Technical Aspects of Thymectomy

Abstract

Surgical excision of the virtually normal thymus encountered in the patient with myasthenia gravis presents few challenges. Even the presence of a benign tumour adds little to the difficulties of this straightforward operation. It is only when surgeons elect to remove invasive tumours that their technical resources will be stressed. Much of the safety of thymectomy is derived from improvements in the preoperative and postoperative management. During the early days of surgery for myasthenia, it was not unusual for weakness of the respiratory muscles to make postoperative ventilator support essential. Red rubber endotracheal tubes were poorly tolerated for more than a day or two so that tracheostomy was performed frequently with all its attendant complications. Modern practice has virtually eliminated the need for long-term ventilation and it is many years since the author performed a tracheostomy following thymectomy.