Surgeons in China have developed a new way of removing the thymus — a procedure called a thymectomy — in myasthenia gravis patients that may be both easier on the doctors operating and likely to improve post-operative outcomes in patients.
The method was described and validated in the study, “Subxiphoid and subcostal arch ‘Three ports’ thoracoscopic extended thymectomy for myasthenia gravis,” that appeared in the Journal of Thoracic Disease.
Surgical removal of the thymus is the most effective method of preventing production of autoantibodies — harmful antibodies that attack normal tissue instead of foreign dangers, such as bacteria or viruses — that cause myasthenia gravis.
There are different approaches when performing a thymectomy: a more invasive open-chest approach, or the thoracoscopic method, which is a minimally invasive procedure that involves inserting a tiny camera and surgical instruments through small incisions in the chest wall.
While the thoracoscopic method has many benefits for patients, a conventional unilateral (right- or left-sided) approach can limit surgeons’ ability to see the area of interest and remove all the affected tissue.
The team in China positioned cameras and all the necessary equipment below the rib cage in a frontal approach, providing a broader view of the thymus and surrounding area than the unilateral approach.
To validate the procedure — which they call in a clinical trial the “3-Hole” subxiphoid approach — the researchers compared the outcomes of 41 patients who were operated on via the new method with that of 36 patients treated with the conventional one-sided approach.
The new approach was linked to significantly shorter operation time, less blood loss during surgery, and shorter post-operative hospital stays. Also, for seven days after the procedure, patients reported less pain than those treated with the standard method. Post-operative scars and cosmetic outcomes were similar in both groups.
No serious complications were reported and the new approach was found to be generally safe. No myasthenia crisis was reported during follow-up and mortality rates were similar in both groups.
The team is currently evaluating the novel thymectomy approach in a Phase 2 trial (NCT02317224). The study, to take place in China, is expected to confirm the advantages and long-term benefit of the “3-Hole” technique compared with other approaches used.