title: Robot-assisted thoracoscopic thymectomy for treating myasthenia gravis in children.
abstract: BACKGROUND
  In the United States, the prevalence of myasthenia gravis (MG) is approximately 14-20 per 100,000. One treatment option involves a thymectomy, which can lead to remission of symptoms. The amount of thymic tissue removed is correlated with a better outcome for patients. Thus, it is critical that the procedure used when performing a thymectomy maximize the resection of thymic tissue. Robotic-assisted thoracoscopic thymectomy provides a minimally invasive platform that avoids the mortality and morbidity of a median sternotomy while providing better visualization and a more delicate dissection than is available in a standard thoracoscopic procedure.
  
  
  METHODS
  Following Institutional Review Board approval, in total, 9 patients who underwent robotic thymectomy were reviewed. Intraoperative statistics such as operative time and blood loss were reviewed from operative records. Postoperative outcomes such as hospital stay, discharge medications, and complications were reviewed from hospital charts. Lastly, disease response was evaluated in consultation with a pediatric neurologist who specializes in MG.
  
  
  RESULTS
  Age at operation ranged from 2 to 15 years of age (average, 9.4 years). A majority of patients had an MGFA classification of II or greater (n=5). All patients were on pyridostigmine preoperatively, and 7 of 9 (77%) were taking prednisone. Mean operative time was 160.1±6.1 minutes. Average postoperative hospital stay was 1.1±0.3 days. One patient had a documented persistent pneumothorax on postoperative Day 1, which was treated with nasal cannula oxygen for an additional day. There were no additional operative complications, and all patients were discharged home on acetaminophen with codeine for pain control. Eight of 9 patients had improvement in MG symptoms after the procedure.
  
  
  CONCLUSIONS
  Robotic-assisted thoracoscopic thymectomy is a safe and effective operation for children with MG. Robotic assistance allows for articulating instruments, three-dimensional visualization, and minimal blood loss. These factors may allow for a more complete resection compared with a standard thoracoscopic thymectomy.
authors: Division of Pediatric Surgery, Department of Surgery, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia 23298, USA.
authors: Joseph
authors: J
authors: Hartwich
authors: Sanjeev
authors: S
authors: Tyagi
authors: Franklin
authors: F
authors: Margaron
authors: Claudio
authors: C
authors: Oitcica
authors: Jean
authors: J
authors: Teasley
authors: David
authors: D
authors: Lanning
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009157:Myasthenia Gravis / Q000601:surgery*; D011183:Postoperative Complications; D012371:Robotics; D013934:Thymectomy / Q000379:methods*; D016896:Treatment Outcome