WOFAPS 2025 8th World Congress of Pediatric Surgery

Fatima Ampar, Natalya Shcherbakova, Oleg Pikin, Dmitriy Eremin, Vladimir Rozinov

Children's City Clinical Hospital No. 9 named after G.N. Speransky

Purpose

To evaluate the safety and efficacy of thoracoscopic thymectomy in pediatric patients with ocular and generalized forms of myasthenia gravis, and to determine optimal surgical techniques based on clinical, neurophysiological, and immunological indicators.

Methods

The authors have experience in treating 213 pediatric patients with myasthenia gravis. A multifactorial analysis was conducted on 8 children (7 girls, 1 boy) who underwent thoracoscopic thymectomy between 2023 and 2025. Among them, 4 had generalized myasthenia and 4 had the ocular form. The age range was from 1 year and 1 month to 11 years (median 7 years). The diagnosis was confirmed by clinical presentation, positive neostigmine test, neurophysiological findings, and immunological markers. Radical resection of all thymic tissue, including ectopic fragments, was achieved through a standardized trocar placement scheme and stepwise intraoperative revision using high-resolution thoracoscopic instruments.

Results

Clinical improvement was observed in 5 patients within the first postoperative days. In 3 cases, the therapeutic effect manifested between 1 to 3 months after surgery. The mean follow-up period ranged from 6 months to 1.5 years (median 6 months). Histopathological confirmation was obtained in all cases: true thymic hyperplasia was detected in 6 patients, and incomplete thymic involution in 2. No thymomas were found.

Conclusion

Thoracoscopic thymectomy is a safe and effective treatment for both generalized and ocular forms of pediatric myasthenia gravis. The full benefits of the endoscopic approach are realized with strict adherence to the diagnostic algorithm, intraoperative neuromuscular monitoring, and advanced surgical techniques tailored for pediatric thoracic surgery.