To compare the surgical procedures and long-term clinical effects of thymectomy for myasthenia gravis without thymoma between video-assisted thoracoscopic surgery(VATS) and transsternal surgery (median sternotomy and transverse sternotomy).

Between January 1st 2000 and December 31st 2013, 355 patients with myasthenia gravis combined with thymic hyperplasia underwent surgery in Huashan Hospital, and retrospective study was conducated in 272 of those with follow-up results. Among these 272 patients, 58 received VATS(VATS group), 23 received median sternotomy(median sternotomy group) and the other 191 received transverse sternotomy(transverse sternotomy group).

Compared with median sternotomy group, there was less blood loss[(96.90±47.69)ml vs (152.30±93.19)ml, χ²=3.497, P<0.001], shorter time of postoperative drainage [(1.93±0.97)d vs (2.61±0.94)d, t=2.857, P=0.006] and shorter postoperative hospital stay in VATS group[(3.48±1.68)d vs (8.04±4.23)d, t=6.993, P<0.001]. Compared with transverse sternotomy group, there was shorter time of postoperative drainage [(1.93±0.97)d vs (2.75±0.97)d, t=5.612, P<0.001] and shorter postoperative hospital stay in VATS group[(3.48±1.68)d vs (6.87±4.16)d, t=6.042, P<0.001]. Patients were followed up for 12 to 76 months, and the mean time of follow up was 55 months. The overall remission rates of VATS group, median sternotomy group and transverse sternotomy group were 79.3%, 86.9% and 85.3%, respectively, and there was no significant difference among three groups(χ²=0.638, P=0.424; χ²=1.200, P=0.273).

Thymectomy for myasthenia gravis without thymoma by VATS has the advantages of small incision, less blood loss, fast postoperative recovery and shorter postoperative hospital stay, and also has the same clinical effect as transsternal surgery. Therefore, VATS is preferable for the treatment of myasthenia gravis without thymoma.