title: Left- and right-sided video-assisted thoracoscopic thymectomy exhibit similar effects on myasthenia gravis.
abstract: BACKGROUND
  Unilateral video-assisted thoracoscopic (VATS) thymectomy features less operative trauma, improved cosmesis, and similar efficiency compared with transsternal (TS) thymectomy for treatment of patients with myasthenia gravis (MG). Unilateral VATS thymectomy can be easily performed from either side of the thorax, because thymus is located in the middle of mediastinum. Nevertheless, the side that provides better outcomes remains controversial. This study presents our experience on treatments for MG and reveals the differences between the unilateral VATS thymectomy performed on each side.
  
  
  METHODS
  Eighty-one consecutive patients with MG who underwent TS or VATS thymectomy on either side between January 2003 and December 2012 were enrolled in the study. Clinicopathologic data and surgical outcomes were retrospectively analyzed and compared among different surgical approaches.
  
  
  RESULTS
  TS thymectomy was administered in 50 patients, whereas unilateral VATS approaches were performed on the remaining 31 patients, 15 on the left side and 16 on the right side. The VATS group exhibited a significantly shorter surgery duration (P<0.001), less intraoperative blood loss (P=0.009), shorter postoperative hospital stay (P=0.025), smaller thoracic drainage volume (P=0.033), shorter thoracic drainage duration (P=0.006), and less postoperative complications (P<0.001) compared with the TS group. However, disease remission rates did not significantly differ among the groups (P=0.988). The left-sided group exhibited considerably longer thoracic drainage duration than the right-sided group (P=0.041). Moreover, surgical time (P=0.736), intraoperative blood loss (P=0.281), postoperative hospital stay (P=0.599), thoracic drainage volume (P=0.571), postoperative complications (P=0.742) and therapeutic effect (P=1.000) did not significantly differ among the groups. Multivariate analysis revealed that the ocular type of MG is the only independent factor for clinical remission (P=0.002).
  
  
  CONCLUSIONS
  Unilateral VATS thymectomy can reduce surgical risks and shorten hospitalization duration without threatening the therapeutic effect. This technique can be safely and effectively performed by experienced surgeons in either side of the thorax.
authors.affiliation: 1 Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, 2 Department of Thoracic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China ; 3 Department of Thoracic Surgery, General Hospital of Ningxia Medical University, Yinchuan 750004, China.
authors.forename: Xuan
authors.initials: X
authors.lastname: Xie
authors.affiliation: 1 Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, 2 Department of Thoracic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China ; 3 Department of Thoracic Surgery, General Hospital of Ningxia Medical University, Yinchuan 750004, China.
authors.forename: Xiangfeng
authors.initials: X
authors.lastname: Gan
authors.affiliation: 1 Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, 2 Department of Thoracic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China ; 3 Department of Thoracic Surgery, General Hospital of Ningxia Medical University, Yinchuan 750004, China.
authors.forename: Baishen
authors.initials: B
authors.lastname: Chen
authors.affiliation: 1 Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, 2 Department of Thoracic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China ; 3 Department of Thoracic Surgery, General Hospital of Ningxia Medical University, Yinchuan 750004, China.
authors.forename: Zhuojian
authors.initials: Z
authors.lastname: Shen
authors.affiliation: 1 Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, 2 Department of Thoracic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China ; 3 Department of Thoracic Surgery, General Hospital of Ningxia Medical University, Yinchuan 750004, China.
authors.forename: Minghui
authors.initials: M
authors.lastname: Wang
authors.affiliation: 1 Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, 2 Department of Thoracic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China ; 3 Department of Thoracic Surgery, General Hospital of Ningxia Medical University, Yinchuan 750004, China.
authors.forename: Huizhong
authors.initials: H
authors.lastname: Zhang
authors.affiliation: 1 Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, 2 Department of Thoracic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China ; 3 Department of Thoracic Surgery, General Hospital of Ningxia Medical University, Yinchuan 750004, China.
authors.forename: Xia
authors.initials: X
authors.lastname: Xu
authors.affiliation: 1 Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, 2 Department of Thoracic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China ; 3 Department of Thoracic Surgery, General Hospital of Ningxia Medical University, Yinchuan 750004, China.
authors.forename: Ju
authors.initials: J
authors.lastname: Chen
keywords: Myasthenia gravis (MG); outcomes; thoracoscopy; thymectomy