Geisinger Medical Center performs first transcervical thymectomy

The Department of Thoracic Surgery at Geisinger Medical Center (GMC) recently performed its first transcervical thymectomy, joining other major academic medical centers nationwide that perform the minimally invasive surgical procedure.

The thymus is a gland in front of the heart involved with regulation of the immune system. Removal of the thymus, a thymectomy, becomes necessary when tumors arise within the gland. A thymectomy can also be performed for patients with myasthenia gravis, an autoimmune neurologic disease that results when the thymus begins to produce antibodies that interfere with the muscle's ability to contract - particularly the eyes, face, throat, legs and arms. Individuals suffering from the disease may have difficulty speaking, swallowing or chewing, or notice droopy eyelids, blurred vision or difficulty making facial expressions.

"Treatment for myasthenia gravis involves medications to suppress the immune system," said Michael Friscia, M.D., thoracic surgeon at GMC. "Surgical removal of the thymus also can result in significant improvement in symptoms as well."

The classic approach for removing the thymus is a sternotomy. Surgeons divide the breastbone through a vertical incision from the neck to the upper abdomen - the same incision used for open-heart surgery. Patients typically remain hospitalized for several days followed by weeks of recovery at home.

The invasiveness of the open-chest approach often caused patients to put off the procedure until their symptoms progressed.

The transcervical approach is performed through a 5-centimeter horizontal incision in the neck. Advantages of this approach are significant, according to Dr. Friscia, including less pain and just one night in the hospital.

"In patients with myasthenia gravis, the main value of the transcervical thymectomy is that more patients decide to undergo thymectomy" said Dr. Friscia. "In the years following surgery, the majority of patients experience improvement in symptoms, and many can go off medications completely."

This is particularly advantageous for patients with myasthenia gravis because the resulting muscle weakness, which can make swallowing and breathing difficult, can make recovery from surgery more hazardous, Dr. Friscia added.

"The results of the transcervical thymectomy are equivalent to those seen following open-chest procedures, but with a less invasive approach," Dr. Friscia said. "Immediately following the operation, patients continue to take the same medication they took before the procedure, but the majority of patients regain normal muscle strength and many experience complete remission."