title: Mediastinoscopic extended thymectomy for pediatric patients with myasthenia gravis.
abstract: BACKGROUND
  Extended thymectomy is indicated for children with myasthenia gravis (MG) when drug-resistance or dependence is seen. We have employed a technique for mediastinoscopic extended thymectomy (MET) on children with MG.
  
  
  METHODS
  A total of 14 children underwent MET at Kanagawa Children's Medical Center between 2005 and 2013. A mediastinal operation field was made by a V-shaped hook infrasternally to extirpate the thymus with adipose tissue around the thymus.
  
  
  RESULTS
  The operation time and the amount of blood loss were 182±44 minutes and 34±43 ml, respectively. Postoperative complications, in the form of transient paralysis of the right recurrent nerve, occurred in 2 patients. The median length of postoperative hospital stay was 4.5 days. After MET, 6 patients achieved complete remission and 7 patients achieved steroid dose reduction, but no improvement was seen in 1 patient.
  
  
  CONCLUSIONS
  This procedure offers the advantage of good surgical access for dissection around the bilateral phrenic nerves in extended total thymectomy, while achieving good cosmetic results.
authors.affiliation: Department of Surgery, Kanagawa Children's Medical Center, Yokohama, Japan. Electronic address: norihikok@nifty.com.
authors.forename: N
authors.initials: N
authors.lastname: Kitagawa
authors.affiliation: Department of Surgery, Kanagawa Children's Medical Center, Yokohama, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Shinkai
authors.affiliation: Department of Surgery, Kanagawa Children's Medical Center, Yokohama, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Take
authors.affiliation: Department of Surgery, Kanagawa Children's Medical Center, Yokohama, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Mochizuki
authors.affiliation: Department of Surgery, Kanagawa Children's Medical Center, Yokohama, Japan.
authors.forename: F
authors.initials: F
authors.lastname: Asano
authors.affiliation: Department of Surgery, Kanagawa Children's Medical Center, Yokohama, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Usui
authors.affiliation: Department of Surgery, Kanagawa Children's Medical Center, Yokohama, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Miyagi
authors.affiliation: Department of Respiratory Surgery, Shion Hospital, Osaka, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Kido
authors.affiliation: Department of Surgery, Hakodate Municipal Hospital, Hokkaido, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Kurauchi
authors.affiliation: Department of Neurology, Kanagawa Children's Medical Center, Yokohama, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Osaka
authors.affiliation: Department of Neurology, Kanagawa Children's Medical Center, Yokohama, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Yamashita
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008481:Mediastinoscopy / Q000379:methods*; D008866:Microsurgery / Q000379:methods*; D009157:Myasthenia Gravis / Q000601:surgery*; D013934:Thymectomy / Q000379:methods*; D016896:Treatment Outcome
keywords: Children; Endoscopic surgery; Mediastinoscopy; Myasthenia gravis