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Thoracic Surgery Clinics May 2019In the early 1900s, chance observations of improved symptoms in several myasthenic patients undergoing thyroidectomy for goiters with concomitant resection of the... (Review)
Review
In the early 1900s, chance observations of improved symptoms in several myasthenic patients undergoing thyroidectomy for goiters with concomitant resection of the adjacent thymus gland, first suggested a possible association between the thymus and myasthenia gravis. With the remarkable progress made in the understanding and treatment of myasthenia and in the anesthetic, surgical, and postoperative management of patients undergoing thoracic procedures, the initial high morbidity and mortality associated with thymectomy have been all but eliminated, and thymectomy is frequently incorporated into the long-term management strategy of this disease.
Topics: History, 20th Century; Humans; Myasthenia Gravis; Thymectomy
PubMed: 30927996
DOI: 10.1016/j.thorsurg.2018.12.011 -
Thoracic Surgery Clinics May 2019Surgery has proven superiority over medical management for patients with nonthymomatous myasthenia gravis. The key is complete resection of the gland, which can be... (Review)
Review
Surgery has proven superiority over medical management for patients with nonthymomatous myasthenia gravis. The key is complete resection of the gland, which can be achieved with various techniques. The uniportal video-assisted transcervical technique allows minimally invasive surgery with a low complication rate, a good cosmetic result, and a short length of recovery.
Topics: Humans; Myasthenia Gravis; Patient Selection; Thoracic Surgery, Video-Assisted; Thymectomy
PubMed: 30928000
DOI: 10.1016/j.thorsurg.2018.12.009 -
Thoracic Surgery Clinics May 2010The two primary indications for thymectomy are the treatments of patients with thymoma and patients with myasthenia gravis. Several different methods have been described... (Review)
Review
The two primary indications for thymectomy are the treatments of patients with thymoma and patients with myasthenia gravis. Several different methods have been described to remove the thymus gland, including transcervical-transsternal "maximal" thymectomy, extended transsternal thymectomy, classic transsternal thymectomy, (extended) transcervical thymectomy, and video-assisted thoracoscopic thymectomy. The purpose of this article is to focus on the technical aspects of performing an extended transsternal thymectomy and the published results of extended transsternal thymectomy as compared with other techniques available.
Topics: Humans; Life Tables; Myasthenia Gravis; Patient Readmission; Sternum; Thymectomy; Thymoma; Thymus Neoplasms
PubMed: 20451135
DOI: 10.1016/j.thorsurg.2010.02.005 -
The Thoracic and Cardiovascular Surgeon Apr 2015Thymectomy is a well-established indication for management of myasthenia gravis and it represents the most effective treatment for thymic tumors. The traditional... (Review)
Review
Thymectomy is a well-established indication for management of myasthenia gravis and it represents the most effective treatment for thymic tumors. The traditional surgical approach is median sternotomy. More recently, different less-invasive surgical approaches for thymectomy have been proposed as an alternative to open surgery. This article discusses the main technical aspects and results of literature.
Topics: Humans; Minimally Invasive Surgical Procedures; Myasthenia Gravis; Sternotomy; Thymectomy; Thymoma; Thymus Neoplasms
PubMed: 25503818
DOI: 10.1055/s-0034-1396083 -
Seminars in Thoracic and Cardiovascular... 2008Thymectomy is an established therapy for myasthenia gravis. Minimally invasive surgery for thymectomy has been reported, but not clearly shown to be equivalent to open... (Review)
Review
Thymectomy is an established therapy for myasthenia gravis. Minimally invasive surgery for thymectomy has been reported, but not clearly shown to be equivalent to open resection. Robotic-assisted thymectomy may provide the benefit of a full resection of thymic tissue and anterior mediastinal tissue for the treatment of myasthenia gravis by a minimally invasive approach. We present a review of the experience of robotic thymectomy.
Topics: Humans; Minimally Invasive Surgical Procedures; Myasthenia Gravis; Postoperative Complications; Robotics; Thymectomy
PubMed: 19251172
DOI: 10.1053/j.semtcvs.2008.11.007 -
Neurologic Clinics May 2018With specialized care, patients with myasthenia gravis can have very good outcomes. The mainstays of treatment are acetylcholinesterase inhibitors, and immunosuppressive... (Review)
Review
With specialized care, patients with myasthenia gravis can have very good outcomes. The mainstays of treatment are acetylcholinesterase inhibitors, and immunosuppressive and immunomodulatory therapies. There is good evidence thymectomy is beneficial in thymomatous and nonthymomatous disease. Nearly all of the drugs used for MG are considered "off-label." The 2 exceptions are acetylcholinesterase inhibitors and complement inhibition with eculizumab, which was recently approved by the US Food and Drug Administration for myasthenia gravis. This article reviews the evidence base and provides a framework for the treatment of myasthenia gravis, highlighting recent additions to the literature.
