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Ann Thorac Surg 2000;70:1661
© 2000 The Society of Thoracic Surgeons

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Discussion

Discussion

Discussion

DR SHAFIQUE H. KESHAVJEE (Toronto, Ontario, Canada): I would like to congratulate Dr Ruckert and his colleagues on the performance of a very nice study with an excellent, clear presentation. I also appreciated the opportunity to review their manuscript well in advance.

It is well accepted that thymectomy provides benefit to the vast majority of patients with myasthenia gravis, and the literature reveals that the results with respect to symptomatic improvement and remission of the disease are equivalent regardless of the route of surgery performed.

Myasthenic patients, by virtue of their disease, are high-risk surgical candidates and, indeed, the primary complications after thymectomy are respiratory, that is, respiratory failure or pneumonia. The surgical and anesthetic management of these patients must take this into account. Ideally, the thymectomy should add minimal respiratory insult. Most importantly, Dr Ruckert’s study has demonstrated that surgical technique can impact on the respiratory function and that a less invasive approach has a potential benefit in this setting.

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