Transsternal versus video-assisted thoracoscopic thymectomy in correlation to clinical improvement evaluated by the Myasthenia Gravis Foundation of America score in myasthenic patients

Background
Surgical management of myasthenia gravis is well established and has proven high efficacy in addition to clinical management for improving clinical outcome. Different surgical approaches for thymectomy are feasible including cervicotomy, median sternotomy, manubriotomy (ministernotomy), and video-assisted thoracoscopic surgery (VATS). Each approach has its pros and cons in terms of wound healing, operative time, the amount of blood lost during the operation, and the level of expertise necessary. Depending on the size of the excised thymus and its attachment to the surrounding structures, the best treatment for thymectomy varies from patient to patient.
Objectives
This study aimed to compare the clinical outcomes of traditional transsternal and video-assisted thoracoscopic methods in thymomatous and nonthymomatous myasthenic patients as measured by the Myasthenia Gravis Foundation of America score in thymomatous and nonthymomatous myasthenic patients.
Patients and methods
Clinical follow-up of two equal groups of myasthenic patients undergoing thymectomy by transsternal (median sternotomy and manubriotomy) and VATS approaches was performed.
Result
Transsternal thymectomy still have superior outcome to VATS in terms of clinical improvement of myasthenic symptoms, which may be attributed to better access, wider field, and ability to perform extended radical thymectomy involving removal of the whole thymic tissue and surrounding fat.
Conclusion
Selecting the surgical approach for thymectomy plays a crucial role in postoperative clinical improvement. Thymectomy through open transsternal access is still favored in large thymic masses for complete stable clinical remission.