P02: Comparison a novel 3-hole surgery with VATS for myasthenia gravis: a retrospective study
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P02: Comparison a novel 3-hole surgery with VATS for myasthenia gravis: a retrospective study

Qiang Lu, Yongan Zhou, Juzheng Wang

Thoracic Surgery, Fourth Military Medical University, Xi’an 710032, China


Background: To compare the safety and effectiveness of a novel 3-hole surgical method using an approach through the subxiphoid with VATS in treating myasthenia gravis.

Methods: From January 2013 to August 2014, 70 cases of myasthenia gravis were selected, 34 of which were operated on using the novel 3-hole surgical method extended thymectomy approach and 36 using VATS from the right side of the chest. The novel 3-hole surgical method procedure was as follows: (I) with the patient in a supine position and legs apart at 45°–60°, one 2.0-cm incision and two 0.5-cm surgery holes were made subxiphoid and the bilateral rib arch; (II) the retrosternal space was exposed using both blunt and sharp dissection. The thymus, the bilateral mediastinal pleurae and its surrounding fat tissues were completely removed; (III) at the end of the surgery, drainage was not necessary after draw off all mediastinum CO2. The observed indices were operation time, bleeding volume, length of postoperative hospital stay, occurrence of pain, sternotomy conversion ratio and its reasons, mortality rate from complications.

Results: (I) The mean surgery time in the 3-hole group was significantly less than that of the VATS group (90.3±21.1 vs. 120±24.6 min, P<0.01), and the volume of bleeding in the 3-hold group was less than that in the VATS group (20.3±8.9 vs. 55.1±10.4 mL, P<0.05); (II) among those in the 3-hole group, sternotomy was performed on two cases (5.8% of the total cases) because of the close adhesion of lesions with the left 阿 vein. Among those in the VATS group, thoracotomy was performed on four cases (11.1%) because of the close adhesion of lesions with the left innominate vein (5.5%, two cases) and hemorrhage caused by injury to the left innominate vein (5.5%, two cases). There were no differences observed between the two groups (5.8% vs. 11.11%, P=0.435); (III) using the Visual Analog Pain Scale, postoperative pain was assessed as being much lower in the 3-hole group than in the VATS group (3.2±0.8 vs. 4.5±1.5, P<0.01); (IV) the length of postoperative hospital stay in the 3-hole group was also less than that of the VATS group (2.3±1.1 vs. 7.4±2.3 d, P<0.05); (V) in both groups, the complication and mortality rates were 0%.

Conclusions: Our innovative 3-hole surgical method is markedly better than VATS in extended thymus resection in the following ways: (I) less possibility of injuring any vessels during surgery; (II) the surgery time and bleeding volume were also significantly reduced; (III) postoperative pain was significantly reduced; (IV) postoperative drainage was not necessary; (V) postoperative complications and length of stay were also significantly decreased; (VI) bilateral mediastinal pleurae and adipose tissues could be completely removed and the remission rate of myasthenia gravis greatly improved. This is a good surgical treatment for myasthenia gravis.

Keywords: Safety; effectiveness; 3-hole approach and VATS; myasthenia gravis


doi: 10.3978/j.issn.2072-1439.2015.AB071


Cite this abstract as: Lu Q, Zhou Y, Wang J. P02: Comparison a novel 3-hole surgery with VATS for myasthenia gravis: a retrospective study. J Thorac Dis 2015;7(Suppl 3):AB071. doi: 10.3978/j.issn.2072-1439.2015.AB071

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