Abstract
Background and Purpose: Thymectomy for myasthenia gravis is routinely performed by thoracoscopy in adults. To assess its safety and efficacy by the same route in children, we evaluated our experience. Patients and Methods: Eight girls and two boys aged 5 to 18 (mean 11.6) years were referred for thymectomy. Each had confirmed myasthenia gravis, none had thymomas, and all were maintained preoperatively on pyridostigmine bromide and prednisone. Four of the children had required plasmapheresis for severe symptoms. Single-lung anesthesia was maintained using right mainstem intubation or a bronchial blocker. The mediastinum was accessed through the left side of the chest. The telescope port (10 or 5 mm) was placed in the anterior axillary line in the fourth intercostal space. Two 3- or 5-mm working ports were placed lateral to the telescope port. Anterior to the phrenic nerve, the pleura was incised and the mediastinum opened. Visibility was excellent, and the pink-yellow and lobular appearance of the thymus was easy to distinguish from the surrounding fat. The entire mediastinum, from the thoracic inlet to the diaphragm, could be explored easily, and visibility of all major vessels and nerves was excellent. Dissection was done bluntly and with bipolar electocautery. All vessels were clipped before their division. The gland was removed intact through one of the ports. Chest tubes were not required. Results: The average operative time was 114 (range 70-150) minutes. There was no blood loss or complication. All patients were discharged on the first postoperative day. At 4 to 19 months' follow-up, all of the children are off medication and are symptom free. Conclusions: Thoracoscopic thymectomy for myasthenia gravis in this, the largest pediatric experience, was safe and effective.
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