VATS Timectomy Performed at MMA

16. 05. 2012

For the first time doctors of Military Medical Academy performedVATS timectomy procedure on the patient with a diagnosis of generalized myasthenia gravis. Medical team included: Major Dr. Nebojša Marić (surgeon), Dr. Nataša Vešović (assistant), Dr. Snežana Kovačević (anesthesiologist) and Jasna Lukić as operating-room nurse.
The surgery was performed using minimally invasive chest surgery procedure without open chest wall. In this way 49- old patient has been removed enlarged thymus gland presented in this specific case as limited tumor situated behind the chest bone in precisely defined anatomic region named upper mediastinum.
In normal life conditions, thymus gland disappears during the life while its subsistence and growth depends on different pathological conditions. It may become the thymus tumor and in that form to be associated with myasthenia gravis. Myasthenia gravis is neurological disease called also “severe muscle disease”. It reduces volitional muscular activity while its symptoms are fast muscle weakness, difficulty with speech (dysarthria), dysphagia (difficulty in swallowing) and very often a drooping of one or both eyelids (ptosis). In deterioration phases it involves also breathing musculature when patient is in directly life-threatening condition (myasthenic crisis).
Since now, this kind of operative procedures are being performed using aggressive approach, in the most common cases sternotomy (same approach as for the heart operations) or thoractomy (same approach as for the lung operations). That made treatment process harder, longer and more expensive, due to prolonged postoperative care. Since the patients with myasthenia are in risking condition for anesthesia as well as for postoperative monitoring, trauma diminution contributes to faster recovery and less hospital time in more than 50 percents.    

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