Skip to main content
SpringerLink
Log in

Transcervical video-assisted thymectomy: preliminary results of a modified surgical approach

  • How-I-Do-It Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

A number of surgical approaches have been reported for thymectomy, including transsternal, transcervical, a combination of complete transsternal and transcervical, and various video-assisted thoracoscopic surgery techniques. A modified video-assisted transcervical approach to thymectomy is here described.

Methods

A video-assisted total thymectomy was performed through a 30-mm cervical incision. No hyperextension of the patient's neck or sternal retractor was used. The surgical instruments utilized for the resection were the ones created for the minimally invasive video-assisted thyroidectomy.

Results

Five patients have been operated on so far. The encapsulated gland was removed without any difficulties. No complications occurred. No pain relief was administered after the first 24 h. The patients were discharged within the first two postoperative days. An improvement in clinical symptoms was registered in all patients.

Conclusions

An advantage of this minimally invasive video-assisted transcervical approach to thymectomy is that the entire operation can be performed without neck hyperextension or permanent sternum elevation. Moreover, the surgical instruments created for minimally invasive video-assisted thyroidectomy enabled us to be very precise and to complete the resection without any postoperative morbidity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Yu L, Shan M, Jiang J, Jing Y, Zang N, Wang T, Gamliel Z, Krasna MJ (2008) Combined transcervical and unilateral-thoracoscopic thymectomy for myasthenia gravis: 2 years of follow-up. Surg Laparosc Endosc Percutan Tech 18:489–492. doi:10.1097/SLE.0b013e31817c55a8

    Article  PubMed  Google Scholar 

  2. Blalock A, Mason MF, Morgan HJ, Riven SS (1939) Myasthenia gravis and tumors of the thymic region. Report of a case in which the tumor was removed. Ann Surg 110:544–561

    Article  CAS  PubMed  Google Scholar 

  3. Blalock A, Harvey AG, Ford FR, Lilienthal JL Jr (1941) The treatment of myasthenia gravis by removal of the thymus gland: preliminary report. J Am Med Assoc 117:1529–1533

    Google Scholar 

  4. Magee MJ, Mack MJ (2009) Surgical approaches to the in patients with myasthenia gravis. Thorac Surg Clin 19:83–89. doi:10.1016/j.thorsurg.2008.09.013

    Article  PubMed  Google Scholar 

  5. Toker A, Tanju S, Sungur Z, Parman Y, Senturk M, Serdaroglu P, Dilege S, Deymeer F (2008) Videothoracoscopic thymectomy for nonthymomatous myasthenia gravis: results of 90 patients. Surg Endosc 22:912–916. doi:10.1007/s00464-007-9507-2

    Article  PubMed  Google Scholar 

  6. Zielinski M, Kuzdzał J, Szlubowski A, Soja J (2004) Transcervical-subxiphoid-videothoracoscopic “maximal” thymectomy--operative technique and early results. Ann Thorac Surg 78:404–409. doi:10.1016/j.athoracsur.2004.02.021

    Article  PubMed  Google Scholar 

  7. Shigemura N, Shiono H, Inoue M, Minami M, Ohta M, Okumura M, Matsuda H (2006) Inclusion of the transcervical approach in video-assisted thoracoscopic extended thymectomy (VATET) for myasthenia gravis: a prospective trial. Surg Endosc 20:1614–1618. doi:10.1007/s00464-005-0614-7

    Article  CAS  PubMed  Google Scholar 

  8. Rueckert JC, Sobel HK, Goehring S, Einhaeupl KM, Mueller JM (2003) Matched-pair comparison of three different approaches for thymectomy in myasthenia gravis. Surg Endosc 17:711–715. doi:10.1007/s00464-002-9162-6

    Article  Google Scholar 

  9. Wolf N, Husemann B, Druschky KF, Kalies I, Giedl J, Groitl H, Wagner W (1983) Thymektomie bei Patienten mit Myasthenia gravis. Langenbecks Arch Surg 361:913–916. doi:10.1007/BF01276196

    Google Scholar 

  10. Weinreich AJ, Silvay G, Eisenkraft JB, Papatestos A (1983) Transcervical thymectomy in the treatment of myastenia gravis. Langenbecks Arch Surg 361:756–761. doi:10.1007/BF01276057

    Google Scholar 

  11. Bril V, Kojic J, Ilse W, Cooper J (1998) Long-term clinical outcome after transcervical thymectomy for myasthenia gravis. Ann Thorac Surg 65:1520–1522. doi:10.1016/S0003-4975(98)00184-2

