Thymectomy

Thymectomy, the surgical removal of the thymus gland, is a cornerstone procedure for managing various conditions, including thymic tumors—such as thymomas, thymic carcinomas, and thymic neuroendocrine tumors—and myasthenia gravis (MG). Historically, thymectomy was first performed incidentally by Garre and Sauerbruch during thyroidectomies for Graves disease. However, it was not until Blalock and colleagues demonstrated its utility in managing MG, including in patients without thymomas, that thymectomy gained widespread clinical significance. Advances in surgical techniques have transformed the traditional median sternotomy or transsternal approach, which remains the gold standard, to less invasive alternatives. These include upper partial sternotomy, transcervical approaches, video-assisted thoracoscopic surgery, and robotic-assisted thymectomy. These minimally invasive techniques have demonstrated superior outcomes, including shorter hospital stays and reduced morbidity and mortality. Preoperative imaging is essential for evaluating tumor resectability and determining the need for induction therapy. At the same time, thorough functional and pulmonary assessments guide the surgical plan, particularly in single-lung ventilation for thoracoscopic approaches. This course examines the evolving role of thymectomy in clinical practice, focusing on indications, surgical techniques, and outcomes.