Abstract
Gaurav Patel
Background There are different surgical techniques used for maximal thymectomy. Each technique
has its own advantages and disadvantages. We propose a mini sternotomy with pleural
preservation approach for complete maximal thymectomy.
Methods Over time range of 5 years, 32 patients with diagnosis of thymoma with or without
myasthenia gravis (MG) underwent maximal thymectomy by mini sternotomy in our institute.
Patient records were examined for the following parameters: age, sex, preoperative
medication, symptoms of MG as per Myasthenia Gravis Foundation of America grading
system, operating time, duration of postoperative ventilation, length of stay in the
intensive care unit, overall length of hospitalization, and postoperative complications.
Results The mean age of patients in our study was 43.66. Sex ratio in this study was almost
equal. Sixty-nine percent of patients were stage I thymoma according to Masaoka staging.
Size of the tumor ranged from 3 to 8 cm with mean size being 4.54 cm. Complete resection
with negative tumor margins was possible in all the cases. Four patients had intraoperative
pleural injury out of which two patients required intercostal tube insertion. We did
not have any serious postoperative complications with no perioperative mortality.
Conclusions Mini sternotomy allows maximal removal of thymus through a less invasive approach
and is associated with a significantly smoother postoperative course, less overall
complications, and good clinical outcome. It is a simple technique that can be performed
by any thoracic and surgical oncologists especially in Indian subcontinent where facilities
of video-assisted thoracoscopic surgery and robotic video-assisted thoracoscopic surgery
are not available in all areas and are expensive.
Keywords
thymectomy - sternotomy - thymic neoplasm, thymoma - myasthenia gravis - thoracic
surgery, video-assisted - surgery, robotic-assisted
