Thoracoscopic Thymectomy in Myasthenia Gravis

Abstract

Abstract:  Myasthenia gravis (MG) is a neuromuscular disorder. The treatments consist of medication eg. cholinesterase inhibitors, and/or immune suppressants, plasma exchange and the gold standard management, thymectomy. Objective: To report the cases of MG treated with thymectomy, both thoracoscopic thymectomy (TT) and conventional median sternotomy thymectomy (MT). Patients and methods: The cases of generalized MG diagnosed and medically treated by neurologist were referred for thymectomy in Maharat Nakhon Ratchasima Hospital during August 1997 – August 2003. Results: Twenty-one cases were retrospectively reviewed, 1 male and 20 females. They were classified into 2 groups according to methods of operation. The TT group had 17 cases and MT group had 4 cases. Both groups had same mean age 36.5 ± 9.3 years and same dosage of mestinon. Mainly patients are grade III B clinical classification. There were no difference in operation time, admission days, pathological findings and post-operative pain, except ICU stay and post-operative pain at third month (P=0.04 and 0.01 respectively). Clinical manifestations were improved and dosage of mestinon could be decreased in both groups. Conclusion: Thymectomy could improve clinical manifestation and decrease dosage of mestinon in cases of MG. Both TT and MT had the same results. However in TT group, there were less post-operative pain at third month and better cosmetic effect.