Open Videoassisted Techniques: Thoracoscopic Extended Thymectomy with Bilateral Approach and Anterior Chest Wall Lifting

  • Hiroyuki Shiono
  • Mitsunori Ohta
  • Meinoshin Okumura


A thymectomy is now generally accepted as a major option of treatment for myasthenia gravis (MG) patients, both with and without thymomas. In recent years, developments in endoscopic surgical procedures have achieved the benefit of less invasiveness, though that has led to discussion regarding the most suitable surgical approach. The rationale for choosing a thymectomy for nonthymomatous MG is based on its function to remove the germinal centers (GCs) in the thymi, where acetylcholine receptor (AChR)-specific B cells clonally proliferate, and differentiate into antibody producing cells with a high affinity, as demonstrated by the author when working with Willcox [1, 2]. In addition, we found that a decrease in antibody titer 1 year after a thymectomy had a significant inverted correlation with the number of GC B cells in thymic lymphocytes in those patients [3]. Further, the author and Willcox reported that lymphocytes in remnant thymi adjacent to tumors spontaneously produce anti-AChR an tibodies in MG patients with a thymoma [4].


Superior Vena Cava Phrenic Nerve Thymic Tissue Left Brachiocephalic Vein Extended Thymectomy 
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Copyright information

© Springer-Verlag Italia 2008

Authors and Affiliations

  • Hiroyuki Shiono
    • 1
  • Mitsunori Ohta
    • 1
  • Meinoshin Okumura
    • 1
  1. 1.Department of General Thoracic SurgeryOsaka University Graduate School of MedicineOsakaJapan

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