Comparison between video-assisted thoracoscopic thymectomy and transternal thymectomy for myasthenia gravis (analysis of 82 cases)

Torng Sen Lin, Ching Tzao, Shih Chun Lee, Chin Yen Wu, Cheng Jen Shy, Ching Yi Lee, Ming Chih Chou

Research output: Contribution to journalArticle

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Abstract

Video-assisted thoracoscopic surgery (VATS) provides a new approach to thymectomy for myasthenia gravis (MG). We compared the results of video-assisted thoracoscopic thymectomy (VATT) and transternal thymectomy (TT) in Taiwanese people with MG. From January 1997 to August 2002, we enrolled a total of 82 patients with MG who underwent TT and anterior mediastinal adipose tissue removal in our study. Of those, 51 patients underwent VATT, and 31 patients underwent TT. The men-to-women ratios were 18:33 and 15:16 in the VATT and TT groups, respectively. The mean age was 37.9 ± 17.56 years in the VATT group and 35.6 ± 16.8 years in the TT group (P = 0.55). Preoperative Osserman's classification revealed the following: class I: 11 (21.6%), 13 (41.9%); class IIA: 18 (35.3%), 11 (35.5%); class IIB: 18 (35.3%), 5 (16.1%); class III: 2 (3.9%), 0; and class IV: 2 (3.9%), 2 (6.5%), respectively, in the two groups (P = 0.06). During VATT, all but two patients were placed supine in the 45° left lateral decubitus position under double-lumen intubated anesthesia. Usually three 1-cm incision wounds over anterior axillary line at the third, fifth, and sixth intercostal spaces were necessary. A total of 82 patients (51 with VATT and 31 with TT) were studied. There were no statistical differences between the two groups of patients in terms of sex, age, and severity of MG. In VATT and TT groups, postoperative hospital stays were 6.1 ± 3.3 and 26.9 ± 14.1 days, respectively (P = 0.001). Intensive care unit stays were 1.5 ± 1.1 and 3.2 ± 2.3 days, respectively (P = 0.018). Operative times were 180.0 ± 53.4 and 248.2 ± 71.9 minutes, respectively (P = 0.004). Thymus weights were 43.7 ± 22.5 and 52.2 ± 29.6 g, respectively (P = 0.141). Fifty-one VATT procedures were performed through a right-side approach without conversion. Most patients were extubated in the operating room or recovery room. The harvested thymus glands had an average weight of 49.4 g (range, 21.4-90 g). There were no surgical mortality cases. There was no statistically significant difference (P = 0.574) in the post-operative improvement classification between the two groups, with a mean of 4 years of follow-up. In the VATT group, 14 (27.5%) patients had complete remission without any medication, 14 (27.5%) patients were in class II, 21 (41.1%) patients were in class III, 2 (3.9%) patients were in class IV, and 0 (0%) patients were in class V, according to postoperative classification of DeFilippi et al.4 We concluded that VATT is technically feasible and safe and is associated with a favorable postoperative outcome compared with the transsternal approach.

Original languageEnglish
Pages (from-to)36-41
Number of pages6
JournalInternational Surgery
Volume90
Issue number1
Publication statusPublished - Jan 2005
Externally publishedYes

Fingerprint

Thymectomy
Myasthenia Gravis
Thymus Gland
Recovery Room
Video-Assisted Thoracic Surgery
Weights and Measures

Keywords

  • Myasthenia gravis
  • Thoracoscopic thymectomy
  • Transternal thymectomy
  • Video-assisted thoracoscopic surgery
  • Video-assisted thoracoscopic thymectomy

ASJC Scopus subject areas

  • Surgery

Cite this

Comparison between video-assisted thoracoscopic thymectomy and transternal thymectomy for myasthenia gravis (analysis of 82 cases). / Lin, Torng Sen; Tzao, Ching; Lee, Shih Chun; Wu, Chin Yen; Shy, Cheng Jen; Lee, Ching Yi; Chou, Ming Chih.

In: International Surgery, Vol. 90, No. 1, 01.2005, p. 36-41.

