A comparison of outcomes after robotic open extended thymectomy for myasthenia gravis.

OBJECTIVE: The aim of this study was to analyze the effect of the surgical approach on surgical and neurologic outcomes after extended thymectomy for myasthenia gravis.

METHODS: A retrospective analysis of the institutional extended thymectomies for myasthenia gravis within the last decade was performed. Patients of group A (open access by total median sternotomy; n=10; 1996-2002) and of group B (video assisted thoracoscopic surgery approach with the da Vinci robotic system; n=9; 2003-2006) did not differ with regard to gender distribution, age, body mass index, American Association of Anaesthetists score and Osserman classification of myasthenia gravis. Primary endpoints were surgical complications and the symptomatic/neurologic outcome of the extended thymectomy. Secondary endpoints were operating times and hospital stay.

RESULTS: Median follow-up was 74+/-23 months in group A and 13+/-10 months in group B. Surgical complications occurred in 4 patients in group A (requiring 2 re-interventions) and in 1 patient in group B (p<0.05). The median dose of Pyridostigminbromid was reduced 3 and 6 months postoperatively in group A to 80% and 60% of the preoperative level and in group B to 66% and 60% of the preoperative level, respectively. Within the first postoperative year all patients of group B had an improvement of their disease whereas 2 patients of group A did not benefit from thymectomy or had a worsening of symptoms. Operating times were significantly shorter in group A (110 (42-152) min vs 154 (94-312) min, p<0.05), hospital stay was significantly shorter in group B (5 (4-15) vs 10 (10-23) days, p<0.05).

CONCLUSIONS: The results of this small series favour the robotic approach for extended thymectomy for myasthenia gravis in respect of both surgical and early neurologic outcome. However, prospective randomized trials are required to prove a general validity.