Abstract

Objective: The present report reviews our recent 5 years experience with thymectomy in miastenia gravis MG) patients with and without thymoma performed with an original video assisted sternotomic technique and a cosmetic cutaneous access.

Methods: From January 1993 through December 1997, 72 patients with diagnosis of MG underwent thymectomy in our Institution. Cutaneous incision is 5--6 centimetres horizontal, upward curvilinear, 4--5 centimetres above the xyphoid. A subcutaneous flap is created to the notch, the linear alba and the emiclavear lines. Sternum is cut from the xyphoid upward. A small retractor is then placed in the middle portion and the two halves are separated (5--6 centimetres). Thymus is removed 'en bloc' with the mediastinal surrounding fatty tissue (radical thymectomy). Preparation of the phrenic nerves, the thymic veins and the upper poles is affected by the flap that interfere with the direct vision. In these steps, the thoracoscope is helpful, in fact an enhancement is obtained and dissection can be performed, looking at the monitor, with usual surgical instruments. Sternum is closed with re-adsorbable suture.

Results: No post-operative death or major complications are reported. We report 4 post-operative complications. Cumulative improvement rate from MG in the 62 patients who have been followed for at least 12 months after surgery is 90%.

Conclusion: we can conclude that: a) the exposure of the anterior mediastinum that is obtained is optimal and allows the execution of a classic 'extended' radical thymectomy; b) the procedure is safe being rapidly convertible in a traditional one; c) good improvement and remission rates from MG are obtained and d) it is very satisfactory from the cosmetic point of view.