Video-assisted thoracoscopic thymectomy in treatment of myasthenia gravis

AIM. Myasthenia gravis is a rare autoimmune disease characterized by episodic muscle weakness and fatigue. The aim of the current study was to analyse the results of videoassisted thoracoscopic (VATS) thymectomy as a new approach to thymectomy for myasthenia gravis.

METHODS AND RESULTS. Nine consecutive patients (7 female, 2 male) with a mean age of 41 (± 11) years underwent VATS thymectomy between February 2005 and May 2008. Their main symptoms were muscle weakness, swallowing difficulties and diplopia. Operation was indicated due to progression of the disease. Using the right-sided VATS approach, the thymus was removed from the diaphragm up to the neck together with the anterior mediastinal tissue. A balanced technique of general anaesthesia was maintained by sevofl urane 0.5–3.5% in 50% oxygen, supplemented with propofol and fentanyl or remifentanil. Either atracurium (mean dose 0.1 mg kg-1 h-1) or rocuronium (mean dose  0.23 mg kg-1 h-1) was used, respectively. At the end of the procedure neostigmine 2.5 mg and atropine 1 mg were given in all cases. Mean operation time was 178 (± 43) min. Postoperatively, transient phrenic nerve palsy and subsequent respiratory failure was observed in one patient; another patient suffered from pneumonia. No mortality occurred. Mean postoperative follow-up was 22 (± 13) months. In all cases the dose of pyridostigmin was diminished; the mean daily dose pre- and postoperatively was 470 mg and 306 mg, respectively (p = 0.007). A clear tendency of decrease in muscle weakness was demonstrated (p = 0.052).

CONCLUSION. Init ial exper iences with VATS thymectomy confi rmed the safety of this technique. Postoperative ventilatory support was avoided in all but one case. VATS thymectomy appears to be at least as effective as open thymectomy in terms of resolution of myasthenia symptoms, but provides clear advantages of minimal invasive surgery.

Eesti Arst 2009; 88(12):811−816