title: Infrasternal mediastinoscopic thymectomy in myasthenia gravis: surgical results in 23 patients.
abstract: BACKGROUND
  Infrasternal mediastinoscopic surgery is a new approach to resection of the anterior mediastinal mass.
  
  
  METHODS
  We evaluated this new approach in 23 patients with myasthenia gravis who underwent total thymectomy assisted by infrasternal mediastinoscopy between 1998 and 2000. The results were analyzed with special reference to morbidity and short-term improvement of the disease severity determined according to quantitative myasthenia gravis (QMG) scores.
  
  
  RESULTS
  Complete removal of the thymic gland with the pericardial adipose tissue was accomplished through an infrasternal mediastinoscopic approach in 21 of the 23 (91.3%) patients. The remaining 2 patients required conversion to sternotomy, the one for insufficient sternal lifting with vascular tape and the other for invasion of a thymoma to the innominate vein. There was no related mortality and only one complication, a phrenic nerve injury in 1 patient (4.3%). Significant clinical improvement of disease was achieved in the short term and several advantages were apparent.
  
  
  CONCLUSIONS
  Infrasternal mediastinoscopic thymectomy is safe and feasible for patients with myasthenia gravis.
authors.affiliation: Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. uchiyama@surg1.med.kyushu-u.ac.jp
authors.forename: A
authors.initials: A
authors.lastname: Uchiyama
authors.forename: S
authors.initials: S
authors.lastname: Shimizu
authors.forename: H
authors.initials: H
authors.lastname: Murai
authors.forename: S
authors.initials: S
authors.lastname: Kuroki
authors.forename: M
authors.initials: M
authors.lastname: Okido
authors.forename: M
authors.initials: M
authors.lastname: Tanaka
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008481:Mediastinoscopy / Q000379:methods*; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000601:surgery*; D010791:Phrenic Nerve / Q000293:injuries; D011183:Postoperative Complications / Q000209:etiology*; D013249:Sternum / Q000601:surgery; D013934:Thymectomy / Q000379:methods*; D016896:Treatment Outcome