title: Bilateral thoracoscopic extended thymectomy versus sternotomy.
abstract: BACKGROUND
  Complete open surgical resection is the standard treatment for thymoma and myasthenia gravis. We evaluated the feasibility of bilateral video-assisted thoracoscopic extended thymectomy, and compared it to surgery via sternotomy.
  
  
  METHODS
  From 2011 to 2014, 43 patients undergoing thymectomy were divided into 2 groups: 23 underwent video-assisted thoracoscopic extended thymectomy, and 20 had thymectomy via sternotomy. The primary outcomes were postoperative pain score (visual analog scale) at 6, 12, 24, 48, and 72 h, and 1-month postoperatively, and morphine consumption in the first 48 h. Secondary outcomes were surgical and clinical results.
  
  
  RESULTS
  There were no significant differences between the 2 groups in terms of demographics and preoperative clinical data. Compared to the sternotomy group, the video-assisted thoracoscopic thymectomy group had lower pain scores and morphine consumption at all time points, significantly less operative blood loss and chest drainage volume, and shorter hospital stay. The rates of improvement in myasthenia gravis were 85% and 86% in the video-assisted thoracoscopic thymectomy and sternotomy groups, respectively. No recurrence of thymoma was found in either group (median follow-up 27 months).
  
  
  CONCLUSIONS
  Our results seem to confirm that in selected cases, video-assisted thoracoscopic thymectomy allows complete resection of thymus and perithymic tissue, similar to sternotomy but with the known advantages of minimally invasive surgery including less pain and a good cosmetic result.
authors.affiliation: Thoracic Surgery Unit, Istituto Oncologico del Mediterraneo, Catania, Italy alfonso.fiorelli@unina2.it.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Fiorelli
authors.affiliation: Thoracic Surgery Unit, Istituto Oncologico del Mediterraneo, Catania, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Mazzella
authors.affiliation: Thoracic Surgery Unit, Istituto Oncologico del Mediterraneo, Catania, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Cascone
authors.affiliation: Thoracic Surgery Unit, Second University of Naples, Naples, Italy.
authors.forename: Francesco Paolo
authors.initials: FP
authors.lastname: Caronia
authors.affiliation: Thoracic Surgery Unit, Second University of Naples, Naples, Italy.
authors.forename: Ettore
authors.initials: E
authors.lastname: Arrigo
authors.affiliation: Thoracic Surgery Unit, Istituto Oncologico del Mediterraneo, Catania, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Santini
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage; D016063:Blood Loss, Surgical / Q000517:prevention & control; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007558:Italy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D009157:Myasthenia Gravis / Q000175:diagnosis / Q000601:surgery*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D012189:Retrospective Studies; D056346:Sternotomy / Q000009:adverse effects; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects; D013934:Thymectomy / Q000009:adverse effects / Q000379:methods*; D013945:Thymoma / Q000175:diagnosis / Q000601:surgery*; D013953:Thymus Neoplasms / Q000175:diagnosis / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine
keywords: Myasthenia gravis; Sternotomy; Thoracic surgery; Thymectomy; Thymus gland; video-assisted