Extended transsternal thymectomy.

The two primary indications for thymectomy are the treatments of patients with thymoma and patients with myasthenia gravis. Several different methods have been described to remove the thymus gland, including transcervical-transsternal "maximal" thymectomy, extended transsternal thymectomy, classic transsternal thymectomy, (extended) transcervical thymectomy, and video-assisted thoracoscopic thymectomy. The purpose of this article is to focus on the technical aspects of performing an extended transsternal thymectomy and the published results of extended transsternal thymectomy as compared with other techniques available.

Thymectomy for nonthymomatous myasthenia gravis: a critical analysis.

There continues to be debate concerning which thymectomy technique is the procedure of choice in the treatment of nonthymomatous myasthenia gravis (MG). The debate persists primarily because of the lack of controlled prospective studies but also because of the varying presentations and clinical courses of MG patients. Analysis has been complicated by the absence, until very recently, of accepted objective definitions of severity of the illness and response to therapy as well as variable patient selection, timing of surgery, type of surgery, and methods of analysis of results. Without resolution of these issues by properly designed prospective studies, there can be no unequivocally valid comparison of the various thymectomy techniques. In this review, attempts have been made to clarify some of the controversial issues concerning the selection of a thymectomy technique in the treatment of nonthymomatous MG and to make limited recommendations based on the best available evidence.

[Thymectomy for autoimmune myasthenia gravis].

Thymectomy has been performed as surgical treatment for autoimmune myasthenia gravis (MG) since the mid-1900s. Although it has been performed for more than half a century, there has been no report objectively confirming the validity of this treatment. Many groups have reported that surgery is effective in treating patients with MG, but the indications and type of surgery differ in each case. In addition, there has been no comparative trial of the results of surgery and natural progression of the disease. To resolve this situation, it would be desirable to standardize the indications for surgery in MG patients and to establish the surgical approach, as is being attempted by the Myasthenia Gravis Foundation of America although the results have not yet been announced. With recent advances in video-assisted surgery, the number of institutions in which thoracoscopic surgery is performed has increased. However, it appears that improvement in MG symptoms is dependent on the extent of resection in thymectomy. With the cervical or thorascopic approach, the extent of resection appears to be less than that using the transsternal or cervical plus transsternal approach. Before establishing a standard surgical approach, the validity of thymectomy for the treatment of MG should be confirmed in a randomized, controlled trial.

Miastenia Gravis: revisión para el anestesiólogo

El paciente con miastenia gravis como cualquier otro es susceptible de requerir de una intervención quirúrgica en algún momento de su vida, más aún si se tiene en cuenta la eficacia comprobada de la timectomía como opción quirúrgica para el tratamiento de su enfermedad. El anestesiólogo encuentra un reto en el manejo de este tipo de pacientes por todas las implicaciones que dicha patología conllleva, lo cual hace necesario un conocimiento preciso de aspectos relevantes tanto de la enfermedad como de su manejo médico, quirúrgico y por supuesto anestésico. La presente revisión hace referencia a aspectos fisiopatológicos, clínicos y terapéuticos de la miastenia gravis así como también el manejo anestésico preoperatorio, transoperatorio y postoperatorio del paciente miasténico sometido a timectomía, dado que es esta la cirugía que con mayor frecuencia se realiza en este grupo de pacientes. Se hace énfasis además en la importancia de la analgesia postoperatoria, destacando cómo una prevención adecuada y el control del dolor contribuyen de forma importante a una evolución mejor de la función respiratoria una vez realizada la timectomía