Myasthenia Gravis is a disease with significant symptoms such as muscle weakness and fatigue. Most commonly it affects the eyes, face and throat. The intensity of these symptoms can vary over time.
Myasthenia most commonly affects young women (under 40 years old) and older men (over 60 years old). Since this is an autoimmune disease, treatment is complex.
Treatment for myasthenia
Treatment mainly includes the use of antibodies such as antiacetilcolina (Mestinon), corticosteroids and immunosuppressive drugs. In severe cases, plasmapheresis or immunoglobulin to control outbreaks is used. About a quarter of patients affected have a thymoma (a tumor of the thymus, with varying degrees of malignancy) for which surgery is most commonly suggested. Surgical removal of the thymus has for many years been considered an important phase of treatment for patients who do not present a thymoma. The validity of removal when there has not been a thymoma present has been based mainly on retrospective observational studies.
Recently the benefits of surgery have now been validated by a large randomized trial published in a prestigious scientific journal. The trial showed that the removal of the thymus and mediastinal fat significantly improves neurological symptoms. The result is a reduction in necessary dosages and side effects of the medical treatment.
We spoke with Dr. Giulia Veronesi, director of robotic surgery at the Unit of General and Thoracic Surgery at Humanitas directed by prof. Marco Alloisio.
Robotic Surgery
“When we decide to use surgery for thymectomy we prefer a minimally invasive technique. Specifically, videothoracoscopy compared to the opencast surgical approach (sternotomy). This is because of the increased invasiveness and longer recovery times that the latter technique requires. To date, minimally invasive surgery was uncommon due to the risks. Risks associated did not guarantee the elimination with the same radicalness of mediastinal fat, which often contain parts of the thymic tissue and is therefore important to remove for the effectiveness of intervention” explains Dr Veronesi.
“The robotic technique overcomes this problem of manual videothoracoscopy. There is an advantage of using unilateral access compared to the bilateral approach associated with cervicotomy used in videothoracoscopy. Humanitas is currently coordinating a multicenter ongoing analysis which has the purpose of comparing the results of videothoracoscopy and robotic surgery in this disease. So I think we will be able to compare these techniques and in general compare all treatments for myasthenia which we will present in front of an audience of General Practitioners, at the conference to be held on November 15 right here at Humanitas”.
