Thymectomy Overview

A thymectomy is surgery to remove the thymus gland. This gland is located in the upper portion of the chest, behind the sternum (breastbone).

Thymus Gland © 2009 Nucleus Medical Media, Inc.

Prior to Procedure

• Your doctor will likely do the following:

• X-rays —a test that uses radiation to take a picture of structures inside the body
• Blood tests
• Urine tests
• Muscle strength tests
• Breathing tests

• Follow a special diet, which may include withholding foods and fluids before surgery.

• Take prescribed medicines.

• Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:

• Aspirin or other anti-inflammatory drugs
• Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)

• Arrange to have someone drive you to and from the procedure. Ask for help at home after your procedure.

Anesthesia

General anesthesia will be given. You will be asleep.

Description of Procedure

There are three common methods:

• Transsternal approach—An incision will be made in the skin over your breastbone. The breastbone will be pulled apart. The thymus gland will then be exposed and removed. The incision will be closed with stitches or staples.

• Transcervical approach—A small incision is made across the lower part of the neck, just above the breastbone. The thymus gland will be removed. The incision will be closed with stitches or staples.

• Video-assisted thoracic surgery (VATS) or robot-assisted thoracic procedures —This is a less invasive option. Several tiny incisions are made in the area. A tiny camera will be inserted through one of the incisions. The camera will send images to a monitor in the room. Robotic arms may be used to do the surgery. Special tools will be passed through the remaining incisions to remove the thymus. After the thymus is removed, the incisions will be closed with stitches.

Immediately After Procedure

You will be taken to a recovery room. There you will be monitored for any complications.

How Long Will It Take?

About 1-3 hours

How Much Will It Hurt?

Anesthesia will block the pain during the surgery. You may feel some pain as the anesthesia wears off. Your doctor will give you medicine to help manage the pain.

Average Hospital Stay

The usual length of stay is 1-3 days. Your doctor may choose to keep you longer if complications arise.

Post-procedure Care

At the Hospital

You will be given fluids and medicine via an 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.

At Home

The 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. Be sure to follow your doctor’s instructions.

If the surgery was done for myasthenia gravis:

• 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 medicines.

RESOURCES:

Myasthenia Gravis Foundation of America
http://www.myasthenia.org/

National Institute of Neurological Disorders and Stroke
http://www.ninds.nih.gov/

CANADIAN RESOURCES:

Health Canada
http://www.hc-sc.gc.ca/index-eng.php

Muscular Dystrophy Canada
http://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/myastheniagravis/detailmyasthenia_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.