[Video-assisted thoracoscopic thymectomy for the treatment of myasthenia gravis].
OBJECTIVE
Traditionally, thymectomy for myasthenia gravis has been performed using either a transcervical approach or a median sternotomy. However, excision of the thymic tissue by video-assisted thoracoscopic surgery is less aggressive and recovery is faster. The aim of this study was to evaluate the usefulness and outcomes of video-assisted thoracoscopic thymectomy.


METHODS
Over the past 10 years, we have performed 25 video-assisted thoracoscopic thymectomies on patients with myasthenia gravis at our unit. This study included 16 women and 9 men, with a mean age of 48.1 years (range, 14-74 years). Right-side (22 cases) or left-side (3 cases) thoracoscopic surgery was performed, with a mean intervention time of 110 minutes (range, 60-193 minutes).


RESULTS
No patient required assisted ventilation for more than 4 hours and the maximum stay in intensive care was less than 24 hours. Complications from surgery included 3 cases of contralateral pneumothorax, 1 pleural effusion, and 2 intraoperative hemorrhages from the thymic vein, all of which were resolved by video-assisted thoracoscopy. Likewise, 3 cases required conversion (due to hemorrhaging in 2 patients and technical difficulties in 1) and 2 required a second thoracoscopic intervention. No deaths occurred and clinical outcome was excellent in 11 cases (medical treatment no longer required), good in 10 (reduced medical treatment), and poor in 4 (no changes).


CONCLUSIONS
Video-assisted thoracoscopic thymectomy is effective in the treatment of myasthenia gravis and improves patient recovery. In addition, the excellent surgical view allows the thymectomy to be performed with absolute safety.
Servicio de Cirugía General y Torácica, Hospital Universitario Virgen Macarena, Sevilla, Spain. jloscert@us.es
J
J
Loscertales
J
J
Ayarra Jarne
M
M
Congregado
A
A
Arroyo Tristán
R
R
Jiménez Merchán
J C
JC
Girón Arjona
C
C
Arenas Linares
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000601:surgery*; D011183:Postoperative Complications; D012086:Reoperation; D012449:Safety; D020775:Thoracic Surgery, Video-Assisted; D013934:Thymectomy; D013997:Time Factors; D016896:Treatment Outcome