A new technique called transareolar uniportal thoracoscopic extended thymectomy (TUTET) is safe and effective in men with myasthenia gravis, according to a study published in the journal Frontiers in Surgery. 

The uniportal incision is hidden in the areola with sound cosmetic effects,” the developers of the technique wrote. “We believe that TUTET is an acceptable procedure for extended thymectomy.”

Myasthenia gravis with thymic hyperplasia or thymoma can be treated with video-assisted thoracoscopic extended thymectomy (VATET). However, the procedure is associated with intercostal nerve injury and wound-related pain even when it is done unilaterally. It also causes a permanent cosmetic defect in the form of 3 visible scars on the chest wall.

Read more about the treatment of myasthenia gravis

In the present study, a team of researchers from China tested the safety and feasibility of TUTET in 46 men with myasthenia gravis. All men were followed up for 1 to 7 years following the operation. Notably, the procedure is not recommended for women because of their progressed mammary glands.

The average operation time for all patients was a little over an hour (72.6 minutes). The mean size of the transareolar uniportal incision was 3 cm, and the mean cosmetic score following the operation was 3.1 at the time of discharge from the hospital. 

Three months after the operation, none of the patients had an apparent surgical scar on their chest wall, and none of them complained of pain. One year after the procedure, all patients had sound cosmetic effects and were highly satisfied with the procedure.

“Substantial amelioration of the disease was achieved in a short period, and several benefits were clear,” the researchers wrote. “TUTET may be a promising therapeutic approach for [myasthenia gravis].”

Myasthenia gravis is a rare autoimmune disease characterized by the body’s immune system attacking components of the neuromuscular junction, thereby disrupting the transmission of signals from the nerves to the muscles. The development of the disease can be linked to abnormalities in the thymus gland, so a thymectomy generally is indicated.


Lin J, Lin N, Li X, Lai F. Transareolar uniportal thoracoscopic extended thymectomy for patients with myasthenia gravis. Front Surg. Published online October 11, 2022. doi:10.3389/fsurg.2022.914677