2005

Minimally Invasive Transcervical Thymectomy, an Excellent Alternative to Sternotomy for Removal of Thymus Gland

For patients with myasthenia gravis, surgical removal of the thymus gland has been a frequently used treatment for decades. Traditionally, the thymus has been removed through a full sternotomy in which the entire sternum is split vertically. Although results were excellent, morbidity and prolonged recovery from this sternal splitting maneuver was not uncommon for patients.

Mayo Clinic was one of the first centers to advocate use of a less invasive mini-sternotomy, and for the past decade, this has been the standard procedure. Within the past 3 years, Mayo Clinic thoracic surgeons have further improved the procedure to reduce patient discomfort, while maintaining excellent results. Mayo Clinic thoracic surgeons now perform minimally invasive transcervical thymectomy preferentially for removal of the thymus gland.

Because of the special training required, Mayo Clinic is one of only a few medical centers in North America to offer this procedure. Using a small incision in the neck, a customized retractor, and the videoscope, the thoracic surgeon is able to visualize and remove the entire thymus gland. Because of its effectiveness and potential for quick recovery, transcervical thymectomy is now the treatment of choice for removing the thymus gland and small thymomas.

Benefits of Transcervical Thymectomy

The great advantage of transcervical thymectomy over mini-sternotomy is that it reduces pain and disability for the patient. The hospital stay is also reduced to 1 day vs 3 to 5 days after mini-sternotomy. In addition, patients are able to resume work and normal activities quickly, with no restrictions on lifting.

Contraindications

Transcervical thymectomy is best suited for patients with myasthenia gravis without tumors of the thymus. If tumors are present, they should be relatively small (usually less than 2 cm in diameter); patients with tumors larger than 2 cm still need to undergo a sternotomy.