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

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