Rajinder Parshad, MD, General Surgery, Eshan Verma, Vinay Goyal, DM, Neurology, Rohit Bhatia, DM, Neurology, Raju Sharma, MD, Radiology, Lokesh Kashyap, MD, Anesthesia, Siddharth Datta Gupta, MD, Pathology. AIIMS
Objective: Video assisted thoracoscopic thymectomy(VATS) has emerged as a minimally invasive alternative to the standard transsternal approach. We present herewith the surgical and neurological outcomes after VATS thymectomy in the patients with Myasthenia Gravis
Methods: This is a prospective observational study carried out between April 2012 and May 2017. The primary objective was analysis of surgical and neurological outcomes. All myasthenia gravis patients referred for thymectomy were evaluated , their demographic and disease profile was recorded. Patients were classified according to Osserman classification. Contrast enhanced CT scans were done to rule out thymoma. Ninety out of 98 patients were found suitable and underwent video-assisted thymectomy . Their Operative time, blood loss, conversion rate and post operative parameters like intensive care unit (ICU) stay, inter-costal drainage (ICD) indwelling time, hospital stay were recorded. Neurological outcomes were assessed based on Myasthenia Gravis Foundation of America (MGFA) post intervention status classification. Statistical analysis was done using STATA 14 software.
Results: Ninety patients underwent thoracoscopic thymectomy during the study period. VATS was done through right approach in 47 (53.4%), left approach in 33 (38%) bilateral approach in 6 patients (7%) and subxiphoid approach in 2 (2.2%) . There was conversion to open approach in 2(2.2%) patients due to dense adhesions. Mean operative time was 145.9 min (SD = 31.11). No major intra-operative complications occurred. none of the patients had accidental phrenic nerve injury. Only 4 patients needed post operative ICU stay; 2 for 1 day and 2 for 10 days. Median ICD indwelling time was 2 days and median post operative hospital stay was 4 days. There was no mortality. Histology showed 45% thymic hyperplasia, 41% thymoma and 14% normal thymus. The ectopic thymus was found in 20 out of 86 patients (23.2%). At a median follow-up of 32.5 months, 64 patients had completed one year follow up and were analyzed for neurological outcome. Sixteen(25%) patients showed complete stable remission (CSR) and 82.7% patients showed an overall improvement with a significant reduction in dosages of pre-operative medications. Osserman grade 1 and 2a were found to be predictors of CSR .
Conclusion: Video-assisted thymectomy is a safe procedure and can be performed with minimal morbidity. It results in significant improvement of symptoms and reduction in drug dosage post-operatively.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87838
Program Number: P680
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster