Patient Details

Age: 70

Gender: Female

Medical History: The patient had a history of severe breathlessness and extreme fatigue over the past four years. Detailed imaging showed no abnormalities in her lungs or heart. Later on, a closer examination revealed a thymoma and she was diagnosed with Myasthenia Gravis, a condition causing increased fatigue.

Case Presentation

A 70-year-old woman sought the expertise of Dr. George Karimundackal, a renowned Thoracic Surgeon in Mumbai. She experienced severe breathlessness and extreme fatigue that had persisted for four years. Previous investigations revealed no abnormalities in her lungs or heart. Recently, she was diagnosed with Myasthenia Gravis, a chronic autoimmune disorder that leads to muscle weakness and fatigue.

Dr. Karimundackal reviewed her case thoroughly, recognizing the need for a comprehensive and multifaceted treatment approach. “When I first saw her, it was clear that her condition had significantly impacted her quality of life. We needed to act quickly and efficiently,” Dr. Karimundackal stated.

Diagnosis

The diagnosis of Myasthenia Gravis was confirmed based on her symptoms, imaging and lab investigations .

Dr. George Karimundackal explains, “Myasthenia Gravis is an autoimmune disorder that disrupts the communication between nerves and muscles. This condition primarily affects voluntary muscles, causing persistent fatigue and weakness. Understanding this condition is essential for developing an effective treatment plan and improving the patient’s quality of life.”

Treatment

Dr. Karimundackal and his team decided to optimize her medication regimen, increase her activity levels, and introduce IV immunoglobulin therapy. Given the partial response to these treatments, we decided on a robotic resection of the thymus gland (thymectomy) in conjunction with her neurologist.

“We knew that adjusting her medications and incorporating IV therapy were necessary first steps, but the thymectomy would be pivotal in her long-term recovery,” explained Dr. Karimundackal.

Symptoms

The patient exhibited:

  • severe breathlessness
  • extreme fatigue
  • muscle weakness

These symptoms were persistent and significantly affected her quality of life.

Tests Performed

Multiple lung and heart scans (previously conducted)

Neurological assessments confirming Myasthenia Gravis

Blood tests to evaluate immune function and rule out other conditions

Pre-operative imaging to assess the thymus gland

Detailed Description of Robotic Thymectomy

Pre-Operative Preparation: The surgical team conducted pre-operative evaluations, including imaging and consultations. Pre-operative instructions and anesthesia planning are completed.

Anesthesia Administration: The doctor placed the patient under general anesthesia to ensure comfort and complete unconsciousness throughout the procedure.

Incision and Port Placement: After making small incisions in the chest, the surgeon inserted robotic surgical instruments and a camera (endoscope). The ports allow access to the thymus gland with minimal invasiveness.

Robotic Surgery: The surgeon controlled robotic arms to perform the thymectomy with high precision. The robotic system enhances dexterity and visualization, enabling the removal of the thymus gland while minimizing damage to surrounding tissues.

Gland Removal: The surgeon carefully dissected and removed the thymus gland through one of the incisions. The procedure was performed with precise control to ensure complete removal and to avoid complications.

Closure: After removing the thymus gland, the incisions were closed with sutures or adhesive strips. The surgical team ensured that there was no excessive bleeding or complications before completing the procedure.

Post-Operative Care: The patient was moved to the recovery area, where the team monitored her as the anesthesia wore off. Pain management and post-operative instructions were provided.

Recovery and Follow-Up: The patient’s recovery was monitored over the following days. A follow-up visit was scheduled to assess the surgical site, overall recovery, and to make any necessary adjustments to the treatment plan.

“We knew that adjusting her medications and incorporating IV therapy were necessary first steps, but the thymectomy would be pivotal in her long-term recovery,” explained Dr. Karimundackal.

Post-Operative Assessment

The patient recovered remarkably well from the robotic thymectomy. Her symptoms almost completely disappeared, and she was discharged on the third day post-surgery. Follow-up visits revealed that she remained symptom-free and required significantly reduced doses of medication.

Dr. Karimundackal remarked, “Seeing her improve so dramatically and regain her quality of life was incredibly rewarding. It’s cases like these that highlight the importance of a thorough and personalized treatment approach.”