Short-Term Perioperative Outcomes of Video-Assisted Thoracoscopic Versus Open Thymectomy in Myasthenia Gravis: A Single-Center Cross-Sectional Study

Document Type : Original Article

Authors

1 Endoscopic and Minimally Invasive Research Center, Department of Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Department of Persian Medicine, School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Clinical Research Development Unit, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

4 Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

5 Department of Neurology, Torbat Heydarieh University of Medical Sciences, Torbat Heydarieh, Iran.

6 Lung Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

Introduction: Thymectomy is a crucial aspect of managing myasthenia gravis (MG). Video-assisted thoracoscopic surgery (VATS) offers a less invasive option compared to traditional open transsternal thymectomy. However, there is limited data on perioperative outcomes in Iran remain limited.
Methods: This cross-sectional study included 66 MG patients who underwent thymectomy at Mashhad University of Medical Sciences between 2005 to 2024. Patients underwent either open surgery (n=44) or VATS (n=22). Perioperative outcomes, such as operative time, blood loss, postoperative drainage, ICU and hospital stay, transfusion requirements, cardiovascular complications, and conversion to open surgery, were compared using Mann–Whitney U and chi-square tests.
Results: VATS thymectomy had longer operative times (124.9±9.6 vs. 88.2±6.5 min, P<0.001) but was associated with lower blood loss (252±52 vs. 323±55 mL, P<0.001), reduced postoperative drainage (273±61 vs. 308±53 mL, P=0.006), shorter ICU stay (1.0±0.0 vs. 1.7±0.5 days, P<0.001), shorter total hospital stay (3.0±0.8 vs. 5.9±0.8 days, P<0.001), and fewer patients requiring transfusion (13.6% vs. 20.0%, P=0.23). Cardiovascular complications were rare and comparable (9.1% vs. 8.9%, P>0.999). Two patients (9.1%) in the VATS group required conversion to open surgery.
Conclusions: VATS thymectomy is a safe and effective minimally invasive alternative to open surgery for MG, providing superior short-term perioperative outcomes without increasing complications. These findings support the adoption of VATS in centers with adequate surgical expertise. Multicenter prospective studies are needed to confirm long-term outcomes and cost-effectiveness.

Keywords

References

  1. Fecto F. Myasthenia gravis: Mechanisms, clinical syndromes, and diagnosis. Disease-a-Month. 2025 Jun 26:101969.
  2.  Dresser L, Wlodarski R, Rezania K, Soliven B. Myasthenia gravis: epidemiology, pathophysiology and clinical manifestations. Journal of clinical medicine. 2021 May 21;10(11):2235.
  3.  Khan MA, Anjum F. Thymic hyperplasia.2020.
  4. Di Crescenzo VG, Napolitano F, Panico C, Di Crescenzo RM, Zeppa P, Vatrella A, et al. Surgical approach in thymectomy: Our experience and review of the literature. International Journal of Surgery Case Reports. 2017 Jan 1;39:19-24.
  5. Hess NR, Sarkaria IS, Pennathur A, Levy RM, Christie NA, Luketich JD. Minimally invasive versus open thymectomy: a systematic review of surgical techniques, patient demographics, and perioperative outcomes. Annals of cardiothoracic surgery. 2016 Jan;5(1):1.
  6. Soder SA, Pollock C, Ferraro P, Lafontaine E, Martin J, Nasir B, et al. Post-operative outcomes associated with open versus robotic thymectomy: a propensity matched analysis. InSeminars in Thoracic and Cardiovascular Surgery 2023 Mar 1 (Vol. 35, No. 1, pp. 189-199). WB Saunders.
  7. Coco D, Leanza S. Robotic thymectomy: a review of techniques and results. Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery. 2023 Mar;20(1):36-44.
  8. Xie A, Tjahjono R, Phan K, Yan TD. Video-assisted thoracoscopic surgery versus open thymectomy for thymoma: a systematic review. Annals of Cardiothoracic Surgery. 2015 Nov;4(6):495.
  9. Saber B, Agrawal DK. Long-Term Outcomes of Minimally Invasive vs. Traditional Open Spinal Fusion: A Comparative Analysis. Journal of spine research and surgery. 2025 Mar 26;7(1):18.
  10. Erşen E, Kılıç B, Kara HV, İşcan M, Sarbay İ, Demirkaya A, et al. Comparative study of video-assisted thoracoscopic surgery versus open thymectomy for thymoma and myasthenia gravis. Videosurgery and Other Miniinvasive Techniques. 2018 May 16;13(3):376.
  11. Pennathur A, Qureshi I, Schuchert MJ, Dhupar R, Ferson PF, Gooding WE, et al. Comparison of surgical techniques for early-stage thymoma: feasibility of minimally invasive thymectomy and comparison with open resection. The Journal of Thoracic and Cardiovascular Surgery. 2011 Mar 1;141(3):694-701.
  12. Wang GW, Tao T, Li CK, Li QC, Duan GX, Sang HW, et al. Comparison between thoracoscopic and open approaches in thymoma resection. Journal of Thoracic Disease. 2019 Oct;11(10):4159.
  13. Imielski B, Kurihara C, Manerikar A, Chaudhary S, Kosterski S, Odell D, et al. Comparative effectiveness and cost-efficiency of surgical approaches for thymectomy. Surgery. 2020 Oct 1;168(4):737-42.
  14. Gross DJ, Zangbar B, Muthu N, Chang EH, Badami A, Stein L, et al. Saving the split: the benefits of VATS thymectomy. Journal of Thoracic Disease. 2019 Apr;11(4):1428.
  15. Yang Y, Dong J, Huang Y. Thoracoscopic thymectomy versus open thymectomy for the treatment of thymoma: a meta-analysis. European Journal of Surgical Oncology (EJSO). 2016 Nov 1;42(11):1720-8.
  16. Hireche K, Canaud L, Lounes Y, Aouinti S, Molinari N, Alric P. Thoracoscopic versus open lobectomy after induction therapy for nonsmall cell lung cancer: new study results and meta-analysis. Journal of Surgical Research. 2022 Aug 1;276:416-32.
Journal of Cardio-Thoracic Medicine
Volume 13, Issue 4
December 2025
Pages 1599-1603

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