The treatment of myasthenia gravis by video thoracoscopic thymectomy. The technic and the initial results

The primary role of thymectomy for the treatment of myasthenia gravis is currently undisputed. Traditionally, the approach of choice has been sternotomy, although a transcervical route has also been advocated because of its lower rate of associated morbidity. Our department performed thymectomy usin...

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Bibliographic Details
Published in:Archivos de bronconeumología 1999-01, Vol.35 (1), p.9-14
Main Authors: Loscertales, J, Jiménez Merchán, R, Arenas Linares, C J, García Díaz, F, Girón Arjona, J C, Congregado Loscertales, M, Martínez Parra, C, Izquierdo Ayuso, G
Format: Article
Language:Spanish
Subjects:
Adult
Aged
Endoscopy - methods
Female
Humans
Male
Middle Aged
Myasthenia Gravis - diagnosis
Myasthenia Gravis - surgery
Preoperative Care
Thoracoscopy - methods
Thymectomy - methods
Treatment Outcome
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Summary:The primary role of thymectomy for the treatment of myasthenia gravis is currently undisputed. Traditionally, the approach of choice has been sternotomy, although a transcervical route has also been advocated because of its lower rate of associated morbidity. Our department performed thymectomy using a video-assisted thoracoscopic technique in 7 patients (2 men and 5 women) between March 1993 and October 1995. The patients' mean age was 43.4 years (range 20 to 66 years). Complications were few, consisting of 2 cases of pneumothorax due to contralateral opening of the pleura, resolved by pleural drainage. No deaths occurred. Clinical results over periods of observation ranging from 14 to 44 months were excellent in 2 cases of complete remission; good in 3 patients with considerable reduction in drug requirements; and fair in 2 patients who continued to need the same doses of medication throughout the 14 months after thymectomy. The technique we propose is less aggressive than mid-sternotomy, offering incontrovertible advantages and leading to faster. No patient required assisted ventilation for longer than 4 hours and the maximum time spent in the intensive care unit was 24 hours. We therefore suggest that thymectomy to treat myasthenia gravis be performed by thoracoscopy.
ISSN:0300-2896