Improving outcomes in myasthenia gravis: uni-portal video-assisted thoracoscopic (UVATS) thymectomy in a single-centre retrospective cohort

BACKGROUND: Thymectomy is a well-established treatment for myasthenia gravis (MG), with minimally invasive approaches increasingly preferred due to reduced morbidity. This study evaluates the safety and clinical outcomes of uni-portal video-assisted thoracoscopic surgery (UVATS) thymectomy in MG patients at a Malaysian tertiary centre. METHODS: We conducted a retrospective cohort study of 30 patients who underwent UVATS thymectomy for MG at Universiti Malaya Medical Centre between August 2016 and July 2025. Of these, 24 patients with complete perioperative and follow-up data were included. Outcomes assessed included postoperative complications, length of stay, disease severity by Modified Osserman classification, medication requirements, and symptomatic improvement. RESULTS: The cohort (58% female, mean age 42.5 ± 18.2 years) had 50% thymoma. Postoperatively, 88% demonstrated clinical improvement. Osserman Class I proportion increased from 8% preoperatively to 75% postoperatively (p < 0.001). Corticosteroid dependency decreased from 75% to 33% (p = 0.003), pyridostigmine from 67% to 29%. Mean hospital stay was 3.4 ± 1.2 days. Complication rate was 8% (all minor), with no perioperative mortality. CONCLUSIONS: "UVATS thymectomy is safe and demonstrates favorable short-term clinical outcomes in appropriately selected MG patients as the result has demonstrated significant clinical improvement, reduced medication requirements, and low morbidity. These findings support UVATS as the preferred minimally invasive approach in suitable candidates.