    Article  CAS  PubMed  Google Scholar 

  12. Shrager JB, Deeb ME, Mick R, Brinster CJ, Childers HE, Marshall MB, Kucharczuk JC, Galetta SL, Bird SJ, Kaiser LR (2002) Transcervical thymectomy for myasthenia gravis achieves results comparable to thymectomy by sternotomy. Ann Thorac Surg 74:320–326. doi:10.1016/S0003-4975(03)00488-0

    Article  PubMed  Google Scholar 

  13. Schumacher E, Roth J (1912) Thymektomie bei cenum Fall von Morbus Basedowii mit myasthenia. Mit a d Grezgeb d Med Chir 25:746

    Google Scholar 

  14. Crile G Jr (1966) Thymectomy through the neck. Surgery 59:213–215

    PubMed  Google Scholar 

  15. Del Rio P, Arcuri MF, Pisani P, De Simone B, Sianesi M (2010) Minimally invasive video-assisted thyroidectomy (MIVAT): what is the real advantage? Langenbecks Arch Surg 395:323–326. doi:10.1007/s00423-009-0589-2

    Article  PubMed  Google Scholar 

  16. Kirschner PA, Osserman KE, Kark AE (1969) Studies in myasthenia gravis: transcervical total thymectomy. JAMA 209:906–910

    Article  CAS  PubMed  Google Scholar 

  17. Kark AE, Kirschner PA (1971) Total thymectomy by the transcervical approach. Br J Surg 58:321–326

    Article  CAS  PubMed  Google Scholar 

  18. Cooper JD, Al-Jilaihawa AN, Pearson FG, Humphrey JG, Humphrey HE (1988) An improved technique to facilitate transcervical thymectomy for myasthenia gravis. Ann Thorac Surg 45:242–247

    Article  CAS  PubMed  Google Scholar 

  19. Jaretzki A III, Penn AS, Younger DS, Wolff M, Olarte MR, Lovelace RE, Rowland LP (1988) “Maximal” thymectomy for myasthenia gravis. Results. J Thorac Cardiovasc Surg 95:747–757

    PubMed  Google Scholar 

  20. Mantegazza R, Baggi F, Bernasconi P, Antozzi C, Confalonieri P, Novellino L, Spinelli L, Ferrò MT, Beghi E, Cornelio F (2003) Video-assisted thoracoscopic extended thymectomy and extended transsternal thymectomy (T-3b) in non-thymomatous myasthenia gravis patients: remission after 6 years of follow-up. J Neurol Sci 212:31–36. doi:10.1016/S0022-510X(03)00087-X

    Article  PubMed  Google Scholar 

  21. Shrager BJ, Nathan D, Brinster CJ, Yousuf O, Spence A, Chen Z, Kaiser LR (2006) Outcomes after 151 extended transcervical thymectomies for myasthenia gravis. Ann Thorac Surg 82:1863–1869. doi:10.1016/j.athoracsur.2006.05.110

    Article  PubMed  Google Scholar 

  22. Mineo TC, Pompeo E (2010) Extended videothoracoscopic thymectomy in non-thymomatous myasthenia gravis. Thorac Surg Clin 20:253–263. doi:10.1016/j.thorsurg.2010.01.002

    Article  PubMed  Google Scholar 

  23. Daniel VC, Wright CD (2010) Extended transsternal thymectomy. Thorac Surg Clin 20:245–252. doi:10.1016/j.thorsurg.2010.02.005

    Article  PubMed  Google Scholar 

  24. Yoshino I, Hashizume M, Shimada M, Tomikawa M, Tomiyasu M, Suemitsu R, Sugimachi K (2001) Thoracoscopic thymomectomy with the da Vinci computer-enhanced surgical system. J Thorac Cardiovasc Surg 122:783–785. doi:10.1067/mtc.2001.115231

    Article  CAS  PubMed  Google Scholar 

  25. Limmer KK, Kernstine KH (2011) Minimally invasive and robotic-assisted thymus resection. Thorac Surg Clin 21:69–83. doi:10.1016/j.thorsurg.2010.08.005

    Article  PubMed  Google Scholar 

Download references

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Thoracic Surgery, University Hospital of Parma, via Gramsci 14, 43126, Parma, Italy

    Luca Ampollini, Michele Rusca & Paolo Carbognani

  2. General Surgery and Organ Transplantation, University Hospital of Parma, via Gramsci 14, 43126, Parma, Italy

    Paolo Del Rio & Mario Sianesi

Authors
  1. Luca Ampollini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paolo Del Rio
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mario Sianesi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michele Rusca
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Paolo Carbognani
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Luca Ampollini.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ampollini, L., Del Rio, P., Sianesi, M. et al. Transcervical video-assisted thymectomy: preliminary results of a modified surgical approach. Langenbecks Arch Surg 396, 267–271 (2011). https://doi.org/10.1007/s00423-010-0737-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-010-0737-8

Keywords

Search

Navigation