title: Hybrid combination of small subxiphoid incision and thoracoscopic thymectomy for juvenile myasthenia gravis.
abstract: OBJECTIVE
  Myasthenia gravis is an autoimmune disease that usually responds positively to treatment with thymectomy. Various approaches via video-assisted thoracic thymectomy as a substitute for conventional sternotomy have been reported. We reported a less invasive technique for thymectomy in pediatric groups.
  
  
  METHODS
  Four adolescents with juvenile myasthenia gravis all underwent hybrid combination of small subxiphoid incision and thoracoscopic thymectomy at our institute. Clinical characteristics and surgical outcome were consecutively collected.
  
  
  RESULTS
  In these 4 patients, 2 presented with Osserman class III and 2 with class IIb. The mean operative time was 180 minutes. There was no conversion to sternotomy, and there was only minimal blood loss. Follow-up duration was 3 to 64 months. Postoperatively, 1 patient had complete remission and 3 patients had improvement in clinical symptoms.
  
  
  CONCLUSIONS
  Hybrid combination of small subxiphoid incision and thoracoscopic thymectomy may be an effective alternative with low surgical invasiveness for treating juvenile myasthenia gravis.
authors.affiliation: Division of Thoracic Surgery, Department of Health, Taichung Hospital, Executive Yuan, Taichung, Taiwan.
authors.forename: Chou-Ming
authors.initials: CM
authors.lastname: Yeh
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Hou-Chuan
authors.initials: HC
authors.lastname: Chen
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan. Electronic address: cmchou@vghtc.gov.tw.
authors.forename: Chia-Man
authors.initials: CM
authors.lastname: Chou
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Chung-Ping
authors.initials: CP
authors.lastname: Hsu
mesh_terms: D000293:Adolescent; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009157:Myasthenia Gravis / Q000601:surgery*; D013906:Thoracoscopy / Q000379:methods*; D013934:Thymectomy / Q000379:methods*; D014989:Xiphoid Bone / Q000601:surgery*