{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T00:34:25Z","timestamp":1760834065891,"version":"build-2065373602"},"reference-count":8,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T00:00:00Z","timestamp":1760745600000},"content-version":"vor","delay-in-days":18,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Myasthenia gravis (MG) is a chronic autoimmune disorder characterized by fatigable muscle weakness, typically caused by antibodies against acetylcholine receptors (AChR) or muscle-specific kinas. While it primarily affects adults, juvenile cases represent a significant minority and often pose greater therapeutic challenges. Extended thymectomy has proven beneficial in AChR-positive MG, reducing symptoms and immunosuppressive needs. Robotic-assisted thymectomy offers enhanced precision with lower morbidity. We report the first such procedure in Ecuador, performed on a 21-year-old woman with recurrent myasthenic crises. The surgery was uneventful, and follow-up showed marked clinical improvement without recurrence, highlighting the feasibility of advanced techniques in low-resource settings.<\/jats:p>","DOI":"10.1093\/jscr\/rjaf759","type":"journal-article","created":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T17:01:53Z","timestamp":1760806913000},"source":"Crossref","is-referenced-by-count":0,"title":["Robot-assisted extended thymectomy in juvenile myasthenia gravis: first case performed in Ecuador"],"prefix":"10.1093","volume":"2025","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1134-4784","authenticated-orcid":false,"given":"Enrique","family":"Gagliardo","sequence":"first","affiliation":[{"name":"National Oncology Institute SOLCA Guayaquil , Department of Thoracic Surgery, Guayaquil, Guayas 090505,","place":["Ecuador"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1531-020X","authenticated-orcid":false,"given":"Luis","family":"Aguagui\u00f1a Toainga","sequence":"additional","affiliation":[{"name":"Hospital General Monte Sina\u00ed , Guayaquil ,","place":["Ecuador"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6436-5135","authenticated-orcid":false,"given":"Janneth Alejandra","family":"P\u00e9rez Cede\u00f1o","sequence":"additional","affiliation":[{"name":"National Oncology Institute SOLCA Guayaquil , Department of Thoracic Surgery, Guayaquil, Guayas 090505,","place":["Ecuador"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2310-7126","authenticated-orcid":false,"given":"Luis Alberto","family":"Barrera Delgado","sequence":"additional","affiliation":[{"name":"National Oncology Institute SOLCA Guayaquil , Department of Thoracic Surgery, Guayaquil, Guayas 090505,","place":["Ecuador"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9682-5896","authenticated-orcid":false,"given":"Luis","family":"Munoz Andrade","sequence":"additional","affiliation":[{"name":"National Oncology Institute SOLCA Guayaquil , Department of Thoracic Surgery, Guayaquil, Guayas 090505,","place":["Ecuador"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,10,18]]},"reference":[{"key":"2025101813014897300_ref1","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1038\/s41572-019-0079-y","article-title":"Myasthenia gravis","volume":"5","author":"Gilhus","year":"2019","journal-title":"Nat Rev Dis Primers"},{"key":"2025101813014897300_ref2","doi-asserted-by":"publisher","first-page":"e59104","DOI":"10.7759\/cureus.59104","article-title":"Advances in understanding and managing myasthenia gravis: current trends and future 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Clin"},{"key":"2025101813014897300_ref6","doi-asserted-by":"publisher","first-page":"890","DOI":"10.1093\/ejcts\/ezab253","article-title":"Robotic thymectomy for thymoma in patients with myasthenia gravis: neurological and oncological outcomes","volume":"60","author":"Romano","year":"2021","journal-title":"Eur J Cardiothorac Surg"},{"key":"2025101813014897300_ref7","first-page":"5555","article-title":"Extended thymectomy versus limited thymectomy in non-thymomatous myasthenia gravis: a systematic review and meta-analysis","volume":"12","author":"Comacchio","year":"2020","journal-title":"J Thorac Dis"},{"key":"2025101813014897300_ref8","doi-asserted-by":"publisher","first-page":"1774","DOI":"10.1016\/j.athoracsur.2018.07.026","article-title":"Comparison of robotic and video-assisted thoracoscopic thymectomy for myasthenia gravis: a meta-analysis","volume":"106","author":"Yang","year":"2018","journal-title":"Ann Thorac Surg"}],"container-title":["Journal of Surgical Case 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