Video-Assisted Thoracoscopic Thymectomy for the Treatment of My asthenia Gravis

• Published in: Archivos de bronconeumología (English ed.) 2004-09, Vol.40 (9), p.409-413
• Main Authors: Loscertales, J., Ayarra Jarne, J., Congregado, M., Tristán, A. Arroyo, Merchán, R. Jiménez, Girón Arjona, J.C., Arenas Linares, C.
• Format: Article
• Language: English
• Subjects: Miastenia gravis; Myasthenia gravis; Thymectomy; Timectomía; Video-assisted thoracoscopy; Videotoracoscopia
• ISSN: 1579-2129; 1579-2129
• DOI: 10.1016/S1579-2129(06)60344-3

Traditionally, thymectomy for myasthenia gravis has been performed using either a transcervical approach or a median sternotomy. However, excision of the thymic tissue by video-assisted thoracoscopic surgery is less aggressive and recovery is faster. The aim of this study was to evaluate the usefulness and outcomes of video-assisted thoracoscopic thymectomy. Over the past 10 years, we have performed 25 video-assisted thoracoscopic thymectomies on patients with myasthenia gravis at our unit. This study included 16 women and 9 men, with a mean age of 48.1 years (range, 14-74 years). Right-side (22 cases) or left-side (3 cases) thoracoscopic surgery was performed, with a mean intervention time of 110 minutes (range, 60-193 minutes). No patient required assisted ventilation for more than 4 hours and the maximum stay in intensive care was less than 24 hours. Complications from surgery included 3 cases of contralateral pneumothorax, 1 pleural effusion, and 2 intraoperative hemorrhages from the thymic vein, all of which were resolved by video-assisted thoracoscopy. Likewise, 3 cases required conversion (due to hemorrhaging in 2 patients and technical difficulties in 1) and 2 required a second thoracoscopic intervention. No deaths occurred and clinical outcome was excellent in 11 cases (medical treatment no longer required), good in 10 (reduced medical treatment), and poor in 4 (no changes). Video-assisted thoracoscopic thymectomy is effective in the treatment of myasthenia gravis and improves patient recovery. In addition, the excellent surgical view allows the thymectomy to be performed with absolute safety. Tradicionalmente la timectomía en el tratamiento de la miastenia gravis se ha realizado por esternotomía media o transcervical; técnicamente, la cirugía videotoracoscópica permite la extirpación del tejido tímico con menor agresión quirúrgica y una recuperación temprana. El objetivo de este estudio es valorar la utilidad y los resultados de la timectomía videotoracoscópica. En los últimos 10 años, hemos practicado 25 timectomías por videotoracoscopia en nuestro servicio a pacientes con miastenia gravis. Los pacientes incluidos en este estudio son 16 mujeres y 9 varones, con una edad media de 48,1 años (intervalo: 14-74). La intervención se realizó por toracoscopia (derecha en 22 casos e izquierda en los 3 restantes) y tuvo una duración media de 110 min (intervalo: 60-193 min). Ningún paciente precisó ventilación asistida durante más de 4 h y la estancia en l