Extended thymectomy by a cervical incision additional to bilateral VATS approach.

BACKGROUND

Video-assisted thoracoscopic surgery (VATS) in thymectomy has shown safe and effective with many advantages in myasthenia gravis (MG) patients with or without thymoma than transsternal approach. This video aims to show the procedure of extended thymectomy via a cervical incision additional to bilateral VATS approach in a MG patient with an early stage thymoma.

METHODS

The patient was a 46-year-old male who had onset of symptoms of blurred vision, dysarthria and dysphagia for 10 months before administration. A diagnosis of MG was then confirmed using anticholinesterase test and electromyography test by neurologists. A CT scan showed enlarged thymus and a mass close to the left innominate vein in the anterior mediastinum with a size of 12 mm × 13 mm. Without any contradictions, the patient was planned to receive a procedure of extended thymectomy.

RESULTS

The patient recovered with no complications and was discharged on the 8th postoperative day. Histological pathology examination revealed a type B3 thymoma of Masaoka stage II.

CONCLUSIONS

Oncological principles and immunological considerations are equally important in surgery for the MG patients with thymoma. All the thymus gland in the mediastinum including ectopic thymic tissue in the cervical region should be removed in the procedure. In conclusion, we suggest this approach to be safe and feasible for thymoma surgery in patients with MG.