Video-assisted thoracoscopic thymectomy for myasthenia gravis: where we are

Thymectomy has long been considered one of the treatment modalities for myasthenia gravis (MG). The centre of debate has been the surgical technique for thymectomy, such as complete, extended and maximal thymectomies, and the surgical approach with the transsternal approach being the most common. Partial sternal splitting was the gold standard approach for many decades with less postoperative complications and safety. Transcervical thymectomy and video-assisted thoracoscopic surgery (VATS) thymectomy gained popularity for superior cosmesis, less invasive approach, shorter hospital stays and increased safety. Both techniques may provide a complete removal of the thymus gland. Now, different VATS techniques are preferred by different surgeons and clinics. The debate is shifting to the options of an extended thymectomy or a bigger thymus resection with minimally invasive techniques. Robotic thymectomy, which is considered a robot-assisted VATS thymectomy, became an important choice for surgical treatment in several centres. In this study, we aimed to study the role of thymectomy in the treatment of MG, including debatable indications and recently developed attitudes for the difficult decisions, and the effects of recent technology on the outcome of MG treatment.