Thymectomy

Thymectomy is an operation where the thymus and surrounding tissue is excised from the centre of the chest. The thymus is a lymph gland that is part of the body’s immune system. It is located in front of the heart, behind the sternum (breastbone) and in between the lungs. It is responsible for maturing immune cells and is more important in childhood. It is known that abnormalities of the thymus can occur in some auto-immune diseases such as myasthenia gravis. Tumors and lymphoma can also occur in the thymus. Removal of the thymus in people with myasthenia gravis may sometimes result in improvement in symptoms of muscle weakness.

Thymectomy is advised if a mass (tumour) is found in the thymus (thymoma) or in people with myasthenia gravis who are thought to benefit depending on the opinion of their neurologist.

Indications for Thymectomy

Thymectomy is advised if a mass (tumour) is found in the thymus (thymoma) or in people with myasthenia gravis who are thought to benefit depending on the opinion of their neurologist.

Procedure

Approaches to this procedure have three different variations:

  • Trans-sternal. With this conventional approach access is obtained by dividing the sternum (breastbone) in the midline and removing the thymus. The fatty tissue next to the thymus is also removed to ensure that no abnormal tissue is left behind. This is the most commonly used approach
  • Videoscopic (VATS). A less invasive method that creates small incisions on the chest and uses a small camera (thoracoscope) and long instruments to view and remove the thymus and fatty tissues.

Risks

Complications associated with this procedure include:

  • Bleeding
  • Infection
  • Damage to other organs
  • Nerve injury
  • Air leaking from one of the lungs
  • Acute worsening of muscle weakness in those with myasthenia gravis that may result in inability to breath effectively
  • Blood clots in the legs that can go to the lungs

What to expect

Before performing the procedure, certain protocols are needed to be accomplished. Your clinical records will be reviewed and you will be ordered to undergo complete physical exam. The procedure will be discussed with you, giving you surgical options, possible complications and the results.

You will have a pre-admission appointment one to two weeks beforehand, in which you will have routine blood testing and consultation with the anaesthesiologist.

If you are taking any medications, you may be asked to stop or change the dose of the drug. Intake of foods and fluids is stopped 6-8 hours before the surgery.

Certain tests will also be required such as:

  • X-rays
  • CT scan
  • Blood tests
  • Urine tests
  • Muscle strength tests
  • Breathing tests

Recovery

  • A ventilator may be required after the surgery. You will be encouraged to do deep breathing and coughing exercise once the equipment is removed to clear the lungs from any accumulation of fluids or mucus
  • One or two chest tubes will be placed during the operation to drain any residual fluid or air
  • Pain medications will be given to control the pain
  • You will be instructed to gradually perform physical activities from light to heavy until you are fully recovered
  • Regular walking is recommended during recovery as a form of gentle exercise
  • The Children's Hospital at Westmead
  • Heart Centre for Children- The Children's Hospital at Westmead
  • Sydney Children's Hospital Randwick
  • Westmead Hospital
  • Westmead Private Hospital
  • Royal Australasian College of Surgeons
  • International Society for Heart and Lung Transplantation
  • Sydney Adventist Hospital