Article

Infrasternal mediastinoscopic thymectomy in myasthenia gravis: surgical results in 23 patients.

Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
The Annals of Thoracic Surgery (impact factor: 3.74). 01/2002; 72(6):1902-5. pp.1902-5
Source: PubMed

ABSTRACT Infrasternal mediastinoscopic surgery is a new approach to resection of the anterior mediastinal mass.
We evaluated this new approach in 23 patients with myasthenia gravis who underwent total thymectomy assisted by infrasternal mediastinoscopy between 1998 and 2000. The results were analyzed with special reference to morbidity and short-term improvement of the disease severity determined according to quantitative myasthenia gravis (QMG) scores.
Complete removal of the thymic gland with the pericardial adipose tissue was accomplished through an infrasternal mediastinoscopic approach in 21 of the 23 (91.3%) patients. The remaining 2 patients required conversion to sternotomy, the one for insufficient sternal lifting with vascular tape and the other for invasion of a thymoma to the innominate vein. There was no related mortality and only one complication, a phrenic nerve injury in 1 patient (4.3%). Significant clinical improvement of disease was achieved in the short term and several advantages were apparent.
Infrasternal mediastinoscopic thymectomy is safe and feasible for patients with myasthenia gravis.

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    Article: Comparison between the right side and subxiphoid bilateral approaches in performing video-assisted thoracoscopic extended thymectomy for myasthenia gravis.
    C-P Hsu, C-Y Chuang, N-Y Hsu, C-Y Chen
    [show abstract] [hide abstract]
    ABSTRACT: This study aimed to compare the efficacy of the right thoracoscopic (RtT) approach and the subxiphoid bilateral thoracoscopic (SxBiT) approach in performing thymectomy for myasthenia gravis. Between March 2001 and April 2003, 27 myasthenic patients were enrolled in this prospective study. The operations were conducted by two surgical teams in a single institute. The surgical procedures included RtT for 12 patients and SxBiT for 15 patients. The operation time, resected thymus weights, and thoracic drainage periods were compared. Subxiphoid video-assisted thoracoscopic extended thymectomy (SxVATET) and right-side thoracoscopic extended thymectomy (RtVATET) were performed for 27 consecutive myasthenic patients. The mean operation time, weights of resected specimens, and duration of hospital stay for the SxVATET and RtVATET groups were, respectively, 151.3 min (range, 120-200 min) versus 191.5 min (range, 120-225 min) (p = 0.0012), 73.3 g (range, 40-90 g) versus 50.8 g (range, 5-90 g) (p = 0.0029), and 3.1 days (range, 2-4 days) versus 3.8 days (range, 2-4 days) (p = 0.914). Ten patients (37%) had complete remission, observed during a mean follow-up period of 18.5 months (range, 6-30 months). During this consecutive experience, both the RtT and SxBiT approaches showed satisfactory results for nonthymomatous myasthenic patients. However, a better view of the bilateral pleural cavities and more radical thymectomy could be achieved only by the SxBiT approach.
    Surgical Endoscopy 06/2004; 18(5):821-4. · 4.01 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.

Keywords

1 patient
 
23 patients
 
4.3%). Significant clinical improvement
 
anterior mediastinal mass
 
infrasternal mediastinoscopic approach
 
Infrasternal mediastinoscopic surgery
 
Infrasternal mediastinoscopic thymectomy
 
infrasternal mediastinoscopy
 
innominate vein
 
myasthenia gravis
 
one complication
 
pericardial adipose tissue
 
quantitative myasthenia gravis
 
remaining 2 patients
 
short term
 
short-term improvement
 
special reference
 
thymic gland
 
total thymectomy
 
vascular tape
 

A Uchiyama