It was at the end of Summer 2008 that now 23-year-old Ashley Grandell began experiencing muscle weakness. The Hillsboro resident—an athlete who swam, surfed and was a former cheerleader and lifeguard—had difficulty pulling herself out of a pool. Her unexplained symptoms continued, as she began dropping things and exhibiting droopy eyelids. Most upsetting was when she was at the gym on an elliptical machine and her legs gave out beneath her.
“I’d always done a lot of things that demanded strength, so it was frustrating and scary when I couldn’t do the things I loved, things I’d been doing my whole life,” she recalls.
Neurological testing revealed nothing at first. Finally, one year later, she was diagnosed with myasthenia gravis, an autoimmune disease that weakens the muscles. Treatment options for the illness include removal of the thymus, a gland located behind the breast bone that is important for developing immunity in newborns but is not as vital in adults. When Ashley’s condition progressed despite medication, her neurologist recommended thymectomy; a physician for whom her mother worked referred her to The Thoracic Group in Somerset.
Dr. Robert Caccavale proposed Ashley have a VATS (video-assisted thoracic surgery) thymectomy, a minimally invasive procedure that has become a successful alternative to sternotomy, traditional surgery in which the breast bone is sawed open in order to access the thymus gland and then closed with wires upon completion. With sternotomy, patients undergo a longer operation, have an extended hospital stay, and are prone to such complications as severe pain and injury to muscles and the rib cage; additionally, full recovery can take up to four months. “In contrast, VATS thymectomy is far less injurious to the chest, reduces morbidity, causes much less pain and suffering, and speeds recovery,” notes Dr Caccavale.
The VATS technique, which is used to both diagnose and treat chest problems, involves inserting a thoracoscope (or tiny high-resolution camera) as well as surgical instruments through small incisions made in the chest area. The camera sends video images that are projected onto high-definition monitors and help guide the surgeon. VATS is now commonly utilized in many other thoracic procedures, including lung biopsy and surgical removal of the lung.
The Thoracic Group is a pioneer in video-assisted thoracic surgery, playing a central role in the development of the technique in the early 1990s. Dr. Caccavale and his partner, Dr. Jean-Philippe Bocage, are highly skilled and experienced in the precise practice and always work together as co-surgeons. They have performed close to 6,000 VATS procedures and currently use it in more than 99 percent of their cases, with excellent outcomes.
Ashley, eager to get her life back and feeling that a less invasive approach was more suitable to her lifestyle, opted for VATS. This past June, she underwent a VATS thymectomy under general anesthesia at Somerset Medical Center, which saved her a hospital stay and months of recovery had she had a sternotomy. Drs. Caccavale and Bocage, along with their anesthesia and nursing team, performed the procedure in 25 minutes through four small incisions the size of a fingertip. Four hours later, Ashley was discharged.
“The VATS approach provides better visibility and illumination within the chest than the traditional open approach. Because we don’t have to cut through muscle, there is little tissue damage,” Dr. Caccavale explains. “This is an excellent surgical alternative to the standard, very invasive operation, with few adverse effects.
“Within a week, most patients have returned to the majority of their normal preoperative activities,” he continues, emphasizing the many months required following sternotomy. “Ashley has done remarkably well.”
For now, Ashley is feeling much better and has resumed her active lifestyle. Within two weeks of her VATS procedure, she was swimming in her backyard pool, and within four weeks, she was surfing.
“I was nervous about the operation, but less so if I was going to have traditional surgery. I also didn’t want a big scar and am happy to have just a few very small ones on my left side,” she says. “The staff at Somerset Medical Center was very friendly and the nurses came to check on me a lot. And Dr. Caccavale was so nice and up front with me, explaining everything and letting me know what to expect when I woke up from anesthesia. I trusted him fully. I’m so glad that I’m getting back to the activities I love to do.”