Research output: Contribution to journalArticle

Lin, Torng Sen ; Tzao, Ching ; Lee, Shih Chun ; Wu, Chin Yen ; Shy, Cheng Jen ; Lee, Ching Yi ; Chou, Ming Chih. / Comparison between video-assisted thoracoscopic thymectomy and transternal thymectomy for myasthenia gravis (analysis of 82 cases). In: International Surgery. 2005 ; Vol. 90, No. 1. pp. 36-41.
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abstract = "Video-assisted thoracoscopic surgery (VATS) provides a new approach to thymectomy for myasthenia gravis (MG). We compared the results of video-assisted thoracoscopic thymectomy (VATT) and transternal thymectomy (TT) in Taiwanese people with MG. From January 1997 to August 2002, we enrolled a total of 82 patients with MG who underwent TT and anterior mediastinal adipose tissue removal in our study. Of those, 51 patients underwent VATT, and 31 patients underwent TT. The men-to-women ratios were 18:33 and 15:16 in the VATT and TT groups, respectively. The mean age was 37.9 ± 17.56 years in the VATT group and 35.6 ± 16.8 years in the TT group (P = 0.55). Preoperative Osserman's classification revealed the following: class I: 11 (21.6{\%}), 13 (41.9{\%}); class IIA: 18 (35.3{\%}), 11 (35.5{\%}); class IIB: 18 (35.3{\%}), 5 (16.1{\%}); class III: 2 (3.9{\%}), 0; and class IV: 2 (3.9{\%}), 2 (6.5{\%}), respectively, in the two groups (P = 0.06). During VATT, all but two patients were placed supine in the 45° left lateral decubitus position under double-lumen intubated anesthesia. Usually three 1-cm incision wounds over anterior axillary line at the third, fifth, and sixth intercostal spaces were necessary. A total of 82 patients (51 with VATT and 31 with TT) were studied. There were no statistical differences between the two groups of patients in terms of sex, age, and severity of MG. In VATT and TT groups, postoperative hospital stays were 6.1 ± 3.3 and 26.9 ± 14.1 days, respectively (P = 0.001). Intensive care unit stays were 1.5 ± 1.1 and 3.2 ± 2.3 days, respectively (P = 0.018). Operative times were 180.0 ± 53.4 and 248.2 ± 71.9 minutes, respectively (P = 0.004). Thymus weights were 43.7 ± 22.5 and 52.2 ± 29.6 g, respectively (P = 0.141). Fifty-one VATT procedures were performed through a right-side approach without conversion. Most patients were extubated in the operating room or recovery room. The harvested thymus glands had an average weight of 49.4 g (range, 21.4-90 g). There were no surgical mortality cases. There was no statistically significant difference (P = 0.574) in the post-operative improvement classification between the two groups, with a mean of 4 years of follow-up. In the VATT group, 14 (27.5{\%}) patients had complete remission without any medication, 14 (27.5{\%}) patients were in class II, 21 (41.1{\%}) patients were in class III, 2 (3.9{\%}) patients were in class IV, and 0 (0{\%}) patients were in class V, according to postoperative classification of DeFilippi et al.4 We concluded that VATT is technically feasible and safe and is associated with a favorable postoperative outcome compared with the transsternal approach.",
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T1 - Comparison between video-assisted thoracoscopic thymectomy and transternal thymectomy for myasthenia gravis (analysis of 82 cases)

