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Inclusion of the transcervical approach in video-assisted thoracoscopic extended thymectomy (VATET) for myasthenia gravis: a prospective trial

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Abstract

Background

Because evidence-based data regarding the quality of video-assisted thoracoscopic thymectomy for the treatment of myasthenia gravis are lacking, a prospective trial comparing three different operative approaches was conducted to evaluate their efficacy.

Methods

This prospective study enrolled 20 consecutive patients with nonthymomatous myasthenia gravis. A series of three approaches for bilateral video-assisted thoracoscopic extended thymectomy (VATET) using the anterior chest wall–lifting method (original), the original method with a flexed-neck position (modified), and the original method with a transcervical approach (final) were prospectively performed in each patient for quantitative and pathologic evaluation of the residual thymus after each approach.

Results

Complete VATET required 242 ± 48 min, with the transcervical procedure requiring 23 ± 12 min. After the modified method, the residual thymus in the cervical region was 1.5 cm in size and weighed 0.8 g (0.8% of the entire thymus), as compared with a size of 2.2 cm and a weight of 1.3 g (3.2%) after the original method. Each value is the result of comparison with the final method. Histopathologic studies showed residual tissue in the germinal center as well as Hassall’s corpuscles in more than 70% of cases.

Conclusion

The findings show that VATET without the transcervical approach could be an immunologically incomplete treatment for myasthenia gravis. Therefore, the transcervical approach should be included in VATET procedures to ensure radicality.

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Authors and Affiliations

  1. Department of Surgery, Osaka University Graduate School of Medicine, E1, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan

    N. Shigemura, H. Shiono, M. Inoue, M. Minami, M. Okumura & H. Matsuda

  2. The Division of Thoracic Surgery, National Kinki-Chuo Hospital for Chest Diseases, Osaka, Japan

    M. Ohta

Authors
  1. N. Shigemura
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  2. H. Shiono
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  3. M. Inoue
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  4. M. Minami
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  5. M. Ohta
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  6. M. Okumura
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  7. H. Matsuda
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Correspondence to H. Shiono.

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

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  • DOI: https://doi.org/10.1007/s00464-005-0614-7

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