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[32]
thymectomy, which range from 15.8% to 60% . Another neurological outcome measure is the proportion
of patients experiencing an improvement of MG symptoms, as defined by the MGFA postintervention
status classification, which ranges from 77% to 87.5% in robotic thymectomy series [20-23] . Again, these figures
compare well with those reported after transsternal thymectomy, which leads to palliation rates (defined as
[29]
symptom-free on medication or minimal symptoms on no medication) varying between 79% and 86% .
Unfortunately, the limited number of patients, the variable inclusion criteria, the different measures used
to define the neurological outcomes, as well as differences in operative techniques and surgical approaches,
make it impossible to reliably compare neurological outcomes between transsternal and minimally invasive
thymectomy, or thymectomy performed by different minimally invasive techniques (e.g., RATS, VATS and
subxiphoid). To answer these questions, better designed, multicenter, randomized studies are needed.

CONCLUSION
The benefits of thymectomy for patients affected by nonthymomatous MG have now definitively been
proven. RATS is a safe and effective minimally invasive approach to thymectomy, which provides
satisfactory neurological outcomes and a reduced surgical morbidity compared to the transsternal
approach. The lack of well-designed prospective studies makes it impossible to reliably compare surgical
and particularly neurological outcomes between different surgical approaches.

DECLARATIONS
Authors’ contributions
Conception and design of the study: Mammana M, Comacchio GM, Dell’Amore A, Rea F
Data analysis and interpretation: Mammana M, Comacchio G, Faccioli E, De Franceschi E, Rossi S

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2020.

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