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VATS /Robotic/ Videothoracoscopic /VATS/ Thymectomy

Thymectomy: involves complete resection of the thymus gland. The mediastinal pleura is opened in thymus gland removal, and we remove the thymic mass until the thymic vein is exposed.
Thymectomy is usually performed if it is accompanied by myasthenia gravis or thymic tumors.

1. Videothoracoscopic /VATS Thymectomy; It is the most preferred method. It is a closed method through two or three incisions. Usually, the thymus tissue is under the sternum. Without cutting the sternum, the thymus is removed. It has many advantages, including aesthetics, less pain, and early discharge.

Myasthenia Gravis
Mediastinal Masses

Figure 1: Videothoracoscopic and robotic thymectomy surgery positions and incisions from our clinic. Thymus and adipose tissue with poles removed thoracoscopically.

The VATS method is a minimally invasive technique. When surgically removing thymoma/thymic carcinomas, it is necessary to remove the tumor precisely. The general aim should be complete resection without leaving any residual or thymus tissue.

Although thymothymectomy was an open (Median sternotomy/Thoracotomy) procedure in the past, it can be safely performed today with minimally invasive methods such as ROBOTIC and VATS.

Note1: VATS; It should be avoided in tumors with a huge diameter. This way, the local spread of the cancer is prevented.

  1. ROBOTIC Surgery; Generally, three ports (2 arms, one camera) are sufficient for RATS Thymectomy. The surgeon operates with small fractions with the da Vinci Robotic Surgery system. The surgeon performs the operation sitting at the console. A surgeon standing at the patient's bedside during the process helps the surgeon at the console. The surgeon operates on a 3D image, and cameras enlarge the operation area 10-12 times. These tooltips can rotate 540 degrees around their axis and mimic the wrist movements of the human hand.

In recent years, the RATS/VATS technique has shown modifications (classical three ports to 2 ports, bilateral approach, subxiphoid approach), such as subxiphoid RATS/VATS thymectomy and combined subxiphoid-transcervical VATS thymectomy.

Myastenia Gravis
Myastenia Gravis

Figure 2. Subxiphoid Robotic Thymectomy


  1. Parsiel Median sternotomy/ Median Sternotomy should be the standard approach in locally advanced cases, especially if large vessels are involved, superior vena cava invasion, and the tumor diameter are huge.
  2. Thoracotomy: Sometimes, if the tumor is closer to one side and has a different focus, this incision is preferred.

Note2: Since Myasthenia Gravis sometimes accompanies thymoma/thymic carcinomas, paying attention to the phrenic nerves is essential. If cut, the patient may experience severe respiratory distress.


Note 3: You can access our VATS Thymectomy article at the links below.

Frequently Asked Questions About Thymic Hyperplasia

Thymic hyperplasia is abnormal thymus growth. It is often identified with other noncancerous thymus tumors, but it is not an actual tumor. Thymic hyperplasia is associated with myasthenia gravis and other autoimmune diseases.

This case illustrates a phenomenon called thymic rebound (also called benign thymic hyperplasia), which is thymic regrowth of 50% greater than the base volume. This "rebound effect" is known as thymic rebound hyperplasia. It usually takes nine months for the thymus to return to its original size. Examples of acute stress events that can trigger thymic atrophy and rebound are pneumonia and corticosteroid therapy.