AU - Lin, Torng Sen

AU - Tzao, Ching

AU - Lee, Shih Chun

AU - Wu, Chin Yen

AU - Shy, Cheng Jen

AU - Lee, Ching Yi

AU - Chou, Ming Chih

PY - 2005/1

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N2 - Video-assisted thoracoscopic surgery (VATS) provides a new approach to thymectomy for myasthenia gravis (MG). We compared the results of video-assisted thoracoscopic thymectomy (VATT) and transternal thymectomy (TT) in Taiwanese people with MG. From January 1997 to August 2002, we enrolled a total of 82 patients with MG who underwent TT and anterior mediastinal adipose tissue removal in our study. Of those, 51 patients underwent VATT, and 31 patients underwent TT. The men-to-women ratios were 18:33 and 15:16 in the VATT and TT groups, respectively. The mean age was 37.9 ± 17.56 years in the VATT group and 35.6 ± 16.8 years in the TT group (P = 0.55). Preoperative Osserman's classification revealed the following: class I: 11 (21.6%), 13 (41.9%); class IIA: 18 (35.3%), 11 (35.5%); class IIB: 18 (35.3%), 5 (16.1%); class III: 2 (3.9%), 0; and class IV: 2 (3.9%), 2 (6.5%), respectively, in the two groups (P = 0.06). During VATT, all but two patients were placed supine in the 45° left lateral decubitus position under double-lumen intubated anesthesia. Usually three 1-cm incision wounds over anterior axillary line at the third, fifth, and sixth intercostal spaces were necessary. A total of 82 patients (51 with VATT and 31 with TT) were studied. There were no statistical differences between the two groups of patients in terms of sex, age, and severity of MG. In VATT and TT groups, postoperative hospital stays were 6.1 ± 3.3 and 26.9 ± 14.1 days, respectively (P = 0.001). Intensive care unit stays were 1.5 ± 1.1 and 3.2 ± 2.3 days, respectively (P = 0.018). Operative times were 180.0 ± 53.4 and 248.2 ± 71.9 minutes, respectively (P = 0.004). Thymus weights were 43.7 ± 22.5 and 52.2 ± 29.6 g, respectively (P = 0.141). Fifty-one VATT procedures were performed through a right-side approach without conversion. Most patients were extubated in the operating room or recovery room. The harvested thymus glands had an average weight of 49.4 g (range, 21.4-90 g). There were no surgical mortality cases. There was no statistically significant difference (P = 0.574) in the post-operative improvement classification between the two groups, with a mean of 4 years of follow-up. In the VATT group, 14 (27.5%) patients had complete remission without any medication, 14 (27.5%) patients were in class II, 21 (41.1%) patients were in class III, 2 (3.9%) patients were in class IV, and 0 (0%) patients were in class V, according to postoperative classification of DeFilippi et al.4 We concluded that VATT is technically feasible and safe and is associated with a favorable postoperative outcome compared with the transsternal approach.

AB - Video-assisted thoracoscopic surgery (VATS) provides a new approach to thymectomy for myasthenia gravis (MG). We compared the results of video-assisted thoracoscopic thymectomy (VATT) and transternal thymectomy (TT) in Taiwanese people with MG. From January 1997 to August 2002, we enrolled a total of 82 patients with MG who underwent TT and anterior mediastinal adipose tissue removal in our study. Of those, 51 patients underwent VATT, and 31 patients underwent TT. The men-to-women ratios were 18:33 and 15:16 in the VATT and TT groups, respectively. The mean age was 37.9 ± 17.56 years in the VATT group and 35.6 ± 16.8 years in the TT group (P = 0.55). Preoperative Osserman's classification revealed the following: class I: 11 (21.6%), 13 (41.9%); class IIA: 18 (35.3%), 11 (35.5%); class IIB: 18 (35.3%), 5 (16.1%); class III: 2 (3.9%), 0; and class IV: 2 (3.9%), 2 (6.5%), respectively, in the two groups (P = 0.06). During VATT, all but two patients were placed supine in the 45° left lateral decubitus position under double-lumen intubated anesthesia. Usually three 1-cm incision wounds over anterior axillary line at the third, fifth, and sixth intercostal spaces were necessary. A total of 82 patients (51 with VATT and 31 with TT) were studied. There were no statistical differences between the two groups of patients in terms of sex, age, and severity of MG. In VATT and TT groups, postoperative hospital stays were 6.1 ± 3.3 and 26.9 ± 14.1 days, respectively (P = 0.001). Intensive care unit stays were 1.5 ± 1.1 and 3.2 ± 2.3 days, respectively (P = 0.018). Operative times were 180.0 ± 53.4 and 248.2 ± 71.9 minutes, respectively (P = 0.004). Thymus weights were 43.7 ± 22.5 and 52.2 ± 29.6 g, respectively (P = 0.141). Fifty-one VATT procedures were performed through a right-side approach without conversion. Most patients were extubated in the operating room or recovery room. The harvested thymus glands had an average weight of 49.4 g (range, 21.4-90 g). There were no surgical mortality cases. There was no statistically significant difference (P = 0.574) in the post-operative improvement classification between the two groups, with a mean of 4 years of follow-up. In the VATT group, 14 (27.5%) patients had complete remission without any medication, 14 (27.5%) patients were in class II, 21 (41.1%) patients were in class III, 2 (3.9%) patients were in class IV, and 0 (0%) patients were in class V, according to postoperative classification of DeFilippi et al.4 We concluded that VATT is technically feasible and safe and is associated with a favorable postoperative outcome compared with the transsternal approach.

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KW - Video-assisted thoracoscopic surgery

KW - Video-assisted thoracoscopic thymectomy

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