Short-Term Perioperative Outcomes of Video-Assisted Thoracoscopic Versus Open Thymectomy in Myasthenia Gravis: A Single-Center Cross-Sectional Study

Introduction: Thymectomy is a crucial aspect of managing myasthenia gravis (MG). Video-assisted thoracoscopic surgery (VATS) offers a less invasive option compared to traditional open transsternal thymectomy. However, there is limited data on perioperative outcomes in Iran remain limited.Methods: This cross-sectional study included 66 MG patients who underwent thymectomy at Mashhad University of Medical Sciences between 2005 to 2024. Patients underwent either open surgery (n=44) or VATS (n=22). Perioperative outcomes, such as operative time, blood loss, postoperative drainage, ICU and hospital stay, transfusion requirements, cardiovascular complications, and conversion to open surgery, were compared using Mann–Whitney U and chi-square tests.Results: VATS thymectomy had longer operative times (124.9±9.6 vs. 88.2±6.5 min, P<0.001) but was associated with lower blood loss (252±52 vs. 323±55 mL, P<0.001), reduced postoperative drainage (273±61 vs. 308±53 mL, P=0.006), shorter ICU stay (1.0±0.0 vs. 1.7±0.5 days, P<0.001), shorter total hospital stay (3.0±0.8 vs. 5.9±0.8 days, P<0.001), and fewer patients requiring transfusion (13.6% vs. 20.0%, P=0.23). Cardiovascular complications were rare and comparable (9.1% vs. 8.9%, P>0.999). Two patients (9.1%) in the VATS group required conversion to open surgery.Conclusions: VATS thymectomy is a safe and effective minimally invasive alternative to open surgery for MG, providing superior short-term perioperative outcomes without increasing complications. These findings support the adoption of VATS in centers with adequate surgical expertise. Multicenter prospective studies are needed to confirm long-term outcomes and cost-effectiveness.