Open versus Thoracoscopic Thymectomy for juvenile myasthenia gravis

Abstract Background Juvenile myasthenia gravis (JMG) is an antibody mediated autoimmune disorder that manifests as progressive voluntary muscle weakness and fatigue. In medically refractory cases, thymectomy has been shown to abrogate symptoms and reduce glucocorticoid dependence. While trans-cervical or trans-sternal incisions have been the traditional approach, adult trends now favor thoracoscopic thymectomy. Little data exists to support this approach in children. Methods A retrospective review of all patients younger than 20 years of age who underwent a thymectomy for JMG at two pediatric institutions between 2001 and 2018 was performed. Children were divided into either an open (trans-cervical or trans-sternal) or thoracoscopic group and baseline characteristics, perioperative, and postoperative outcomes were compared. Results Thirty-four thymectomies were performed during the 18-year study period; 18 via an open and 16 via a thoracoscopic approach. The operative time was shorter for open procedures compared thoracoscopic ones (108 ± 49 and 145 ± 43 min, respectively, p = 0.025). Thoracoscopic thymectomy was associated with less intraoperative blood loss (5.5 ± 6.0 vs 55 ± 67 ml, p = 0.007), decreased duration of postoperative intravenous narcotic use (5.0 ± 1.5 vs 20 ± 23 h, p = 0.018), and a shorter length of hospitalization (1.7 ± 1.0 vs 2.7 ± 1.1 days, p = 0.009). No perioperative complication occurred in either group. Clinical improvement was reported in 94% of children in both groups. Conclusions Thoracoscopic thymectomy in children is a safe and effective surgical technique for the treatment of JMG. Increased acceptance of this minimally invasive approach by children, families, and referring neurologists may enable earlier surgical intervention. Type of Study Clinical research paper. Level of Evidence III