title: Improved procedures and comparative results for video-assisted thoracoscopic extended thymectomy for myasthenia gravis.
abstract: BACKGROUND
  We previously introduced video-assisted thoracoscopic ET (VATS-ET) as a therapeutic option for MG with acceptable results. We have conducted further investigations to improve the procedure without deterioration of operative results, including myasthenia gravis (MG) remission rate and palliation rate. Here, we report the details of our current procedure, as well as surgical results and patient outcomes as compared with the original VATS-ET procedure.
  
  
  METHODS
  From January 2002 to September 2013, we performed a VATS-ET procedure with an anterior chest wall lifting method for 77 patients who had MG with or without a thymoma. During that period, we investigated the appropriate indications and improved the procedure.
  
  
  RESULTS
  Our current indication for this procedure is MG with the anti-acetylcholine receptor antibody or sero-negative type, or MG with a thymoma <5 cm in diameter without invasion to adjacent organs. With our procedure, the thymus and surrounding tissue are sufficiently resected using a bilateral thoracoscopic surgical method without neck incision. Remission and palliation rates were found to be equivalent to those obtained with the original VATS-ET procedure.
  
  
  CONCLUSIONS
  VATS-ET is suitable for select patients with MG with or without a thymoma. In addition, our current method has shown to be effective while also offering cosmetic advantages as compared with the original, neck incision needed, VATS-ET method.
authors.affiliation: Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-2 L5 Yamadaoka, Suita, Osaka, 565-0871, Japan, gilly64@thoracic.med.osaka-u.ac.jp.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Nakagiri
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Inoue
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Shintani
authors.forename: Soichiro
authors.initials: S
authors.lastname: Funaki
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Kawamura
authors.forename: Masato
authors.initials: M
authors.lastname: Minami
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Ohta
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Kadota
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Shiono
authors.forename: Meinoshin
authors.initials: M
authors.lastname: Okumura
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000150:complications / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D013934:Thymectomy / Q000379:methods*; D013945:Thymoma / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult