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Improved procedures and comparative results for video-assisted thoracoscopic extended thymectomy for myasthenia gravis

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Abstract

Introduction

We previously introduced video-assisted thoracoscopic ET (VATS-ET) as a therapeutic option for MG with acceptable results. We have conducted further investigations to improve the procedure without deterioration of operative results, including myasthenia gravis (MG) remission rate and palliation rate. Here, we report the details of our current procedure, as well as surgical results and patient outcomes as compared with the original VATS-ET procedure.

Material and methods

From January 2002 to September 2013, we performed a VATS-ET procedure with an anterior chest wall lifting method for 77 patients who had MG with or without a thymoma. During that period, we investigated the appropriate indications and improved the procedure.

Results

Our current indication for this procedure is MG with the anti-acetylcholine receptor antibody or sero-negative type, or MG with a thymoma <5 cm in diameter without invasion to adjacent organs. With our procedure, the thymus and surrounding tissue are sufficiently resected using a bilateral thoracoscopic surgical method without neck incision. Remission and palliation rates were found to be equivalent to those obtained with the original VATS-ET procedure.

Conclusion

VATS-ET is suitable for select patients with MG with or without a thymoma. In addition, our current method has shown to be effective while also offering cosmetic advantages as compared with the original, neck incision needed, VATS-ET method.

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Disclosures

Tomoyuki Nakagiri, Masayoshi Inoue, Yasushi Shintani, Soichiro Funaki, Tomohiro Kawamura, Masato Minami, Mitsunori Ohta, Yoshihisa Kadota, Hiroyuki Shiono and Meinoshin Okumura have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, 2-2 L5 Yamadaoka, Suita, Osaka, 565-0871, Japan

    Tomoyuki Nakagiri, Masayoshi Inoue, Yasushi Shintani, Soichiro Funaki, Tomohiro Kawamura, Masato Minami & Meinoshin Okumura

  2. Department of General Thoracic Surgery, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Habikino, Osaka, Japan

    Mitsunori Ohta & Yoshihisa Kadota

  3. Department of General Thoracic Surgery, Nara Hospital Kinki University Faculty of Medicine, Ikoma, Nara, Japan

    Hiroyuki Shiono

Authors
  1. Tomoyuki Nakagiri
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  2. Masayoshi Inoue
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  3. Yasushi Shintani
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  4. Soichiro Funaki
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  5. Tomohiro Kawamura
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  6. Masato Minami
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  7. Mitsunori Ohta
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  8. Yoshihisa Kadota
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  9. Hiroyuki Shiono
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  10. Meinoshin Okumura
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Corresponding author

Correspondence to Tomoyuki Nakagiri.

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Nakagiri, T., Inoue, M., Shintani, Y. et al. Improved procedures and comparative results for video-assisted thoracoscopic extended thymectomy for myasthenia gravis. Surg Endosc 29, 2859–2865 (2015). https://doi.org/10.1007/s00464-014-3964-1

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  • DOI: https://doi.org/10.1007/s00464-014-3964-1

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