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A Comparison of Transternal, Video Assisted and Robotically Assisted Extended Thymectomy for Myasthenia Gravis
R. K. Freeman1, A. J. Ascioti1, T. C. Wozniak2, J. M. Van Woerkom1, R. J. Robison1. 1St Vincent Hospital, Indianapolis, IN, 2Methodist Hospital, Indianapolis, IN,
BACKGROUND: Thymectomy is recognized as a significant component in the treatment of Myasthenia Gravis. However controversy exists as to the optimal surgical approach. This investigation compares extended thymectomy via sternotomy, video assisted thoracoscopy (VATS) and robotic assisted thoracoscopic thymectomy.
METHODS:Prospective data collection for patients undergoing robotic thymectomy and a retrospective review of patients undergoing thymectomy via sternotomy or VATS for Myasthenia Gravis at two tertiary care medical centers over a five year period was performed. All patients underwent extended thymectomy regardless of the approach. Patient demographics, perioperative statistics, time to return to work, morbidity and mortality were reviewed. Patients were also assessed using the Myasthenia Gravis Foundation of America’s quantitative disease severity score before and after surgery and the post intervention status classification following thymectomy.
RESULTS:
| Sternotomy | VATS | Robotic | p | | N | 26 | 32 | 53 | | Age
(mean years) | 37 | 39 | 35 | NS | Operative Time
(mean minutes) | 133 | 139 | 109 | 0.0008 | | Morbidity | 3 | 2 | 2 | NS | Hospital Stay
(mean days) | 6 | 3 | 2 | 0.0034 | Return to Work
(mean days) | 33 | 22 | 18 | <0.0001 | | "Improved" Symptoms after Surgery* | 22 (85%) | 28 (88%) | 47 (87%) | NS |
* As defined by the Myasthenia Gravis Foundation of America’s Recommendations for Clinical Research Standards.
CONCLUSIONS: Robotic assisted thoracoscopic thymectomy produced a shorter mean hospital stay and return to work interval than either the sternotomy or VATS approach while delivering the same level of improvement in symptoms for patients with Myasthenia Gravis. Robotic thymectomy also provided a shorter mean operative time for thymectomy than the VATS or sternotomy approach. The robotic assisted thoracoscopic approach should be considered the preferred technique for patients undergoing extended thymectomy for Myasthenia Gravis.
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