Thoracoscopic thymectomy for treatment of myasthenia gravis

BACKGROUND: While thymectomy has been established for most of the stages of myasthenia gravis (MG) the optimal surgical approach for thymectomy remains a matter of discussion. Complete thoracoscopic thymectomy has been developed as a minimally invasive technique. Clinical application of thoracoscopic thymectomy has been investigated. PATIENTS/METHODS: A standardized technique for thoracoscopic thymectomy has been developed. In the the supine position with the operated left side elevated at approximately 30 degrees from the horizontal 3 trocars were placed between 3rd and 5th left intercostal spaces. Between 10/1994 and 5/1997 16 patients (12 female, 4 male, mean age 35 +/- 12 years) were prospectively selected for thoracoscopic thymectomy. RESULTS: In 15 cases the indication was MG (Ossermann stage 1-1, stage 2a-7, stage IIb-7 patients), 3 patients had a thymoma, in 2 of these patients both MG and thymoma were found. In 1 case a conversion to median sternotomy was necessary for technical reasons. The mean operation time was 132 +/- 47 minutes. All of the histological findings of the thymus were benign. Preliminary results with a mean follow-up of 16.4 +/- 10.1 months showed equal improvement rates of MG after thoracoscopic thymectomy as compared to conventional thymectomy. There was no perioperative mortality, and morbidity comprised one bleeding, one leakage of the thoracic duct and two pleural effusions. DISCUSSION: Complete thoracoscopic thymectomy is technically feasible with an acceptable learning curve. A very low postoperative morbidity and convincing short-term results have led to high acceptance by patients and neurologists. Long-term results and prospective comparison with median sternotomy may result in thoracoscopic thymectomy to become the operative approach of choice for selected cases.