Background: Thymectomy is a standard treatment for myasthenia gravis (MG) patients. Although there are different approaches for thymectomy available, the standard approach is still known as a median sternotomy. Currently, the video-assisted thoracoscopic (VATS) approach is increasing in popularity. It has shown benefits in less blood loss, less postoperative pain, and improvement of recovery after surgery. However, there are still controversies in the outcomes of these two approaches.

Objective: To compare perioperative and neurological outcomes of thymectomy between the median sternotomy approach and the VATS approach.

Materials and Methods: One hundred twenty-three patients underwent thymectomy between January 1, 2012 and December 30, 2020 and were enrolled in the present retrospective study. They were classified into two groups depending on the approach of the surgery. The perioperative and neurological outcomes were analyzed and compared between the two groups. The analyses were performed using students’ t-test, Mann-Whitney test, chi-square, or Fisher’s exact test.

Results: There were 72 patients in the median sternotomy group and 51 patients in the VATS group, and no death in both groups. There were also no significant differences between the two groups regarding surgical time, postoperative pain, postoperative complications, and neurological outcomes. Intraoperative blood loss, intercostal drainage volume and duration, and length of hospital stay were significantly less in the VATS group. Complete remission was significantly higher in VATS group. The median follows up time was significantly longer in the median sternotomy group.

Conclusion: The VATS approach for thymectomy had shown good outcomes, which were not inferior to the median sternotomy approach.

Keywords: VATS Thymectomy; MG; Thymoma; Thymectomy; Minimally invasive thymectomy; Myasthenia gravis; Left VATS thymectomy; Subxiphoid VATS thymectomy; Anterior mediastinal tumor; Anterior mediastinal mass

DOI: 10.35755/jmedassocthai.2022.04.13299

Received 22 July 2021 | Revised 29 November 2021 | Accepted 29 November 2021