Robotic–Assisted Thymectomy in Patients with Nonthymomatous Myasthenia Gravis

Iskander Al-Githmi
DOI: 10.4236/ss.2011.27086                

Abstract

Complete removal of the thymus and fatty tissue adherent to pericardium is crucial for treating myasthenia gravis. Our aim was to analyze our surgical and clinical results and early experience of robot-assisted thy-mectomy in patients with nonthymomatous myasthenia gravis. Between January 2008 and October 2010, 8 patients, all women, with nonthymomatous myasthenia gravis underwent robot-assisted thymectomy using a 3-port, left-sided approach. There were no operative mortality; 1 patient had left phrenic nerve injury. Com-plete remission was achieved in 25% of the patients at 18 months’ follow-up. There was no significant agreement between preoperative computed tomography and histopathology finding (kappa = 0.059; P = 0.85) and no significant correlation between age and duration of symptoms (P = 0.51). Robotic-assisted thymec-tomy is promising procedure. It can be performed safely and effectively. With follow-up greater than 12 months, 87.5% of the patients who underwent robot-assisted thymectomy demonstrated clinical improve-ment.

Keywords

Myasthenia Gravis, Nonthymoma, Robot, Thymectomy

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	E. Schumacher and J. Roth, “Thmymektomie bie Einem Fall Von Morbus Basedowi mit Masthenie,” Grenzgeb. d.Med.u. Chir. Vol. 25, 1912, pp. 746-765.
[2]	A. Blalock, H. A. McGehee and F. R. Ford, “The Treatment of Myasthenia Gravis by Removal of the Thymus Gland,” Journal of the American Medical Association, Vol. 117, No. 18, 1941, pp. 1529-1533.
[3]	R. F. Calhoun, J. H. Ritter, T. J. Guthrie, A. Pestronk, B. F. Meyers, G. A. Patterson, M. S. Pohl and J. D. Cooper, “Results of Transcervical Thymectomy for Myasthenia Gravis in 100 Consecutive Patients,” Annals of Surgery, Vol. 230, No. 4, 1999, pp. 555-559. doi:10.1097/00000658-199910000-00011
[4]	A. Masaoka, Y. Yamakawa, H. Niwa, I. Fukai, S. Kondo, M. Kobayashi, Y. Fujii and Y. Monden, “Extended Thymectomy for Myasthenia Gravis Patients: A 20-Year Review,” Annals of Thoracic Surgery, Vol. 62, No. 3, 1996, pp. 853-859. doi:10.1016/S0003-4975(96)00376-1
[5]	A. Uchiyama, S. Shimizu, H. Murai, S. Kuroki, M. Okido and M. Tanaka, “Infrasternal Mediastinoscopic Thymectomy in Myasthenia Gravis: Surgical Results in 23 Patients,” Annals of Thoracic Surgery, Vol. 72, No. 6, 2001, pp. 1902-1905. doi:10.1016/S0003-4975(01)03210-6
[6]	T. C. Mineo, E. Pompeo, T. E. Lerut, G. Bernardi, W. Coosemans and I. Nofroni, “Thoracoscopic Thymectomy in Autoimmune Myasthesia: Results of Left-Sided Approach,” Annals of Thoracic Surgery, Vol. 69, No. 5, 2000, pp. 1537-1541. doi:10.1016/S0003-4975(00)01237-6
[7]	M. J. Mack, R. J. Landreneau, A. P. Yim, S. R. Hazelrigg and G. R. Scruggs, “Results of Video-Assisted Thymectomy in Patients with Myasthenia Gravis,” Journal of Thoracic and Cardiovascular Surgery, Vol. 112, No. 5, 1996, pp. 1352-1359. doi:10.1016/S0022-5223(96)70151-4
[8]	R. Vizeteu, M. Damian, B. Smeu, A. Stoica, V. Culman, O. B?jenaru and A. Ene, “Video-Assisted Thoracoscopic Extended Thymectomy (VATET) with Cervical Approach for Myasthenia Gravis—Initial Experience [in Romanian],” Chirurgia (Bucur). Vol. 105, No. 6, 2010, pp. 797-803.
[9]	M. Hashizume, K. Konishi, N. Tsutsumi, S. Yamaguchi and R. Shimabukuro, “A New Era of Robotic Surgery Assisted by a Computer-Enhanced Surgical System,” Surgery, Vol. 131, Supplement 1, 2002, pp. S330-S333.
[10]	I. Yoshino, M. Hashizume, M. Shimada, M. Tomikawa, M. Tomiyasu, R. Suemitsu and K. Sugimachi, “Thoracoscopic Thymomectomy with the Da Vinci Computer-Enhanced Surgical System,” Journal of Thoracic and Cardiovascular Surgery, Vol. 122, No. 4, 2001, pp. 783-785. doi:10.1067/mtc.2001.115231
[11]	A. E. Papatestas, L. I. Alpert and K. E. Osserman, “Studies in Myasthenia Gravis: Effects of Thymectomy Results on 185 Patients with Nonthymomatous and Thymimatous Myasthenia Gravis,” American Journal of Medicine, Vol. 38, 1971, pp. 580-585.
[12]	A. Jaretzki, R. J. Barohn, R. M. Ernstoff, H. J. Kaminski, J. C. Keesey, A. S. Penn and D. B. Sanders, “Myasthenia Gravis: Recommendations for Clinical Research Standards. Task Force of the Medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America,” Annals of Thoracic Surgery, Vol. 70, No. 1, 2000, pp. 327-334. doi:10.1016/S0003-4975(00)01595-2