title: Surgical and neurologic outcomes after robotic thymectomy in 100 consecutive patients with myasthenia gravis.
abstract: OBJECTIVE
  Thymectomy is a well-defined therapeutic option for patients with myasthenia gravis; however, controversies still exist about the surgical approach, indication, and timing for surgery. We reviewed our experience reporting surgical and neurologic results after robotic thymectomy in patients with myasthenia gravis.
  
  
  METHODS
  Between 2002 and 2010, 100 patients (74 female and 26 male; median age, 37 years) underwent left-sided robotic thymectomy using the da Vinci robotic system (Intuitive Surgical, Inc, Sunnyvale, Calif). The Myasthenia Gravis Foundation of America classification was adopted for pre- and postoperative evaluation. Preoperative Myasthenia Gravis Foundation of America class was I in 10% of patients, II in 35% of patients, III in 39% of patients, and IV in 16% of patients.
  
  
  RESULTS
  Median operative time was 120 (60-300) minutes. No death or intraoperative complications occurred. Postoperative complications were observed in 6 patients (6%) (bleeding requiring blood transfusions in 3, chylothorax in 1, fever in 1, and myasthenic crisis in 1). Median hospital stay was 3 days (range, 2-14 days). Histologic analysis revealed 76 patients (76%) with hyperplasia, 7 patients (7%) with atrophy, 8 patients (8%) with small thymomas, and 9 patients (9%) with normal thymus; ectopic thymic tissue was found in 26 patients (26%). Clinical follow-up showed a 5-year probability of complete stable remission and overall improvement of 28.5% and 87.5%. Remission was significantly associated with preoperative I to II Myasthenia Gravis Foundation of America class (P = .02). A significant improvement rate was found in Myasthenia Gravis Foundation of America class I to II (P = .03) and AbAchR+ (P = .04). A high percentage of patients interrupted or reduced their medications.
  
  
  CONCLUSIONS
  Robotic thymectomy is a safe and effective procedure. We observed a neurologic benefit in a great number of patients. A better clinical outcome was obtained in patients with early Myasthenia Gravis Foundation of America class.
authors: Division of Thoracic Surgery, Department of Cardiologic, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy. giuseppe.marulli@unipd.it
authors: Giuseppe
authors: G
authors: Marulli
authors: Marco
authors: M
authors: Schiavon
authors: Egle
authors: E
authors: Perissinotto
authors: Antonella
authors: A
authors: Bugana
authors: Francesco
authors: F
authors: Di Chiara
authors: Alessandro
authors: A
authors: Rebusso
authors: Federico
authors: F
authors: Rea
mesh_terms: D000328:Adult; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000601:surgery*; D061646:Operative Time; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D013934:Thymectomy / Q000379:methods*; D016896:Treatment Outcome