficult Decisions in Minimally Invasive Surgery of the Thymus

Cancers ◽

10.3390/cancers13235887 ◽

2021 ◽

Vol 13 (23) ◽

pp. 5887

Author(s):

Ankit Dhamija ◽

Jahnavi Kakuturu ◽

J. W. Awori Hayanga ◽

Alper Toker

Keyword(s):

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Myasthenia Gravis ◽

Invasive Surgery ◽

Early Stage ◽

Disease Process ◽

Standard Of Care ◽

Prognostic Importance

A minimally invasive resection of thymomas has been accepted as standard of care in the last decade for early stage thymomas. This is somewhat controversial in terms of higher-staged thymomas and myasthenia gravis patients due to the prognostic importance of complete resections and the indolent characteristics of the disease process. Despite concerted efforts to standardize minimally invasive approaches, there is still controversy as to the extent of excision, approach of surgery, and the platform utilized. In this article, we aim to provide our surgical perspective of thymic resection and a review of the existing literature.

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Impact of minimally invasive trans-cervical thymectomy on outcome in patients with myasthenia gravis

European Journal of Cardio-Thoracic Surgery ◽

10.1016/j.ejcts.2003.08.002 ◽

2003 ◽

Vol 24 (5) ◽

pp. 677-683 ◽

Cited By ~ 61

Author(s):

Marc de Perrot ◽

Vera Bril ◽

Karen McRae ◽

Shaf Keshavjee

Keyword(s):

Minimally Invasive ◽

Myasthenia Gravis

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Thymectomy in Myasthenia Gravis

Neurology International Open ◽

10.1055/a-0559-2746 ◽

2018 ◽

Vol 2 (02) ◽

pp. E124-E130

Author(s):

Jens Rückert ◽

Marc Swierzy ◽

Siegfried Kohler ◽

Andreas Meisel ◽

Mahmoud Ismail

Keyword(s):

Minimally Invasive ◽

Myasthenia Gravis ◽

Median Sternotomy ◽

Surgical Techniques ◽

Thymic Tissue ◽

Unilateral Approach ◽

Immunosuppressive Medication ◽

Receptor Antibodies ◽

Made In

AbstractIn recent years much progress has been made in the investigation of the pathophysiology, characterizing subgroups, and extension of multimodal treatment of myasthenia gravis (MG). This applies especially to the role of thymectomy (Thx). Thymectomy is always indicated for thymoma-associated myasthenia gravis. Furthermore, based on large cohort studies, during recent decades thymectomy has also become a central part of immune-modulating MG therapy in patients without thymoma. The lack of randomized studies, however, caused a certain persistent reluctance as to the significance of thymectomy. The current MGTX trial has shown the effectiveness of thymectomy. A significant improvement of myasthenic complaints and the reduction of immunosuppressive medication was primarily shown for acquired early-onset MG (EOMG) with complete resection of all thymic tissue. Because the MGTX study only included patients younger than 65 years with generalized MG and positive for acetylcholine-receptor antibodies, at present the significance of Thx for other relevant subgroups as juvenile MG, MG in older patients, ocular MG, as well as seronegative patients is under investigation. Even the prevailing opinion of no benefit of thymectomy for MuSk-positive patients probably needs reevaluation based on ambiguous findings. With respect to surgery, based on the exclusive performance of extended median sternotomy for MG in the MGTX, the value of thoracoscopic modifications for thymectomy as a minimally-invasive alternative is currently under evaluation. For clinical reasons further judgment regarding different minimally-invasive thymectomy techniques compared to the conventional open procedures in the form of randomized comparative studies would be required. Currently, however, an experience-based robotic-assisted thoracoscopic unilateral approach to thymectomy meets all requirements related to surgical, clinical-neurological and patient aspects. Ethical reasons, therefore, will lead to other strategies for comparison of different surgical techniques.

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