Removal of the thymus gland, is a critical procedure for managing various health conditions, including myasthenia gravis and thymomas (tumours of the thymus). The surgery has evolved over time, with advancements in technology making it safer, less invasive, and more effective.

What is the Thymus Gland and Why is Thymectomy Performed?

The thymus gland, located in the upper chest, just underneath  breast bone, is an essential part of the immune system, particularly during early childhood. It plays a key role in the development of T-cells, which help the body fight infections. The thymus gland becomes less active after puberty. In some, the gland can cause problems that require its removal.

Conditions Requiring Thymectomy:

Myasthenia Gravis

A neuromuscular disorder causing muscle weakness, often linked to abnormalities in the thymus gland.

Thymomas

Benign or malignant tumours of the thymus.

Thymic Carcinoma

A rare, aggressive cancer of the thymus. Other Autoimmune Disorders
Occasionally, thymectomy is performed to treat conditions like lupus or rheumatoid arthritis.

Types of Thymectomy Surgery

There are several approaches to thymectomy, each tailored to the patient’s condition, anatomy, and overall health.

1. Robotiic Thymectomy

Robotic-assisted surgery has revolutionised thymectomy by offering enhanced precision, reduced trauma, and better visualisation of the surgical site. This method is particularly beneficial for patients with thymomas or myasthenia gravis. The dexterity of the robotic arms allow surgery in deep and narrow areas that is difficult to reach with open or Thoracoscopic surgery.

2. Transsternal Thymectomy

This traditional method involves making an incision in the chest to access the thymus gland directly. While effective, it is more invasive and typically requires a longer recovery period. Nowadays, this “open” approach is sparingly used and restricted to patients with very large tumors or those invading into major blood vessels or lung:  

3. Transcervical Thymectomy

This technique involves making a small incision at the base of the neck, allowing the surgeon to remove the thymus gland without opening the chest. It is less invasive and has a shorter recovery time.

Video-Assisted Thoracoscopic Surgery (VATS) Thymectomy

VATS thymectomy is a minimally invasive technique that uses small incisions and a thoracoscope (a tiny camera). This approach results in less pain, reduced scarring, and quicker recovery.

Benefits of Thymectomy Surgery

Thymectomy offers significant benefits for patients with conditions related to the thymus gland.

1. Symptom Relief

For patients with myasthenia gravis, thymectomy can lead to long-term symptom improvement and, in some cases, complete remission. It helps reduce muscle weakness and fatigue, improving overall quality of life.

2. Tumour Removal

In cases of thymomas or thymic carcinoma, thymectomy removes the tumour and reduces the risk of cancer spreading to nearby tissues or organs.

3. Minimal Impact on Immune Function

Since the thymus gland is less active in adulthood, its removal typically has little to no impact on immune function.

4. Faster Recovery with Minimally Invasive Techniques

Minimally invasive approaches, such as VATS or robotic-assisted surgery, offer quicker recovery times, less pain, and shorter hospital stays compared to traditional methods.

What Entails Thymectomy Surgery

Preparation is crucial for ensuring a successful thymectomy. Patients typically undergo the following steps:

1. Diagnostic Testing

Imaging Studies: CT or MRI scans provide detailed views of the thymus gland and surrounding structures.

Blood Tests: To evaluate overall health and readiness for surgery.
Pulmonary Function Tests: To ensure the lungs can handle anaesthesia and recovery.

2. Preoperative Instructions

Stop taking certain medications, such as blood thinners, as advised by the surgeon.
Avoid eating or drinking after midnight on the night before surgery.
Arrange for transportation and post-surgical support at home.

What Happens During the Procedure

Thymectomy is performed under general anaesthesia, ensuring the patient remains comfortable and unaware throughout the procedure. The steps vary depending on the surgical approach:

1. Anaesthesia and Positioning

The patient is placed in a position that provides optimal access to the thymus gland. For robotic or VATS thymectomy, small incisions are made for the instruments and camera.

2. Removal of the Thymus

Using precise surgical tools, the surgeon carefully removes the thymus gland while avoiding damage to nearby structures such as the heart and lungs.

3. Closure

The incisions are closed with sutures or surgical glue, and the patient is moved to recovery for monitoring.

Effective Recovery

Recovery from thymectomy depends on the surgical approach and the patient’s overall health. Minimally invasive methods typically offer faster recovery and less discomfort.

1. Immediate Postoperative Period

Patients are monitored in a recovery room for a few hours before being transferred to a regular hospital room.
Pain is managed with medications, though minimally invasive techniques usually result in less postoperative pain.

2. Hospital Stay

Traditional transsternal thymectomy may require a hospital stay of 3–5 days, while minimally invasive techniques often allow discharge within 1–2 days.

3. Activity and Mobility

Light activities can be resumed within a few days, but strenuous exercise and heavy lifting should be avoided for several weeks.
Breathing exercises may be recommended to strengthen lung function and prevent complications.

4. Follow-Up Care

Regular follow-up appointments ensure proper healing and monitor for any complications.
For patients with myasthenia gravis, neurologists may adjust medications post-surgery to optimise symptom control.

Potential Risks and Complications

As with any surgery, thymectomy carries some risks, though they are generally rare:
Bleeding or infection.
Injury to nearby structures, such as the lungs or major blood vessels.
Reaction to anaesthesia.
Persistent muscle weakness in myasthenia gravis patients, though symptoms often improve over time.
Choosing an experienced surgical team, especially one skilled in robotic-assisted techniques, significantly reduces these risks.

Overcoming Thymus Problems with Precision Care

Thymectomy surgery is a highly effective procedure for treating conditions like myasthenia gravis and thymomas. Advances in minimally invasive and robotic-assisted techniques have made the surgery safer, less painful, and more accessible, allowing patients to benefit from faster recovery and improved outcomes. At Thangam Robotic Institute (TRI) in Tamil Nadu, patients can rely on the expert care and cutting-edge technology to ensure the best possible surgical experience. TRI remains committed to offering compassionate support and world-class treatment to those on the journey to better health.