Thoracic Surgery – Information for patients: Having a thymectomy procedure

What is thymectomy?

Thymectomy is a surgical procedure to remove the thymus gland, which rests behind the breastbone (also called the sternum). This procedure is carried out under general anaesthesia, which means that you will be asleep during the operation. The thymus gland is different from the thyroid gland which is found in the neck. The thymus plays an important role in the development of the immune system during infancy and early childhood. It is active until puberty and then gradually shrinks away so that in adulthood only fatty tissue remains. After puberty, the thymus gland does not play an important role and removing it does not result in any ill- effects or problems with the immune system.

Why do I need to have thymectomy?

There are a few reasons why you may need to have a thymectomy. For example, you may have developed a thymoma, which is a growth of the thymus gland. This growth may be benign (non-cancerous) or malignant (cancerous). In some cases, it may have invaded the structures of the chest cavity.

Surgery is accepted as the best option to remove the gland and to obtain a definitive diagnosis. If the thymoma is cancerous, there is a very good chance of curing it with surgery alone or in combination with a further treatment, such as radiotherapy.

For patients suffering with the condition Myasthenia Gravis, it is thought that the removal of the thymus reduces the production of the antibodies that affect the nerve-muscle junction, which is what is causing the disease. The surgery may not provide a complete cure but may significantly improve Myasthenia Gravis symptoms.

If thymectomy procedure is recommended to you by your surgeon, there may be several treatment benefits including:

• Reduction in overall muscle weakness
• Reduction in the use of medication such as steroids
• Possible permanent remission of the disease
   

How is thymectomy performed?

There are several ways in which thymectomy can be performed. Your surgeon will outline the different options and advise you on the most suitable option for you.

Sternotomy is a vertical incision down the midline of your chest, whereby the breastbone (sternum) will be cut to open the chest allowing your surgeon access to the thymus gland. Sternotomy may be needed if you have a particularly large growth which cannot be removed by a keyhole technique. At the end of the procedure, the two halves of the sternum will be ‘sewn’ back together with a titanium wire to provide stability and to promote healing. The wires around your breastbone will remain in place permanently and do not have to be removed.

Cervical approach is a small cut made at the base of your neck, just above the breastbone, from where the thymus gland can be accessed and removed.

Video-assisted thoracoscopic surgery (VATS) is an approach whereby a few small cuts are made in the chest, making it possible for a small camera to look inside your chest cavity. The other cuts are used by the surgeon to insert various surgical instruments to perform the operation.

Robotic thymectomy is a minimally invasive approach used to access the chest cavity, and it is now the most common way we treat patients with Myasthenia Gravis. If you will have your thymus gland removed by a robotic procedure, we will provide you with additional information and advice.

During robotic thymectomy, your surgeon will be situated behind a console, and he will be in full control of all movements of the robot. The surgeon will make three to four small (8mm to 12 mm) incisions (ports), which will allow the robot to access your chest. Through these small ports, a surgical assistant will place the miniaturised instruments of the robot into your thoracic cavity. Your surgeon will then use a variety of different surgical instruments, including a high-definition 3D camera, to carry out the planned procedure.

What are the risks of thymectomy?

All surgical procedures carry certain risks, both from the surgery alone as well as from the hospital stay. These risks may include:

• Infection
• Blood clots
• Bleeding
• Pain and discomfort
• Phrenic nerve palsy (damage to the phrenic nerve in the chest).

During your initial consultation with your surgeon as well as during your consent prior to your procedure, the surgeon will explain the risks and benefits of the surgery and will address any concerns you may have. Any risks associated with general anaesthesia will be discussed with you by the anaesthetist on the morning of your procedure.