Comparison Of Video-assisted Thoracoscopic Surgery And Median Sternotomy Approach For Myasthenia Gravis

Objectives: Myasthenia gravis (MG) is a chronic autoimmune neuromuscular disorder of the postsynaptic acetylcholine receptors resulting in striated muscle weakness and fatigue. Currently, the treatment for MG includes drugs and thymectomy. The cholin esterase inhibitor drugs, immunosuppressants and immunoglobulin are used for the medical therapy treatment of MG. Traditionally, the most common surgical approach to the thymus gland for myasthenia gravis is a median sternotomy,either partial or total. Other techniques, namely the transcervical approach and the more-radical approach that combines a median sternotomy with a transcervical incision also have their advocates. Although various surgical approaches to thymic resection exist, minimally invasive techniques have become increasingly popular due to their low procedural morbidity and mortality, improved cosmesis,lesser degree of access trauma, and equivalent efficacy compared to conventional open techniques. Surgical technique of thoracoscopic thyme- ctomy has been well described.Our study is to investigate the value of video-assisted thoracoscopic surgery (VATS) by comparing the clinic effect of VATS and thymectomy in the treatment of myasthenia gravis.Methods: Twenty-eight patients who were confirmed to be MG preoperatively from 2001 to 2007 at the Thoracic Surgery department of First Affiliated Hospital of Dalian Medical University, were divided into VATS group (12 cases) and thoracotomy group (16 cases). To compare the operative time, blood loss during operation, the time of postoperative drainage tube left in chest, postoperative hospitalization days, intensivee care time, tracheal extubation time, MG crisis after operation and the curative effect in two groups.Results: In VATS group, the time of postoperative drainage tube left in chest, pos- toperative hospitalization days, tracheal extubation time and intensive care time were super to those of thoracotomy group ( P<0.05) . There was no postoperative mortality or MG crisis in two groups. During a follow-up of 3-84 months, symptom was improv- ed in 92% of patients in VATS group and 94% in thoracotomy group ( P>0.05).Conclusions: Maximal thymectomy with VATS is safe and feasible with the advantages of less invasion, quick recovery and good curative effect.It is an ideal choice for the surgical treatment of MG without wide range of pleural adhesions and the patients that can not be tolerated one-lung ventilation should accept thymectomy.