Top

Published in:

01-04-2008

Videothoracoscopic thymectomy for nonthymomatous myasthenia gravis: Results of 90 patients

Authors: Alper Toker, Serhan Tanju, Zerrin Sungur, Yesim Parman, Mert Senturk, Piraye Serdaroglu, Sukru Dilege, Feza Deymeer

Published in: Surgical Endoscopy | Issue 4/2008

Abstract

Background

Videothoracoscopic thymectomy is an alternative surgical procedure for patients with nonthymomatous myasthenia gravis. The aim of this study is to present our experience and to analyze the factors contributing to the operative morbidity.

Methods

Ninety myasthenia gravis patients were operated through right-sided videothoracoscopy from June 2002 to September 2006. Prospective data recording was performed. Surgeon-related conversion to open surgery, length of the operation, chest tube duration time, duration of hospital stay, amount of drainage, pain score, and complications were evaluated. Factors contributing to longer operation time and longer postoperative stay were studied.

Results

The mean length of chest tube duration and postoperative hospital stay was 26.7 ± 18.6 hours and 2.2 days ± 1.1 days respectively. Visual analogue scale (VAS) values for pain evaluation were 2.0 ± 1.4. Surgeon-related open conversion occured in two patients (2.2%). Body mass index (BMI) was the sole significant factor for longer operation time. (23.04 ± 2.93 versus 25.61 ± 2.70 (p = 0.001). The amount of pyridostigmine was the only significant factor for longer hospital stay (213.3 ± 101.5 mg versus 270. 0 ± 122.6 mg (p = 0.044).

Conclusions

This study demonstrates the right-sided videothoracoscopy is a safe procedure. The only contributing factors were: BMI >25.61 for longer operation time, and pyridostigmine level >270 mg for duration of postoperative stay.

Cooper J, Al-Jilaihawa A, Pearson FG, Humphrey JG, Humphrey HE (1988) An improved technique to fascilitate transcervical thymectomy for myasthenia gravis. Ann Thorac Surg 45:252–247

Jaretzki A III, Wolf M (1988) Maximal thymectomy for myasthenia gravis: surgical anatomy and operative technique. J Thorac Cardiovasc Surg 96:711–716PubMed

Mack JM (2001) Videoassisted thoracoscopic thymectomy for myasthenia gravis. Chest Surg Clin N Am 11:389–405PubMed

Toker A, Eroğlu O, Ziyade S, Tanju S, Senturk M, Dilege S, Kalayci G (2005) Comparison of early postoperative results of thymectomy:partial sternotomy vs videothoracoscopy. Thorac Cardiovasc Surg 53(2):110–113PubMedCrossRef

Savcenko M, Wendt KG, Prince SL, Mack JM (2002) Video-assisted thymectomy for myasthenia gravis: an update of a single institution experience. Eur J CardioThorac Surg 22:978–983PubMedCrossRef

Mineo TC, Pompe E, Lerut TE, Bernardi G, Coosemans W, Nofroni I (2000) Thoracoscopic thymectomy in autoimmune myasthenia: Results of left sided approach. Ann Thorac Surg 69:1537–1541PubMedCrossRef

Wright GM, Barnett S, Clarke CP (2002) Video-assisted thoracoscopic thymectomy for myasthenia gravis. Intern Med J 32:367–371PubMedCrossRef

Tomulescu V, Ion V, Kosa A, Sgarbura O, Popescu I. (2006) Thoracoscopic thymectomy mid term results. Ann Thorac Surg 82:1003–7PubMedCrossRef

Li JF, Li JR, Yang F, Jiang GC, Wang J (2006). Long term effects of video-assissted thoracoscopic thymectomy for myasthean gravis: 5 years follow up of 18 cases. Zhonghua Yi Xue Za Zhi 86:2312–2314PubMed

10.

Jaretzki A (1997) Thymectomy for myasthenia gravis: Analysis of the controversies regarding technique and results. Neurology 48:52–63

11.

Detterbeck FC, Scott WW, Howard Jr JF, Eagen TM, Keagy PA, Starek JK, Mill MR, Wilcox BR (1996) Onehundred consecutive thymectomies for myasthenia gravis. Ann Thorac Surg 62:242–245PubMedCrossRef

12.

Calhoun RF, Ritter JH, Guthrie TJ, Pestronk A, Meyers BF, Patterson GA, Pohl MS, Cooper JD (1999) Results of transcervical thymectomy for myasthenia gravis in 100 consecutive patients. Ann Surg 230:555–561PubMedCrossRef

13.

Ruckert JC, Walter M, Muller JM (2000) Pulmonary function after thoracoscopic thymectomy versus median sternotomy for myasthenia gravis. Ann Thorac Surg 70:1656–1661PubMedCrossRef

14.

Genkins G, Papatestas AE, Horowitz SH, Kornfield P (1975) Studies in myasthenia gravis : Early thymectomy: Electrophysiologic and pathological correction. Am J Med 58:517–524PubMedCrossRef

15.

Bril V, Kojic J, Ilse WK, Cooper JD (1998) Long term clinical outcome after transcervical thymectomy for myasthenia gravis. Ann Thorac Surg 65:1520–1522PubMedCrossRef

16.

Olanow CW, Wechsler AS, Roses AD (1982) A prospective study of thymectomy and serum acetylcholine receptor antibodies in myasthenia gravis. Ann Surg 196:113–121PubMedCrossRef

17.

Hazellrigg SR (2004) Thoracoscopic or Video-Assisted (VATS) thymectomy. Operative techniques in thoracic and cardiovascular Surgery. 9:184–192CrossRef

Title: Videothoracoscopic thymectomy for nonthymomatous myasthenia gravis: Results of 90 patients
Authors: Alper Toker
Serhan Tanju
Zerrin Sungur
Yesim Parman
Mert Senturk
Piraye Serdaroglu
Sukru Dilege
Feza Deymeer
Publication date: 01-04-2008
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 4/2008
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-007-9507-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Videothoracoscopic thymectomy for nonthymomatous myasthenia gravis: Results of 90 patients

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 4/2008

Laparoscopic training on Thiel human cadavers: A model to teach advanced laparoscopic procedures

Determinants of complications and adequacy of surgical resection in laparoscopic versus open total gastrectomy for adenocarcinoma

Minimally invasive esophagectomy for cancer: laparoscopic transhiatal procedure or thoracoscopy in prone position followed by laparoscopy?

Results of laparoscopic Heller myotomy without anti-reflux procedure in achalasia. Monocentric prospective study of 106 cases

A lightweight, partially absorbable mesh (Ultrapro) for endoscopic hernia repair: experimental biocompatibility results obtained with a porcine model

Clinical evaluation and management of caustic injury in the upper gastrointestinal tract in 95 adult patients in an urban medical center