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Ann Thorac Surg 2001;72:1902-1905
© 2001 The Society of Thoracic Surgeons

Original article: general thoracic

Infrasternal mediastinoscopic thymectomy in myasthenia gravis: surgical results in 23 patients

Akihiko Uchiyama, MD*a, Shuji Shimizu, MDb, Hiroyuki Murai, MDc, Syoji Kuroki, MDa, Masayuki Okido, MDa, Masao Tanaka, MDa

a Department of Surgery and Oncology, Graduate School of Medical Sciences, Fukuoka, Japan
b Department of Endoscopic Diagnostics and Therapeutics, Faculty of Medicine, Fukuoka, Japan
c Department of Neurology, Neurological Institute, Kyushu University, Fukuoka, Japan

Accepted for publication August 8, 2001.

* Address reprint requests to Dr Uchiyama, Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
e-mail: uchiyama{at}surg1.med.kyushu-u.ac.jp

Background. Infrasternal mediastinoscopic surgery is a new approach to resection of the anterior mediastinal mass.

Methods. We evaluated this new approach in 23 patients with myasthenia gravis who underwent total thymectomy assisted by infrasternal mediastinoscopy between 1998 and 2000. The results were analyzed with special reference to morbidity and short-term improvement of the disease severity determined according to quantitative myasthenia gravis (QMG) scores.

Results. Complete removal of the thymic gland with the pericardial adipose tissue was accomplished through an infrasternal mediastinoscopic approach in 21 of the 23 (91.3%) patients. The remaining 2 patients required conversion to sternotomy, the one for insufficient sternal lifting with vascular tape and the other for invasion of a thymoma to the innominate vein. There was no related mortality and only one complication, a phrenic nerve injury in 1 patient (4.3%). Significant clinical improvement of disease was achieved in the short term and several advantages were apparent.

Conclusions. Infrasternal mediastinoscopic thymectomy is safe and feasible for patients with myasthenia gravis.




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