The immune system in the human body is a natural defense mechanism against any disease. Whenever any foreign substance, virus, or bacteria enters the body our immune system starts producing antibodies that attack the bacteria.
However, in people suffering from the autoimmune disease myasthenia gravis (MG), the antibodies produced by the immune system is abnormal. The muscles are not able to receive the correct signals and act accordingly. This leads to symptoms like weakness of the limb, and weakness of eye or eyelid muscle which leads to blurred or double vision, & drooping eyelids. Due to weakness in the throat, the patients face difficulty while swallowing and speaking.
This disease is also known as neuromuscular autoimmune disease. As the immune system starts behaving against the healthy tissues, it causes damage to the body. While people of any age group can get myasthenia gravis, it is commonly seen in younger women and older men.
Scientists have not completely understood the trigger points for the autoimmune reaction in myasthenia gravis, but they do know that the thymus gland plays a role in the disease. This is a small gland that lies in the front of the chest, underneath the breastbone, and extends into the neck's lower part. The role of thymus is accomplished by puberty and with time it gets replaced by fat.
However, in certain cases, this gets formed as a tumor that needs further intervention. The key treatment for the disease begins with an accurate diagnosis done through a blood and nerve test. Further, it also involves the administration of medicines in order to differentiate myasthenia gravis from other diseases of muscles and nerves. Post the diagnosis and the direction of a neurologist a further treatment plan can be developed. The treatment plan is aimed at reducing the number of antibodies causing the disease and strengthening the muscle improving the communication between muscles and nerves.
In the initial phase, the patient is put on medication therapy that improves nerve signal transmission or suppresses antibody production. Another option can be plasmapheresis, which removes antibodies from the blood. High-dose intravenous immune globulin is the infusion of normal antibodies from donated blood to temporarily modify the immune system. The thymus gland which is the main mediator of these abnormal immune responses can also be removed through surgical intervention known as thymectomy and it can be considered by MG patients.
The team at the Fortis Hospital Mulund has recently performed robotic thymectomy on a 34-year-old man suffering from myasthenia gravis for the past few years. Being a software engineer he was finding it difficult to even type the keys of a keyboard or phone due to muscle pain and weakness. He was worried that conventional surgery would lead longer recovery period. Hence, he opted for minimally invasive surgery, wherein he had a speedy recovery and now living a normal life.
Thymectomy procedures can be either performed through open surgery or minimal access surgery. Open surgery is similar to open-heart surgery in which the thymus gland is moved by opening the breastbone through a cut. This is a complex procedure as the operation is done while the heart, lungs, and major other organs are exposed and hence precision becomes important.
In robotic thymectomy, three tiny incisions are made in the left chest through which the surgical instruments along with a small scope is introduced into the body, and the surgery is carried out with the aid of a visual monitor. Advanced technologies provide surgeons with better access and control, helping them make better decisions.
This also helps patients as unlike during open procedure, there are minor cuts, minimal blood, less to no chances of tissue damage, and reduces the chances of infection, lung and nerve damage. This procedure also reduces the pain and helps the patient with a speedy recovery like in this case where the patient was discharged in 3 days.
Dr. Anil Heroor (Director Advanced Onco Surgery Unit ) & Dr. Dhara Shah (Consultant Neurology)