Thoracoscopic Thymectomy for Myasthenia Gravis: An Early Experience in Yemen

Abstract

Background: Thymectomy is an option for the treatment of myasthenia gravis (MG). While the open technique was most frequently performed in the past, nowadays the endoscopic approach has gained wide acceptance. Here we assessed our early experience in thoracoscopic thymectomy (TT). Methods: This case series was retrospectively conducted at Al-Thawra Modern General Hospital and included all patients diagnosed with MG who underwent TT from January 2018 to January 2024. Results: Our case series consisted of 13 predominantly female patients (61.5%), with a median age of 39.5 years. Surgeries typically lasted 50 ± 10.41 minutes, with the majority performed using a left-sided thoracoscopic approach (n=10, 77%). Immediate extubation was achieved in 10 patients (76%). Four patients experienced early postoperative complications (31%), including dyspnoea, prolonged intubation, chest infection, confusion, tracheostomy, and re-tracheostomy. There were 2 recorded deaths due to complications. Eleven patients were followed up for an average of 16.5 months, revealing that 54.5% achieved complete stable remission, 18% showed improvement with reduced symptoms and medications, and 27% remained unchanged. Conclusion: Thoracoscopic thymectomy is feasible and effective procedure for the management of MG in Yemeni patients. The observed remission and improvement rates are promising and align with global experiences. It is recommended that with proper resources and expertise, similar minimally invasive surgical approaches can be implemented in resource-limited regions. Plain language summary: This study was conducted to evaluate the use of thoracoscopic thymectomy (TT) for the treatment of myasthenia gravis (MG) at Al-Thawra Modern General Hospital. In this study, we included 13 predominantly female patients with a median age of 39.5 years. The most common symptoms experienced by the patients were generalized weakness and ptosis (drooping of the eyelids). During the surgeries, which typically lasted around 50 minutes, we primarily used a left-sided thoracoscopic approach. We were successful in immediately removing the breathing tube in 10 out of 13 patients. However, four patients experienced early postoperative complications, including difficulties in breathing, longer intubation, chest infection, confusion, and the need for tracheostomy. Out of the 13 patients, two unfortunately passed away due to complications. We followed up with 11 patients for an average of 16.5 months and observed that 54.5% of them achieved complete stable remission, meaning they had no MG symptoms and did not require any treatment for at least one year. Additionally, 18% of the patients showed improvement with reduced symptoms and medication usage, while 27% remained unchanged. Based on our findings, we conclude that thoracoscopic thymectomy is a safe and effective procedure for managing MG in Yemeni patients. The remission and improvement rates we observed align with experiences from around the world. We believe that with appropriate resources and expertise, similar minimally invasive surgical approaches can be implemented in resource-limited regions.