Minimally-invasive surgery for non-thymomatous myasthenia gravis

Myasthenia gravis (MG) is one of the most common disorders of the neuromuscular transmission, with a wide variation in clinical severity. A recent randomized trial has demonstrated that thymectomy is effective in achieving MG symptoms improvement and definitive patient’s complete stable remission (CSR). Significant debate however continues concerning the ideal surgical approach for thymectomy. Thymic gland is located into the anterior mediastinum, but an extreme anatomical thymic variability has also been described, since ectopic thymic islands may be found in 32–98% of patients in which an extended transternal thymectomy is performed. The recent advent of minimally-invasive operations has extended the indication for thymectomy in MG patients, achieving comparable results in terms of CSR with more aggressive approaches. Thymectomy in non-thymomatous (NT) MG patients may potentially be a morbid surgical intervention, being performed in young and fragile patients. The risk of developing postoperative complications (generally respiratory) is high. Therefore, the optimal surgical approach should take into account these risks and should be chosen through a reduced operative and anesthesia time, avoiding long periods of artificial ventilation as well as painful surgical incisions. The aim of this editorial is to describe MIT results, compared to the classical extended trans-sternal thymectomy.