Preparing for Thymectomy Surgery

Medically reviewed by David Strosberg, MD

Thymectomy is the surgical procedure to remove the thymus. The thymus is an organ found behind the breastbone and in front of the heart. A thymectomy is done when someone has an autoimmune condition called myasthenia gravis or a tumor on the thymus called a thymoma.

While undergoing surgery can be difficult, many of the symptoms people experience resolve after surgery. This article will discuss the different types of thymectomy surgeries and recovery.

Your Thoracic Surgeon and Thymectomy Techniques

A thymectomy is a specialized surgical procedure that should be performed by a thoracic surgeon with experience performing thymectomy. A thoracic surgeon is a physician who performs surgery on the chest. This would include surgery on the heart, lungs, thymus, and other structures.

There are three ways a surgeon can perform a thymectomy. They are:

• Transsternal: This surgical technique opens the breastbone (sternum) to access and remove the thymus.

• Transcervical: The surgeon makes an incision in the neck, just above the sternum, to remove the thymus.

• Video-assisted thoracoscopic thymectomy (VATS): This minimally invasive technique uses three or four small incisions in the chest. Tools are inserted through the incisions, and the surgeon uses a robotic arm to perform the procedure.

Before a Thymectomy

Before thymus surgery, you will need a physical exam and give a full medical history. Your healthcare provider may have you stop certain medications before surgery, like blood thinners.

You may also need imaging like a computed tomography (CT) scan or magnetic resonance imaging (MRI) to look at the thymus and the tissues, blood vessels, and structures that surround it.

If you are having a thymectomy due to myasthenia gravis, you may need to take certain medications to stabilize your condition before surgery. Follow any directions from the surgical team on preparation for surgery and what to bring to the hospital.

During a Thymectomy

A thymectomy is a major surgery that takes two to three hours.

Immediately before surgery, you will be given anesthesia to make you unconscious. A breathing tube will be inserted to assist in breathing during the operation.

The surgeon will perform the thymus removal. The technique used will be discussed with you beforehand. When surgery is complete, anesthesia will be turned off or reversed to allow you to wake up. When you are sufficiently awake, your breathing tube will be removed.

After a Thymectomy

Following a thymus surgery, you will stay in the hospital overnight. Many people only need one night, but depending on the surgical technique, it could be longer. You may have soreness and pain after surgery; pain medicine will be given as needed.

Chest tubes will likely have been placed during surgery. After surgery, these tubes drain excess fluid and blood that accumulates in the chest. They will be removed before you leave the hospital.

Thymectomy Follow-Up

You will have follow-up appointments after a thymectomy. If you have myasthenia gravis, you will likely be able to reduce your medications after the surgery—60% of people will be able to stop taking all of their medications.

If you have a thymoma, you will need to see your healthcare provider for several years after surgery to ensure the thymoma does not grow back. Yearly CT scans will monitor any changes.

Removing the thymus does not affect the immune system in adults. The thymus plays a role in the immune system early in life, training immature T cells. However, it shrinks by adulthood and is no longer needed for immune system function.

Thymectomy Recovery Timeline

The surgeon will have specific instructions on when activities and work can be resumed. Typically people can return to work two weeks after a thymectomy and resume regular activities when they feel ready.

Coping Through Thymectomy Side Effects

Thymectomy is a major surgery that can carry several potential side effects, including certain side effects that can occur with any surgery, like bleeding or nausea. Below are the side effects that are unique to thymus gland surgery:

• Pleural effusion: Buildup of fluid in the chest

• Pneumothorax: Air that enters the chest

• Thoracic duct fistula (also known as a chyle fistula): Lymphatic fluid leaks into the chest space

• Atrial fibrillation: Irregular heart rhythm that causes the heart's top two chambers to pump ineffectively

The side effects listed above are serious and will need immediate medical attention.

Thymectomy Wound and Scar Care

After a thymectomy, the healthcare team will provide instructions on how to care for the wound at home. The instructions may include the following steps:

• Gather all supplies needed to change the wound dressing.

• Wash hands before touching the dressing or wound.

• Remove the old dressing.

• Wash hands again.

• Using a clean cloth or gauze, wash the wound with soapy water.

• Dry the wound with a clean, dry cloth.

• Cover the wound with a clean, dry dressing.

Medication After Thymectomy

After a thymectomy, there will be a follow-up appointment with a healthcare provider to discuss continued care after thymus removal.

Medication after thymectomy will depend on the reason for the thymus gland removal. If it was removed due to cancer, chemotherapy or other treatments may still be necessary.

Summary

Thymectomy is surgery to remove the thymus, which is typically needed as treatment for myasthenia gravis or thymoma. A thoracic surgeon will perform the surgery, and recovery can take a few weeks, depending on why the surgery was performed.

After surgery, follow up with a healthcare provider to adjust any medications and monitor that the surgical wound has healed properly.