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Thymectomy

(Removal of the Thymus Gland)

Definition

A thymectomy is surgery to remove the thymus gland. This gland is located in the upper portion of the chest, behind the breastbone.
Thymus Gland
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Reasons for Procedure

The thymus gland helps immune cell growth. It is usually active when you are an infant, but its function reduces as you get older. The thymus acts abnormally when a person has myasthenia gravis . A thymectomy is used to treat myasthenia gravis.
A thymectomy may also be done if the thymus has a tumor, which is called thymoma. These types of tumors are associated with myasthenia gravis.

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
  • Bleeding
  • Infection
  • Damage to other organs
  • Nerve injury
  • Respiratory failure
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:

What to Expect

Prior to Procedure

  • Your doctor will likely do the following:
    • A physical examination
    • X-rays
    • Blood tests
    • Urine tests
    • Muscle strength tests
    • Breathing tests
  • Follow a special diet, which may include withholding foods and fluids before surgery.
  • Take prescribed medications as directed by your doctor.
  • Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure, like:
    • Anti-inflammatory drugs
    • Blood thinners
    • Antiplatelet drugs
  • 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 during the procedure.

Description of Procedure

There are three common methods:
  • Trans-sternal 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 prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.

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 medication through an IV. 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.
Preventing Infection
During your stay, the hospital staff will take steps to reduce your chance of infection, such as:
  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered
There are also steps you can take to reduce your chance of infection, such as:
  • Washing your hands often and reminding your healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incision
At Home
The recovery time varies from person to person, 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. Ask your doctor about when it is safe to shower, bathe, or soak in water. 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 medications.
  • You may need to work with a physical therapist

Call Your Doctor

Call your doctor if any of the following occur:
  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
  • Pain that you cannot control with the medications you have been given
  • Cough, difficulty breathing, or chest pain
  • Pain, burning, urgency, or frequency of urination, or persistent bleeding in the urine
  • Persistent nausea and vomiting
  • Pain and/or swelling in your feet, calves, or legs
  • New or worsening symptoms
If you think you have an emergency, call for medical help right away.

RESOURCES

Myasthenia Gravis Foundation of America, Inc. 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

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. Updated March 22, 2013. Accessed May 22, 2013.

Myasthenia gravis fact sheet. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/myasthenia%5Fgravis/detail%5Fmyasthenia%5Fgravis.htm#84053153. Updated December 4, 2012. Accessed May 22, 2013.

Shrager JB. Extended transcervical thymectomy: the ultimate minimally invasive approach. Ann Thorac Surg. 2010;89(6):S2128-2134.

Surgical treatment options for myasthenia gravis. University of Maryland Medical Center website. Available at: http://www.umm.edu/mg/surgery.html. Updated August 7, 2008. Accessed May 22, 2013.

6/3/2011 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

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