RESULTS OF VIDEO-ASSISTED THYMECTOMY IN PATIENTS WITH MYASTHENIA-GRAVIS

Objective: The efficacy of video-assisted thoracic surgery for thymect omy with myasthenia gravis has not been examined, Methods: Thirty-thre e consecutive patients underwent total thymectomy by video-assisted te chniques between 1992 and 1995, There were 13 male and 30 female patie nts with a mean age of 38.42 +/- 16.88 Sears (range 9 to 84 years), Th e procedures were performed by either a right (n = 11) or left (n = 22 ) thoracoscopic approach and all anterior mediastinal tissue was remov ed, Results: There was no perioperative mortality or long-term morbidi ty. One patient required conversion of the video-assisted thechnque to a lateral thoracotomy. All patients except one were extubated immedia tely. The mean hospital stay was 4.12 +/- 6.07 days (range 1 to 37 day s) with a median of 3 days, Mean follow-up is 23.39 +/- 11.72 months ( range 3 to 37 months), Clinical improvement was seen in 87.9% (29/33): one of two patients (50%) in stage I, 17 of 19 (89.4%) in stage IIA, eight of nine (88.8%) in stage IIB, and three of three (100%) in stage III. Metaanalysis of these results compared with results in nine publ ished series in which other techniques were used showed no difference in clinical improvement after thymectomy between series. Conclusion: W e conclude that video-assisted thymectomy is as effective as the tradi tional open surgical approaches for performance of thymectomy in the m anagement of patients with myasthenia gravis, In addition, the improve d cosmesis of the video-assisted approach ideally will lead to earlier thymectomy in patients ffith myasthenia gravis.