Minimally Invasive Thymectomy for Myasthenia Gravis Feasibility and Functional Outcomes.

BACKGROUND

Thymectomy is established for myasthenia gravis (MG), but evidence from nonspecialist general thoracic surgery units is limited. This study evaluates the feasibility and outcomes of thymectomy following an institutional transition from sternotomy to minimally invasive surgery and assesses MG Composite and MG-ADL scores as longitudinal outcome measures.

METHODS

A single-centre retrospective cohort study of 58 consecutive MG-thymectomy patients between 2018 and 2026. The primary outcome was favourable clinical status (complete stable remission or improvement) at one year. Secondary outcomes included complications, length of stay, medication reduction, and changes in MG score. Between-group comparisons across surgical approaches are descriptive and exploratory only.

RESULTS

Surgical approaches were RATS (n=29; 50.0%), VATS (n=22; 37.9%), and sternotomy (n=7; 12.1%). Perioperative mortality was zero. Overall complication rate was 10.3%. A favourable outcome was achieved in 68.9% (95% CI, 57.3-81.9%). Sternotomy was associated with longer hospital stay (median 7 vs 2-3 days; p=0.002). Prednisolone and pyridostigmine were reduced or discontinued in 72.1% and 55.3% of preoperative users, respectively (both p<0.001). MG Composite and MG-ADL scores improved progressively from three months onward.

CONCLUSION

Thymectomy can be safely and effectively performed in a general thoracic surgery unit with appropriate specialist input, achieving outcomes comparable to regional referral centres. Transition to minimally invasive surgery did not compromise safety or efficacy while significantly reducing hospital stay. MG Composite and MG-ADL scores should be collected prospectively as standardised outcome measures in future studies.