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: 3.63). 01/2002; 72(6):1902-1905. DOI: 10.1016/S0003-4975(01)03210-6

ABSTRACT 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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    ABSTRACT: A maximally extended thymectomy is performed through four incisions: a transverse 5-8 cm incision in the neck, a 4-6 cm subxiphoid incision and two 1 cm incisions for videothoracoscopic ports. The cervical part of the procedure is performed with an open technique, the intrathoracic part of the procedure is performed with the videothoracoscopy assisted (VATS) technique. The whole thymus with the surrounding fatty tissue containing possible ectopic foci of the thymic tissue is removed. The need for sternotomy is avoided while the completeness of the operation is retained.
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    ABSTRACT: Myasthenia Gravis is an autoimmune disease characterized by progressive weakness of skeletal muscles with improvement following rest. The incidence is 50-142/million population with a female preponderance. We report a case of a 34 year female -diagnosed as Myasthenia Gravis who was receiving the treatment, was investigated in details and optimized. She was posted for right mediastinoscopic excision of thymoma. General Anaesthesia with one lung ventilation was planned. Thoracic epidural catheter was inserted for intraoperative and post-operative analgesia. One Lung Ventilation was achieved with left sided Double Lumen Tube (DLT) for better visualization of the operative field. Intraoperative haemodynamics were maintained using Sevoflurane and Epidural top-ups of Local Anaesthetics. After completion of the surgery, (right lung was re-inflated) DLT was replaced with a cuffed Portex ETT. Patient was shifted to ICU on ventilatory support and was extubated on the 2 nd post-op day. She was haemodynamically stable post-operatively and was eventually shifted to the wards on the 3 rd post-op day Key Messages The key to uneventful anaesthesia lies in understanding the pathophysiology of disease, interactions with the drugs required intraoperatively & vigilant monitoring. The outcome of the surgery depends on successful teamwork between surgeons, anaesthesiologists, & OR staff.