Robotic thymectomy the answer for his myasthenia gravis diagnosis

Oct. 5, 2021
Mike Oster is an avid fisherman but myasthenia gravis was causing serious health issues, until he agreed to a robotic thymectomy.
Mike Oster makes a fishing fly. He is an avid fisherman but myasthenia gravis was causing serious health issues until he agreed to a robotic thymectomy. Photo by Joel Blocker, for UCHealth.

The tiny thymus gland weighs only an ounce but punches much bigger than its weight as a crucial drill sergeant for the development of the human immune system.

It’s located behind the sternum and between your lungs, though it is only active until puberty.

“The thymus is a training center, or what I like to call the ‘barracks’ for the human body’s immune system,” said Dr. Hao Pan, a cardiothoracic surgeon at UCHealth in northern Colorado. “It trains t-cells to attack foreign invaders and around puberty, it shrinks and turns into a big glob of fat.”

But it didn’t go that way for Mike Oster, a Fort Collins retiree and avid fisherman. His thymus remained large. Scientists believe that when this happens, the gland may give incorrect instructions to developing immune cells, ultimately causing the immune system to attack its own cells and tissues and produce acetylcholine receptor antibodies – setting the stage for the attack on neuromuscular transmission, according to the National Institute of Neurological Disorders and Stroke.

Mike Oster enjoying his retirement and fishing after his robotic thymectomy that alleviated his symptoms of myasthenia gravis. Photo courtesy of Mike Oster.
Mike Oster enjoying his retirement and fishing after his robotic thymectomy that alleviated his symptoms of myasthenia gravis. Photo courtesy of Mike Oster.

For most of his life, Oster never had significant health issues. About five years ago, though, he noticed that he functioned well in the morning but as the day progressed, his muscles became weak and his body so tired he couldn’t make it out to fish or do the other things he enjoyed, like working in his yard. He noticed that a small cut would turn into an infection that would need medical intervention to resolve.

In December 2019, doctors diagnosed Oster with a neuromuscular condition called myasthenia gravis, a chronic autoimmune disease that leaves muscles — including those responsible for breathing — weak when they are not at rest.

Oster was prescribed a regimen of steroids and hormone medications to curb the symptoms of myasthenia gravis, but Oster did not like the way they made him feel, both mentally and physically.

Fortunately, medical advancements and research – closely followed by Dr. Pan — showed that removing the thymus, a surgery called a thymectomy, led to a significant reduction to no disease symptoms for 70% of adult patients.

Robotic thymectomy for myasthenia gravis

Dr. Hao Pan, a cardiothoracic surgeon at UCHealth in northern Colorado, who is the only doctor in northern Colorado performing a robotic thymectomy, a specialized robot-assisted surgery to remove the thymus.
Dr. Hao Pan, a cardiothoracic surgeon at UCHealth in northern Colorado.

During his years of surgical training, Pan performed heart surgeries on infants and small children which gave him a thorough understanding of the function and maturation of the thymus. As Pan progressed into his professional career as an adult cardiothoracic surgeon, now with UCHealth Heart and Vascular Center, he often encounters the thymus in adult heart surgery.

“Myasthenia gravis is no longer a medical disease,” said Pan, the only doctor in northern Colorado performing robot-assisted thymectomy surgery. “It’s a surgical disease that is drastically minimized with decreased steroid use. And by using the robot (da Vinci Surgical System) to do the surgery, it’s an easily recoverable procedure.”

Because of myasthenia gravis, Mike Oster would function well in the morning, but as the day progressed his muscles became weak and his body so tired he couldn’t make it out to fish or do the other things he enjoyed, like working in his yard.
Because of myasthenia gravis, Mike Oster would function well in the morning, but as the day progressed his muscles became weak and his body so tired he couldn’t make it out to fish or do the other things he enjoyed, like working in his yard. Photo by Joel Blocker, for UCHealth.

Preparing for a robotic thymectomy

Although there was a 1% chance of major bleeding, Oster agreed to the surgery. Using the da Vinci Surgical System for a thymectomy has many benefits, Pan said.

First, it eliminates the need to split the breastbone to reach the thymus. Because the gland is close to other vital organs, surgical removal requires refined skills and extensive dexterity. Pan uses his skills, with the assistance of the da Vinci Surgical System, to make three 5-millimeter ports on the right side of the chest and one on the left, making sure not to disturb the diaphragm.

“I was perfectly comfortable with Dr. Pan,” Oster said. “He was so confident — he knew what he could do. I wasn’t nervous at all.”

Oster’s surgery was scheduled for early March 2020, but then the pandemic hit and his surgery was postponed. Oster continued on the steroid and hormone pills and had surgery in June 2020.

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Mike Oster and his wife, Phyllis, who are now enjoying retirement today since Mike’s robotic thymectomy helped alleviate his health issues with myasthenia gravis.
Mike Oster and his wife, Phyllis, are now enjoying retirement since Mike’s robotic thymectomy helped alleviate his health issues with myasthenia gravis. Photo by Joel Blocker, for UCHealth.

Recovering from a thymectomy

The surgery took two hours.

“I spent three days in the hospital and then went home and mowed the lawn,” Oster said.

Mike Oster is an avid fisherman but myasthenia gravis was causing serious health issues, until he agreed to a robotic thymectomy.
Mike Oster is an avid fisherman but myasthenia gravis was causing serious health issues until he agreed to a robotic thymectomy. Photo by Joel Blocker, for UCHealth.

His wife, Phyllis, is thrilled with the results. “It’s made a big difference. He’s healthier, sleeps better and is more active.”

Mike Oster hiking after his robotic thymectomy that alleviated his symptoms of myasthenia gravis. Photo courtesy of Mike Oster.
Mike Oster hiking after his robotic thymectomy that alleviated his symptoms of myasthenia gravis. Photo courtesy of Mike Oster.

After the thymectomy, Oster addressed some of his other health issues. He spent the next year getting a “good tune-up,” he said. He had a colonoscopy, knee surgery and a procedure to tame his sleep apnea.

The couple took monthly road trips in the summer, taking their RV to some of Oster’s favorite mountain fishing spots. He also bought a paddleboard.

“I’ve always loved fishing. I grew up in the back of a boat or in the backwoods camping,” he said. “I gained a love for the outdoors, took up fly fishing about 30 years ago and got into tying flies and making my own rods, which I work on in the wintertime.

“To me, it’s very relaxing and an escape. You worry about the basics — do I have water and food — and not much else.”

That’s how retirement – and fishing — should be.

About the author

Kati Blocker has always been driven to learn and explore the world around her. And every day, as a writer for UCHealth, Kati meets inspiring people, learns about life-saving technology, and gets to know the amazing people who are saving lives each day. Even better, she gets to share their stories with the world.

As a journalism major at the University of Wyoming, Kati wrote for her college newspaper. She also studied abroad in Swansea, Wales, while simultaneously writing for a Colorado metaphysical newspaper.

After college, Kati was a reporter for the Montrose Daily Press and the Telluride Watch, covering education and health care in rural Colorado, as well as city news and business.

When she's not writing, Kati is creating her own stories with her husband Joel and their two young children.

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