Video-assisted thoracoscopic versus transsternal thymectomy for myasthenia gravis: our early experience

ABSTRACT

Thymectomy is an accepted surgical modality of therapy for patients with myasthenia gravis. This study aimed at examining the thoracoscopic and transsternal approaches and to compare their surgical outcomes. A prospective cohort study of twenty patients with myasthenia gravis who underwent thymectomy between November 2003 and October 2004. Ten patients [50%] had thoracoscopic surgery while the other ten patients underwent resection by the transsternal route. The patients were followed up for twelve months. Statistical significance was determined by the Student t test or the Fisher's Exact Test. The thoracoscopic group had a mean operating time of 65.5 minutes compared to 76.3 minutes in the transsternal group [P=0.004]. The mean postoperative tube drainage was 54.5 mIs in the thoracoscopic group while it was 118.3 mls in the transsternal group [P=0.0001]. Surgical site infection was the most common complication in the transsternal group occurring in 30% of patients compared to 0% in the thoracoscopic group [P=0.05]. While four patients in the thoracoscopic group [40%] were in remission at 12 months, there were three [30%] in the transsternal group though this was not significant [P=0.23]. Thymectomy through the thoracoscopic approach is a safe and prefecred option for non-thymomatous myasthenia gravis as well as for very small encapsulated thymomas due to the shorter operating time, low complication rates and shorter hospital stay. However, both thoracoscopic and the transsternal routes achieved similar response rates in the short-term