N Kitagawa1, M Shinkai2, H Take2, K Mochizuki2, F Asano2, H Usui2, H Miyagi2, T Kido3, N Kurauchi4, H Osaka5, S Yamashita5. 1. Department of Surgery, Kanagawa Children's Medical Center, Yokohama, Japan. Electronic address: norihikok@nifty.com. 2. Department of Surgery, Kanagawa Children's Medical Center, Yokohama, Japan. 3. Department of Respiratory Surgery, Shion Hospital, Osaka, Japan. 4. Department of Surgery, Hakodate Municipal Hospital, Hokkaido, Japan. 5. Department of Neurology, Kanagawa Children's Medical Center, Yokohama, Japan.
Abstract
BACKGROUND: Extended thymectomy is indicated for children with myasthenia gravis (MG) when drug-resistance or dependence is seen. We have employed a technique for mediastinoscopic extended thymectomy (MET) on children with MG. METHOD: A total of 14 children underwent MET at Kanagawa Children's Medical Center between 2005 and 2013. A mediastinal operation field was made by a V-shaped hook infrasternally to extirpate the thymus with adipose tissue around the thymus. RESULTS: The operation time and the amount of blood loss were 182±44 minutes and 34±43 ml, respectively. Postoperative complications, in the form of transient paralysis of the right recurrent nerve, occurred in 2 patients. The median length of postoperative hospital stay was 4.5 days. After MET, 6 patients achieved complete remission and 7 patients achieved steroid dose reduction, but no improvement was seen in 1 patient. CONCLUSIONS: This procedure offers the advantage of good surgical access for dissection around the bilateral phrenic nerves in extended total thymectomy, while achieving good cosmetic results.
BACKGROUND: Extended thymectomy is indicated for children with myasthenia gravis (MG) when drug-resistance or dependence is seen. We have employed a technique for mediastinoscopic extended thymectomy (MET) on children with MG. METHOD: A total of 14 children underwent MET at Kanagawa Children's Medical Center between 2005 and 2013. A mediastinal operation field was made by a V-shaped hook infrasternally to extirpate the thymus with adipose tissue around the thymus. RESULTS: The operation time and the amount of blood loss were 182±44 minutes and 34±43 ml, respectively. Postoperative complications, in the form of transient paralysis of the right recurrent nerve, occurred in 2 patients. The median length of postoperative hospital stay was 4.5 days. After MET, 6 patients achieved complete remission and 7 patients achieved steroid dose reduction, but no improvement was seen in 1 patient. CONCLUSIONS: This procedure offers the advantage of good surgical access for dissection around the bilateral phrenic nerves in extended total thymectomy, while achieving good cosmetic results.
Authors: Arin L Madenci; George Z Li; Brent R Weil; David Zurakowski; Peter B Kang; Christopher B Weldon Journal: Pediatr Surg Int Date: 2017-04-11 Impact factor: 1.827