Resection of Thymoma by Video-assisted Thoracoscopy for Myasthenia Gravis / 中国微创外科杂志

ABSTRACT

Objective To evaluate the feasibility of video-assisted thoracoscopic resection of thymoma for myasthenia gravis.Methods Between July 2005 and February 2006,10 patients with thymoma were enrolled in this study.After double lumen intubation,video-assisted thoracoscopic resection of the thymus and thymoma was performed on the patients under total intravenous anesthesia.The largest tumor in this series was 6 cm ? 4 cm ? 3 cm.For a three-trocar technique,three incisions with a length of 1,3,or 1.5 cm were made respectively at the fifth intercostal space on the midaxillary line,fourth intercostal space on the middle between the anterior axillary line and midclavicular line,and sixth intercostal space on the anterior axillary line.During the operation,to expose the ipsilateral thymus and part of the contralateral thymus,the mediastinal pleura was cut along the internal thoracic artery,and superior vena cava or phrenic nerve.The thymus was then separated,and the thymic vein was dissected along the brachiocephalic vein and ligated.All the patients received radiotherapy after the operation with a dose of 4000 cGy.Results The operation time ranged from 70 to 130 minutes(mean,110 minutes)and the blood loss was less than 100 ml in all the cases.After the operation,7 patients presented Masaoka stage Ⅰ and 3 were at stage Ⅱ.No patient died or had cardiopulmonary complications or myasthenia crisis.The symptoms of myasthenia gravis were relieved in 1 week.The patients were followed up for 8 to 15 months(mean 13.0 months).During the period,none of them developed recurrence,metastasis,or aggravation of the myasthenia gravis.Conclusions It is feasible to resect stage Ⅰ to Ⅱ thymoma by video-assisted thoracoscopy.The procedure is minimal invasive with a few postoperative complications and good cosmetic outcomes.