Abstract
Background
In the management of autoimmune myasthenia, thymectomy is recognized as effective surgical therapy. The necessity of complete radical thymectomy to achieve maximal improvement has been emphasized. Video-assisted thoracoscopic surgery has been successfully used for thymectomy in adults, and more recently in children, and has been described as achieving the same radicality and functional improvement as median sternotomy or as transcervical thymectomy. The aim of this work is to report our first thoracoscopic experience in this indication.
Methods
Patients with myasthenia gravis on anticholinesterase drugs and/or steroids are discussed for surgery in case of clinical deterioration despite increasing doses of medication or in case of no improvement. We decided to perform thoracoscopic thymectomies by a left-sided approach. Preoperative localization of thymic tissue is done by a thoracic CT exam. Patients are placed on their right side with a thoracic tilt under the thorax. Four thoracoscopic ports are used, a 10-mm for the camera and three 5-mm operating ports. The left lung was collapsed by selective intubation (double-lumen endotrachial intubation).
Results
Two boys, 7.5 and 14 years old, were addressed by the department of neurology for radical thymectomy. They presented an ocular myasthenia gravis for 2 years and a mild general myasthenia gravis for 7 years. The operative times were 120 and 240 min. There was no intraoperative or postoperative complication. Duration of thoracic drainage was 2 days. The children were discharged on the third postoperative day. For the second procedure, an ultrasound exam during surgery was necessary to localize the thymus exactly, thus enabling its complete resection without the need for a conversion. The follow-up is 19 and 7 months with a clinical improvement enabling the diminution of medication for both children, the end of ptosis for the first child, and the general improvement of muscle strength for the second.
Conclusions
Thoracoscopic thymectomy in children with juvenile myasthenia gravis seems to offer a complete surgical resection, as do open techniques. In case of difficulties in finding the thymus, an ultrasound exam is feasible to enable complete resection. The left-sided thoracoscopic approach gives a good mediastinal and cervical exposition. Furthermore, being less painful in the postoperative period, it presents a less pronounced impairment of pulmonary function, and it presents good cosmetic effect.
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References
A Blalock MF Mason HJ Morgan SS Riven (1939) ArticleTitleMyasthenia gravis and tumors of the thymic region: report of a case in which the tumor was removed Ann Surg 110 544–561
JM Budde CD Morris AA Gal KA Mansour I Miller (2001) ArticleTitlePredictors of outcome in thymectomy for myasthenia gravis Ann Thorac Surg 72 197–202 Occurrence Handle10.1016/S0003-4975(01)02678-9 Occurrence Handle1:STN:280:DC%2BD3Mvhs1alsA%3D%3D Occurrence Handle11465178
BK Han HK Yoon YL Suh (2001) ArticleTitleThymic ultrasound. II—Diagnosis of aberrant cervical thymus Pediatr Radiol 31 480–487
A Jaretzki SuffixIII (1997) ArticleTitleThymectomy for myasthenia gravis: analysis of the controversies regarding technique and results Neurology 48 S52–S63
KA Kogut AJ Bufo SS Rothenberg et al. (2000) ArticleTitleThoracoscopic thymectomy for myasthenia gravis in children J Pediatr Surg 35 1576–1577
H Kolski J Vajsar PCW Kim (2000) ArticleTitleThoracoscopic thymectomy in juvenile myasthenia gravis J Pediatr Surg 35 768–770
K Lakhoo J Fonseca ParticleDe J Rodda et al. (1997) ArticleTitleThymectomy in black children with juvenile myasthenia gravis Pediatr Surg Int 12 113–115
MJ Mack RJ Landreneau AP Yim et al. (1996) ArticleTitleResults of video-assisted thymectomy in patients with myasthenia gravis J Thorac Cardiovasc Surg 112 1352–1360
A Masaoka Y Yamakawa H Niwa et al. (1996) ArticleTitleExtended thymectomy for myasthenia gravis patients: a 20-year review Ann Thorac Surg 62 853–859
TC Mineo E Pompeo V Ambrogi et al. (1996) ArticleTitleAdjuvant pneumomediastinum in thoracoscopic thymectomy for myasthenia gravis Ann Thorac Surg 62 1210–1212
TC Mineo E Pompeo TE Lerut et al. (2000) ArticleTitleThoracoscopic thymectomy in autoimmune myasthenia: results of left-sided approach Ann Thorac Surg 69 1537–1541
MA Morita AA Gabbai ASB Oliveira et al. (2001) ArticleTitleMyasthenia gravis in children. Analysis of 18 patients Arq Neuropsiquiatr 59 681–685
H Nakamura Y Taniguchi Y Suzuki et al. (1996) ArticleTitleDelayed remission after thymectomy for myasthenia gravis of the purely ocular type J Thorac Cardiovasc Surg 112 371–375
E Pompeo I Nofroni N Lavicoli et al. (2000) ArticleTitleThoracoscopic completion thymectomy in refractory nonthymomatous myasthenia Ann Thorac Surg 70 918–923
PF Roberts F Venuta E Rendina et al. (2001) ArticleTitleThymectomy in the treatment of ocular myasthenia gravis J Thorac Cardiovasc Surg 122 562–568 Occurrence Handle10.1067/mtc.2001.116191 Occurrence Handle1:STN:280:DC%2BD3MvpvVamuw%3D%3D Occurrence Handle11547310
JC Rückert M Walter JM Müller (2000) ArticleTitlePulmonary function after thoracoscopic thymectomy versus median sternotomy .for myasthenia gravis Ann Thorac Surg 70 1656–1661
CL Skelly CC Jackson CB Wu WJ Chwals DC Liu (2003) ArticleTitleThoracoscopic thymectomy for myasthenia gravis Am Surg 69 1087–1089
M Tripathi K Srivastava SK Misra et al. (2001) ArticleTitlePeri-operative management of patients for video assisted thoracoscopic thymectomy in myasthenia gravis J Postgrad Med 47 258–261
AP Yim RL Kay JK Ho (1995) ArticleTitleVideo-assisted thoracoscopic thymectomy for myasthenia gravis Chest 108 1440–1443
S Youssef (1983) ArticleTitleThymectomy for myasthenia gravis in children J Pediatr Surg 18 537–541
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Seguier-Lipszyc, E., Bonnard, A., Evrard, P. et al. Left thoracoscopic thymectomy in children. Surg Endosc 19, 140–142 (2005). https://doi.org/10.1007/s00464-004-9039-y
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DOI: https://doi.org/10.1007/s00464-004-9039-y