Thymectomy/Mediastinal Mass

The thymus gland is in the front part of the chest just behind the breast bone and in front of the heart. The thymus is part of the body’s immune system, and plays its largest role early in a person’s development. Surgical removal of the thymus has no effect on the immune system for someone after they are born.

A thymectomy is a surgical procedure of the thymus. It is typically recommended for patients under the age of 60 years who have moderate to severe weakness from myasthenia gravis. It may be recommended for patients with mild weakness if it impacts breathing or swallowing. The procedure is also recommended for anyone with a thymoma.

Types of Thymectomy

Thymectomy can be performed by several different surgical techniques:

  • Transsternal thymectomy: The most common technique. In this open-surgical procedure, the incision is made in the skin over the breastbone (sternum), and the breastbone is divided (sternotomy) to expose and remove the thymus.
  • Transcervical thymectomy: In this procedure the incision is made across the lower part of the neck, just above the breastbone (sternum). The doctor removes the thymus through this incision without dividing the sternum.
  • Robotic thymectomy and Video-assisted thoracoscopic thymectomy (VATS): These minimally-invasive techniques use several tiny incisions in the chest. The doctor removes the thymus by using special surgical tools inserted into the other incisions. In a robotic-assisted procedure, the doctor uses robotic arms to perform the surgery.

How to prepare for thymectomy procedure

Prior to the procedure, your doctor and treatment team will explain to you what to expect before, during and after the procedure and potential risks of the procedure. Other recommendations include:

Talk to your doctor about

  • All medications, herbal products and dietary supplements you are currently taking and ask for their recommendations about each.
  • Radiation exposure, especially for those that are pregnant
  • Any allergies to medicines, latex, tape, iodine, and anesthetic agents
  • Any history of bleeding disorders
  • Any body piercings on your chest or abdomen

Other suggestions

  • Eat a normal meal the evening before the procedure. However, do not eat, drink or chew anything after midnight before your procedure. If you must take medications, only take them with sips of water.
  • Leave all jewelry at home
  • Remove all makeup and nail polish
  • Wear comfortable clothing when you come to the hospital.
  • If you normally wear dentures, glasses, or hearing devices at home, plan to wear them during the procedure.

What to expect before thymectomy procedure

To determine whether you need this procedure, your doctor might perform a variety of tests, including:

Diagnostic tests and procedures

What to expect during thymectomy procedure

A thymectomy will typically take 1 to 3 hours to complete. This procedure is typically performed in the cardiothoracic operating room (OR). Check with your doctor about the details of your procedure. Our thoracic surgeons are able to offer the robotic approach. In general, during this approach:

  • A nurse will start the intravenous (IV) line in your arm which will administer medications and fluids during the procedure.
  • Usually, your doctor will administer general anesthesia (make you feel sleepy).
  • Once you are sedated, your doctor may insert a breathing tube through your throat into your lungs and connect you to a ventilator. This will breathe for you during surgery.
  • Your doctor will then proceed to make three tiny incisions on one side of the patient’s chest
  • A tiny camera and specially designed surgical instruments are inserted through the incisions
  • The arms of the DaVinci robot are then attached to the instruments
  • The doctor sits at a nearby console, controlling every movement of the robotic arms
  • The doctor carefully separates the thymus gland from surrounding structures and removes it through one of the incisions
  • Once the procedure is complete, the surgical instruments are removed, and the small incisions sutured closed.

What to expect after thymectomy procedure

After the surgery, you will be taken to a stepdown unit for 1 to 2 days. Other recommendations include:

General guidelines

  • Your recovery process will vary depending on the type of procedure done. The incision sites will be checked often.
  • The breathing tube is removed when you wake up from anesthesia.
  • Diet is started the day after surgery with liquids, and quickly advanced to solids as tolerated.
  • Ambulation is started on the first or second day of surgery.
  • Urine catheters and drainage tubes (chest tubes) are removed after 24 to 72 hours.
  • You can probably do your normal activities after the surgery. But, you may need to take it easy at first. No heavy lifting or vigorous exercises until your body has healed.
  • Your doctor will give you instructions to follow during your recovery.

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