Topics: Humans; Immunosuppressive Agents; Myasthenia Gravis; Thymectomy
PubMed: 29655452
DOI: 10.1016/j.ncl.2018.01.011 -
Neuromuscular Disorders : NMD Nov 2021Thymectomy is an established treatment in adult myasthenia gravis, but its exact role in juvenile myasthenia gravis (JMG) is still uncertain. Thymectomy is frequently... (Review)
Review
Thymectomy is an established treatment in adult myasthenia gravis, but its exact role in juvenile myasthenia gravis (JMG) is still uncertain. Thymectomy is frequently considered in the treatment of severe, medically refractory JMG. Surgical approaches have evolved from open median sternotomy to the more cosmesis-preserving thoracoscopic approach. This paper reviews current evidence on the effectiveness of thymectomy in JMG and discusses clinical characteristics which may be associated with improved outcomes. 17 studies including 588 patients who underwent thymectomy from 1997 to 2020 were found, which either reported uncontrolled cohorts undergoing thymectomy, or compared cohorts undergoing different surgical approaches. An improvement in clinical status or reduced requirement for medical therapy following thymectomy was seen in 453 patients (77%). Complete remission was seen in 40% (n = 172/430). Thoracoscopic approaches may provide improved outcomes, fewer complications, and better cosmetic outcomes. Better surgical outcomes may be associated with early intervention, intervention after the onset of puberty, being acetylcholine receptor antibody positive, having more severe disease and the presence of hyperplastic thymic tissue. However, analysis remains hindered by the limitations of the currently available retrospective studies of small cohorts. Nonetheless, available literature suggests a role for thymectomy in JMG patients, especially those with certain clinical characteristics.
Topics: Adolescent; Child; Child, Preschool; Cohort Studies; Female; Humans; Infant; Male; Myasthenia Gravis; Retrospective Studies; Thymectomy; Treatment Outcome; Young Adult
PubMed: 34756789
DOI: 10.1016/j.nmd.2021.09.013 -
The International Journal of Medical... Dec 2021Recently, thymectomy using minimally invasive approaches has been increasing with the development of robotic video-assisted thoracoscopic surgery (R-VATS). Although... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Recently, thymectomy using minimally invasive approaches has been increasing with the development of robotic video-assisted thoracoscopic surgery (R-VATS). Although multimodal approach is effective for robot assisted thymectomy, it is necessary to determine the approach (left, right or subxiphoid) associated with the least complications.
METHODS
An electronic retrieval from PubMed, Embase, Web of Science, GreyNet International and The Cochrane Library. The single-arm meta-analysis was performed to compare the rate of complications of right- and left-side approaches by R-VATS.
RESULTS
A total of 21 studies including 930 patients were identified. The pooled incidence of total complications was 12.2% (confidence interval: 10.0%-14.8%) for all studies. The overall complication rate was 17.3% for the right-side compared with 7.4% for the left side (P < 0.001, odds ratio = 2.484, 1.601-3.852). The pooled incidence of air leak was significantly higher for the right versus left side (5.1% vs. 1.2%, respectively; p = 0.004). The incidence of atrial fibrillation was higher for the right-side compared with the left-side approach (4% vs. 1.2%, respectively; p = 0.004). The open conversion rate was significantly higher for the right versus the left-side (6.5% vs. 2.9%, respectively; p = 0.004). However, there was no significant difference in the pooled incidence of pleural effusion and thoracic duct fistula when comparing the right- and left-side approaches. In subgroup analysis, in the left approach, the incidence of overall complications (28.6% vs. 5.5%, respectively; p = 0.002) and pleural effusion (14.3% vs. 1%, respectively; p = 0.002) was higher for the 'Old Age' group compared with the 'Youth' group; However, In the subgroup analysis of gender, there was no significant difference in the incidence of complications after thymectomy.
CONCLUSION
Robotic video-assisted thoracoscopic surgery can be performed on the left- and right-sides; however, complications are minimal with the left-side approach. These data demonstrate that the incidence of overall complications, atrial fibrillation, open conversion ratios, and air leak rate of left-side R-VATS thymectomy are lower than those of right-side. Further subgroup analysis showed that the incidence of postoperative complications was higher in the older group.
Topics: Adolescent; Humans; Postoperative Complications; Robotics; Thoracic Surgery, Video-Assisted; Thymectomy; Treatment Outcome
PubMed: 34533876
DOI: 10.1002/rcs.2333 -
Chest Surgery Clinics of North America Feb 1996Transcervical thymectomy has been used in the management of myasthenia gravis for over 20 years. Contraindications to this operation include advanced age, poorly... (Review)
Review
Transcervical thymectomy has been used in the management of myasthenia gravis for over 20 years. Contraindications to this operation include advanced age, poorly controlled neurologic symptoms, and evidence for a thymoma. The procedure is associated with negligible morbidity and requires only a brief hospitalization. Remission rates are comparable with those reported for more extensive thymectomy operations.
Topics: Cervical Vertebrae; Humans; Myasthenia Gravis; Postoperative Care; Thymectomy; Thymus Gland; Treatment Outcome
PubMed: 8646497
DOI: No ID Found -
Seminars in Neurology Mar 2004There continues to be a debate regarding the effectiveness of thymectomy in the treatment of nonthymomatous myasthenia gravis (MG) and, when undertaken, which thymectomy... (Comparative Study)
Comparative Study Review
There continues to be a debate regarding the effectiveness of thymectomy in the treatment of nonthymomatous myasthenia gravis (MG) and, when undertaken, which thymectomy technique is the procedure of choice. The debate persists primarily because of the lack of controlled prospective studies. Analysis has been complicated by the absence, until very recently, of accepted objective definitions of severity of the illness and response to therapy as well as variable patient selection, timing of surgery, type of surgery, and methods of analysis of results. Without resolution of these issues by properly controlled prospective studies, there can be no unequivocal determination of the effectiveness of thymectomy or valid comparison of the various thymectomy techniques. In this review, based on previous analyses, attempts will be made to clarify some of the controversial issues concerning thymectomy for nonthymomatous MG and make limited recommendations based on the best available evidence.
Topics: Data Interpretation, Statistical; Humans; Medical Illustration; Myasthenia Gravis; Patient Selection; Prospective Studies; Thymectomy; Thymus Gland; Treatment Outcome
PubMed: 15229792
DOI: 10.1055/s-2004-829596