Minimally Invasive Treatment for Myasthenia Gravis Patients

Written by John Steuter, MD

Patients with myasthenia gravis (MG) are typically treated with four basic therapies:

1. Symptomatic treatments (anticholinesterase agents)
2. Chronic immunotherapies (glucocorticoids and immunosuppressive drugs)
3. Rapid immunotherapies (plasma exchange and intravenous immune globulin)
4. Surgical treatment (thymectomy)

The first thymectomy for a patient with MG was almost 80 years ago. Various studies and trials conducted are providing the data needed to show that thymectomies are beneficial for clinical outcomes. 

Thymectomy is indicated for all patients with thymoma regardless of MG status but what about patients without thymomas? Research shows that the timing of “when” the thymectomy should occur for those patients without thymomas is when optimal symptom management can no longer be obtained through non-surgical interventions. Preferably, when MG is reasonably under control with minimal bulbar and respiratory symptoms to avoid perioperative problems.  

The purpose of the thymectomy is to remove as much thymic tissue as safely as possible which includes the thymus as well as mediastinal and cervical adipose tissues. Surgical precision is of the essence to avoid causing damage to the surrounding recurrent laryngeal, left vagus and phrenic nerves.

Surgical Procedures Available

• Transcervical thymectomy
• Minimal invasive thymectomy (robotic-assisted)
• Transsternal thymectomy
• Combined transcervical-transsternal thymectomy

*No superior efficiency or long-term remission rates in MG has been shown for any one of these techniques.

Advances in Thymectomy

Traditionally sternotomies were performed, requiring opening the entire chest cavity. With robotic assistance, visualization is increased and a thymectomy can be performed in a minimally invasive fashion. Now surgical teams are able to remove thymic tissue by manipulating instruments in the patient’s intercostal space through small incisions. As with most minimally invasive techniques, patients undergoing a robotic-assisted thymectomy also experience low morbidity and mortality rates. 

While the data from the studies is positive, it is the hand-written thank you notes from patients that hit home the hardest. Young moms, post-thymectomy, now have the energy to play with their children.  They no longer have to sit on the sidelines watching their children from a far – they can get back to living their lives, hands-on.      

Bryan Heart Performs Robotic-Assisted Thymectomies

Bryan Heart Cardiothoracic Surgeons have been performing robotic-assisted thymectomies and are happy to evaluate any MG patient. If you have questions or want to refer a patient, call 402-483-3333.