title: Video-assisted thoracoscopic surgery versus sternotomy in treating myasthenia gravis: comparison by a case-matched study.
abstract: OBJECTIVE
  To clarify the efficacy of a right-sided video-assisted thoracoscopic extended thymectomy (RtVATET) as a surgical alternative for myasthenia gravis (MG) and to determine the optimal timing for a thymectomy.
  
  
  METHODS
  Thirty-three patients who underwent RtVATET in two institutes were enrolled in this study. Another 66 paired, traditional trans-sternal extended thymectomy (TET) patients from the registered database were used to compare these two surgical modalities for MG.
  
  
  RESULTS
  Mean blood loss was 88.5 ml in RtVATET and 226.8 ml in TET group patients (P < 0.001). Mean operation duration was 207.3 min for RtVATET and 172.8 min for TET patients (P = 0.003). Complete stable remission (CSR) rates and total improvement rates for the RtVATET and TET patients were 42.4% vs 60.6% (P = 0.087) and 87.9% vs 90.1% (P = 0.637), respectively. Furthermore, when we focused on the minor grades (classes I and IIa), TET groups showed significantly better CSR than the RtVATET groups (P = 0.012), but there was no statistically significant difference for the more severe grades (classes IIb and III, P = 0.827).
  
  
  CONCLUSIONS
  Both RtVATET and TET are effective for treating MG, although this study does indicate an advantage for TET. We suggest that a thymectomy should therefore be performed earlier, or that the procedures should be extensive enough to remove all of the tissue that contains thymic tissue.
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, No. 201, Section 2, Shih-Pai Road, Taipei, 112, Taiwan.
authors.forename: Chien-Sheng
authors.initials: CS
authors.lastname: Huang
authors.forename: Ching-Yuan
authors.initials: CY
authors.lastname: Cheng
authors.forename: Han-Shui
authors.initials: HS
authors.lastname: Hsu
authors.forename: Ko-Pei
authors.initials: KP
authors.lastname: Kao
authors.forename: Chih-Cheng
authors.initials: CC
authors.lastname: Hsieh
authors.forename: Wen-Hu
authors.initials: WH
authors.lastname: Hsu
authors.forename: Biing-Shiun
authors.initials: BS
authors.lastname: Huang
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009157:Myasthenia Gravis / Q000175:diagnosis / Q000601:surgery*; D012074:Remission Induction; D012189:Retrospective Studies; D012720:Severity of Illness Index; D056346:Sternotomy / Q000379:methods*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D013934:Thymectomy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome