Videothoracoscopos, kiterjesztett thymectomia a myasthenia gravis kezelésében : első tapasztalataink

INTRODUCTION: Extended thymectomy is the key-point of the surgical treatment of the myasthenia gravis (MG), when the thymus with the surrounding fatty tissue on the neck and in the mediastinum is removed. In this study we present a new surgical technique introduced into our practice in November 2004, and with that the thymectomy is performed with video-thoracoscopic method, without sternotomy. PATIENTS AND METHODS: Since November 2004, 6 patients (5 females and 1 male) were operated on for MG. Mean age was 26.2 years (17-41). Symptoms of MG was only ocular in 1 case (Stage I) and mild generalized in 5 cases (Stage II/B). The average preoperative period of the MG was 4 months (1-12). At the beginning of the surgery, the superior poles of the thymus were exposed and the fatty tissue surrounding the thymus in front of the trachea was removed. After that, the sternum was elevated with sternal retractors inserted under the sternum in the cervical and in a subxiphoid incisions. The thymectomy with the removal of the mediastinal fatty tissue was performed with bilateral video-assisted method. RESULTS: Mean operative time was 170 (120-210) minutes. There was no conversion to sternotomy, and there were no mortality and serious morbidity. Patients were extubated in the operating room. Chest tubes were removed on the first and second postoperative days. Mean postoperative hospitalization was 6.3 (5-7) days. At the one-month follow-up, there was 1 complete remission and 5 remissions with medication. In 1 case, the pathology revealed extrathymic thymus tissue in the cervical fat. There were 3 thymus hyperplasias, 2 thymitis and 1 thymic cyst as the pathological disorders of the thymus. CONCLUSIONS: The video-assisted extended thymectomy for MG, that was introduced into our practice, is a safe surgical procedure with good results. The postoperative period is easier for the patients, and the MG was improved in each cases