Thymectomy (Removal of the Thymus Gland)

Description of the ProcedureThere are three common methods:Transsternal approachinvolves making an incision over your sternum. The surgeon then separates the sternum, exposing the thymus gland.Transcervical approachinvolves making a small incision across the lower part of the neck, just above the sternum. In both approaches, the surgeon will remove the thymus gland and then close the incision with stitches or staples.Video-assisted thoracic surgery (VATS) or robot-assisted thoracic proceduresminimally invasive procedures. A surgeon does the surgery through several tiny keyhole incisions. The surgeon can see inside with the help of a tiny camera inserted through one of the incisions. The camera projects a video of the surgical proceeding onto a monitor in the operating room. Robotic arms may be used to perform the surgery, using miniature surgical instruments that are also passed into the chest via the keyhole incisions. After ProcedureOnce the anesthesia has worn off, you will be taken to a recovery room, where you will be given fluids and medication via an intravenous (IV) line. You will be instructed to practice deep breathing, coughing, and frequent turning. Nurses will measure your muscle strength and breathing ability to determine the effectiveness of the surgery.

How Long Will It Take?The surgery takes about 1-3 hours. Will It Hurt?You may feel some pain as the anesthesia wears off, but it can be managed with pain medications. Possible ComplicationsInfectionRespiratory failurePermanent nerve injuryDeath Average Hospital StayYour recovery time in the hospital will be about 1-3 days. Postoperative CareThe recovery time varies from patient to patient, depending on the surgical approach. It may take as little as 1-2 weeks or as long as three months before you can return to work or school. OutcomeThymectomy can lessen the severity of myasthenia gravis symptoms, but the degree to which symptoms are lessened varies among patients. Improvement in muscle strength may take several months to a few years.It is important to work with a neurologist during the recovery period to regulate medications in order to control your myasthenia gravis symptoms.Thymectomy is also performed to try to stop the spread of cancer from the thymus to other organs. Call Your Doctor If Any of the Following OccursSigns of infection, including fever and chillsRedness, swelling, increasing pain, or discharge from the incision siteDifficulty breathingAny other worrisome symptoms RESOURCES: Myasthenia Gravis Foundation of America

http://www.myasthenia.org/ National Institute of Neurological Disorders and Strokehttp://www.ninds.nih.gov/ CANADIAN RESOURCES: Canadian Health Portalhttp://chp-pcs.gc.ca Muscular Dystrophy Canadahttp://www.muscle.ca/ References: General Information about Thymoma and Thymic Cancers. National Cancer Institute. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/thymoma .Accessed February 13, 2008. Myasthenia gravis fact sheet. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/myasthenia_gravis/detail_myasthenia_gravis.htm#84053153 . Accessed February 13, 2008. Practice parameter: thymectomy for autoimmune myasthenia gravis (an evidence-based review). National Guideline Clearinghouse website. Available at: http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=2826&nbr=2052 .Accessed February 13, 2008. Sabiston Textbook of Surgery. 17th ed. Philadelphia, PA: Saunders; 2004. Surgical treatment options for myasthenia gravis. University of Maryland Medical Center website. Available at: http://www.umm.edu/mg/surgery.html .Accessed February 13, 2008.

Thymectomy. Myasthenia Gravis Association of Pennsylvania website. Available at: http://www.mgawpa.org/pages/thymectomy.htm . Accessed February 13, 2008. Last reviewed February 2008 by Rosalyn Carson-DeWitt, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.