Infrasternal mediastinoscopic thymectomy in myasthenia gravis: Surgical results in 23 patients

Department of Neurology, Neurological Institute, Kyushu University, Fukuoka, Japan
The Annals of Thoracic Surgery (Impact Factor: 3.85). 01/2002; 72(6):1902-1905. DOI: 10.1016/S0003-4975(01)03210-6


Background. Infrasternal mediastinoscopic surgery is a new approach to resection of the anterior mediastinal mass.Methods. 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.Results. 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.Conclusions. Infrasternal mediastinoscopic thymectomy is safe and feasible for patients with myasthenia gravis.

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    • "There is some controversy over the use of IMT due to its potential for failing to completely remove adipose tissue embedded in thymus tissues. We previously reported the short-term effect of IMT on MG patients [8], but the long-term outcomes and immunological effects have not been reported. Thus, in the present study we examined the long-term effects of IMT versus TT in MG patients without thymoma. "
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    ABSTRACT: Endoscopic thymectomy is commonly used for treatment of myasthenia gravis (MG) patients due to its relatively low invasiveness. However, the long-term effects of endoscopic thymectomy have not been fully evaluated. To assess the long-term effects of extended infrasternal mediastinoscopic thymectomy (IMT) in MG patients and compare them with those of extended transsternal thymectomy (TT). Among 24 MG patients without thymoma who underwent thymectomy in our Institute between January 1997 and December 2000, 14 patients who received IMT and 10 who received TT were enrolled in the present study. Quantitative myasthenia gravis (QMG) score and anti-acetylcholine receptor antibody (anti-AChR) titers were evaluated before and at five years after surgery. After five years, QMG scores were reduced from 6.6 to 1.8 (p<0.01) in the IMT group, and from 7.6 to 2.7 (p<0.01) in the TT group. The anti-AChR titers were reduced from 75.2 to 40.1 (p=0.027) in the IMT group, and from 224 to 61.3 (p=0.020) in the TT group. These data suggest that the long-term therapeutic effect of IMT is equivalent to TT, and is thus suitable for the treatment of MG patients.
    Journal of the neurological sciences 09/2009; 287(1-2):185-7. DOI:10.1016/j.jns.2009.08.002 · 2.47 Impact Factor
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    • "Multiple techniques are described for removal of the thymus in MG: Transcervical T. (basic or extended), Video-Assisted T. (classic or extended), Transsternal (standard or extended), Infrasternal mediastinoscopic T. There is an ongoing debate about the most suitable surgical approach for thymectomy as illustrated by the wide variety of different techniques that have been described in the literature [2] [3] [4] [5] [6]. "
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    ABSTRACT: We report a thoracoscopic thymectomy performed completely with a robotic surgical system: 'da Vinci surgical system', in a 23-year-old woman with myasthenia gravis.
    Interactive Cardiovascular and Thoracic Surgery 04/2003; 2(1):70-2. DOI:10.1016/S1569-9293(02)00104-4 · 1.16 Impact Factor
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    ABSTRACT: In questo capitolo viene descritto l’intervento di timectomia per via toracoscopica sinistra con ausilio del sistema robotico “Da Vinci”: al momenta attuale gli Autori hanno utilizzato tale tecnica esclusivamente in pazienti con MG non clinicamente correlata a timoma riservando l’approccio sternotomico per le neoplasie maligne del mediastino.
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