University of Wisconsin Cardiovascular Surgery: Da Vinci™ Robotic Thoracoscopic Thymectomy for Myasthenia Gravis

Da Vinci™ Robotic Thoracoscopic Thymectomy for Myasthenia Gravis

Myasthenia gravis is a chronic condition that causes waxing and waning muscle fatigue and weakness. It is considered an autoimmune disorder, mediated by autoantibodies in the body that attack the acetylcholine (Ach) receptors needed for muscle contraction. Reduction in antibody levels leads to improvement in symptoms.

Thymus Gland

It is thought that patients with myasthenia gravis (MG) produce antibodies in the thymus, a gland located behind the sternum and extending towards the bottom of the neck (see diagram below). Typically, the thymus gland begins to grow at birth and continues until puberty. After that, it shrinks in size. But in the instance of MG, 75% of patients have abnormal or retained thymic tissue, believed to, in part, be responsible for destruction of ACh receptors. A neurologist is usually the physician to diagnosis and determine the most appropriate treatment for myasthenia. There are some prescription medications used to treat the symptoms of MG, but thymectomy, surgical resection of the thymus, is often performed if the neurologist believes it is indicated.

At University of Wisconsin Hospital and Clinics, removal of the thymus gland is now done robotically, using a minimally invasive technique known as thoracoscopic thymectomy. In this procedure, three tiny incisions are made, usually in the left chest. A small scope, as well as the robotically-controlled instruments are introduced into the body via these port sites.

The Da Vinci™ Robot

The 3-D visibility afforded by the Da Vinci™ robot and the fine, articulating, movements of the robotic arms enable the thymus gland to be carefully separated from surrounding structures and removed intact using a sterile bag. The total incision is less than one inch. Cutting of the sternum and spreading of the ribs are not required. The procedure now takes about two hours and most patients go home in less than 24 hours.