Early Outcomes of Thoracoscopic versus Open Extended Thymectomy in Myasthenia Gravis Patients

Michael Moawad; Mohamed  Elgariah; Mohamed  Abo Elnasr; Elatafy  Elmetwally

Michael Moawad Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
Mohamed Elgariah Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
Mohamed Abo Elnasr Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
Elatafy Elmetwally Department of Cardiothoracic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt

Keywords: Thoracoscopic thrombectomy, Myasthenia gravis, Video-assisted thoracoscopic surgery, Trans-Sternal and open thymectomy

Abstract

Background: The debate concerning the impact of surgical approaches for thymectomy on the outcomes of myasthenia gravis continues. This study aimed to present the preliminary outcomes of thoracoscopic versus transsternal thymectomy for patients with myasthenia gravis.

Methods: A total of 60 patients participated in this cohort study. Twenty-seven of these patients underwent thymectomy via video-assisted thoracoscopic surgery (VATS) with one (n= 7) or two ports (n= 20) (Group I). Thirty-three patients underwent thymectomy via the transsternal approach (Group II). The study was conducted over one year, and the patients were followed for three months postoperatively.

Results: The duration of the operation (88±9 vs. 131±6 min, P<0.001) and volume of blood loss (109±12 vs. 434± 54 ml; P<0.001) were significantly lower in the VATS patients. Additionally, early extubation was significantly more common in Group I than in Group II (100% vs. 48%; P <0.001). Compared with Group II patients, Group I patients had a significantly lower need for blood transfusions (0 vs. 6 (18%); P<0.001) and postoperative intensive care units (0 vs. 28 (85%); P <0.001). Compared with Group II, Group I had a lower VAS pain score after 24 h (4 (3-5) vs. 6 (6-7); P<0.001). Patient mobilization occurred significantly earlier in Group I than in Group II (5.89 ± 1.45 vs. 19.09 ± 6.38; P <0.001). No cases of video-assisted thoracoscopic surgery were converted to open surgery, and no cases of operative mortality were reported in either group.

Conclusions: Compared with open thymectomy, thoracoscopic thymectomy might yield superior results. Thoracoscopic thymectomy is associated with a shorter duration of operation, less blood loss, less need for blood transfusion, less need for the ICU, a lower pain score, and an earlier timing of patient mobilization. Therefore, thoracoscopic thymectomy could be preferable to open thymectomy for the surgical treatment of myasthenia gravis.