Transcervical-subxiphoid-videothoracoscopic "maximal" thymectomy--operative technique and early results.
BACKGROUND
The operative technique of a transcervical-subxiphoid-videothoracoscopic "maximal" thymectomy without sternotomy is described and the early results of the follow-up of patients operated on are analyzed.


METHODS
One-hundred "maximal" transcervical-subxiphoid-videothoracoscopic thymectomies were performed for nonthymomatous myasthenia gravis during a recent 32-month period (from September 1, 2000 to May 8, 2003). Patient characteristics, complications, pathologic findings, and the results of follow-up were analyzed.


RESULTS
The study group included 83 women and 17 men. The mean age was 29.8 years (range, 10-69 years). The mean preoperative duration of myasthenia was 2.73 years (range, 3 months to 17 years). The preoperative Osserman score was I-III, 27 patients were taking steroids preoperatively. Eleven operations were performed by two teams working simultaneously and 89 operations were performed by one surgeon including four combined thymectomy-thyroid operations in patients with myasthenia and thyroid nodules. The mean operative time for two-team approach thymectomies was 159.09 minutes (range, 140-170 minutes) and the mean operative time for the thymectomy performed by one surgeon was 199.41 minutes (range, 150-270 minutes) (p = 0.0004). There was a 15.0% (15 out of 100) postoperative morbidity and no mortality. Foci of ectopic thymic tissue were found in 71.0% of the patients and were most prevalent in the perithymic fat (37.0%) and in the aorta-pulmonary window (33.0%). The mean weight of the specimen was 78.4 g (range, 14.5-253.0 g). In 48 patients followed-up for 12 months, the improvement rate was 83.3%, the no improvement rate was 14.6%, and 1 patient died during the follow-up period. Complete remission rates were 18.8% and 32.0% after 1 and 2 years of follow-up, respectively.


CONCLUSIONS
We conclude that the "maximal" transcervical-subxiphoid-videothoracoscopic thymectomy is a safe operative technique, avoiding a sternotomy, performed partly in an open fashion with the extensiveness comparable with the transsternal extended and "maximal" thymectomies. The two-team approach helps to reduce the operative time. However, because of the limited time of follow-up it is too early for the final assessment of the long-term results of this method in the treatment of myasthenia gravis.
Department of Thoracic Surgery, Pulmonary Hospital, ul. Gladkie 1, 34-500 Zakopane, Poland. marcinz@mp.pl
Marcin
M
Zieliński
Jarosław
J
Kuzdzał
Artur
A
Szlubowski
Jerzy
J
Soja
D000273:Adipose Tissue / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D001327:Autoimmune Diseases / Q000601:surgery*; D002648:Child; D002828:Choristoma / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000601:surgery*; D009929:Organ Size; D011183:Postoperative Complications / Q000453:epidemiology; D012074:Remission Induction; D020775:Thoracic Surgery, Video-Assisted; D013934:Thymectomy / Q000379:methods* / Q000706:statistics & numerical data; D013950:Thymus Gland / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome