[A technique of videothoracoscopic thymectomy in diseases of the thymus]

Intensive development of thoracoscopic thymectomy (Tthy) has been initiated during the last decade. Unfortunately very few instances of using the procedures have been described in Russian medical literature. So, the paper describes in detail the technique and results obtained in our clinic. At the period from 1998 through 2004 37 Tthy operations were performed in the St. Petersburg Center of intensive pulmonology and thoracic surgery. There were 21 female and 15 male patients with mean age 41.5+/-18.9 years. Myasthenia gravis (MG) was diagnosed in 19 of those patients. Different thoracoscopic approaches were used for Tthy: 20 from the right side, 15 from the left side and 2 combined approaches with neck incision. In 2 cases when invasive thymoma was suspected, sternotomy had to be used. There were 6 postoperative complications (1 haemothorax and 5 myasthenia cases). One patient died in 45 days after operation because of the ventilation-associated pneumonia. The results of treatment were followed up in 34 patients during 6-34 months. The MG course was followed up in 17 out of 19 patients, 9 (52.9%) being asymptomatic, 6 (35.3%) improved and 2 (11.8%) stable. Tthy is a novel technical possibility for a removal of the thymus gland. The procedure is quite safe and radical in the hand of a surgeon experienced in mediastinal and thoracoscopic surgery. Treatment of thymoma using Tthy requires meticulous technique and longer follow-up.