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Alexander Marmureanu

Alexander Marmureanu

Myasthenia Gravis

Myasthenia gravis is an autoimmune disorder in which the body attacks the acetylcholine receptors that bridge nerve endings and muscle tissues. This in turn reduces the ability of the neurotransmitter compound acetylcholine to stimulate the muscles. Patients with myasthenia gravis experience increasing muscle weakness during activity, which is relieved during rest. The condition has a pronounced effect on muscles involved in eye movement, talking, chewing, and swallowing. Other muscle groups are also affected, including those involving breathing, which means that patients may be vulnerable to respiratory paralysis.

The exact cause of the myasthenia gravis is not fully understood, but the thymus gland, located under the breast bone, plays an important role in causing the immune system's attack on the acetylcholine receptors.

Treatments

The condition may be controlled with medications including immune suppressants.

Surgical removal of the thymus gland greatly improves the condition (70% of patients), and in some cases resolves myasthenia gravis. But the treatment has been controversial because it does not help all patients.

Thymectomy, surgery to remove the thymus gland, has traditionally been performed as an open procedure in which the central breast bone, or sternum is cut, and the chest opened (sternotomy).

Transcervical Thymectomy

Transcervical thymectomy is a minimally invasive procedure in which the thymus is removed through a small incision in the lower part of the neck. The procedure is viewed through a video camera inserted together with small surgical instruments through a small horizontal incision across the lower part of the neck. Benefits of this procedure, as compared to the open procedure, include a dramatically faster recovery period and less postoperative pain. Typically, the patient is in the hospital only one day and can return to work and normal activity within a week. Not all patients are candidates for the transcervical approach.

Thoracoscopic Thymectomy

The procedure may also be performed minimally invasively through the side of the chest, via video-assisted thoracoscopy (VATS). The surgeon creates two or three small (¾-inch) incisions. Small surgical instruments and as a camera for viewing the procedure are inserted through the incisions. Surgery takes place entirely inside the closed chest. Benefits include reduced recovery time and less postoperative pain than the open approach. This is the most cosmetically appealing of thymectomy procedures due to the location and the small size of the incisions.

Research

Current research efforts are directed towards the development of a more standardized staging system to allow comparison of different medical and surgical therapies, including robotically assisted minimally invasive thymectomy (removal of the thymus gland).