Right unilateral thoracoscopic thymectomy and thoracoscopic subxiphoid thymectomy have advantages over transsternal thoracoscopic thymectomy to treat nonthymomatous myasthenia gravis (MG) in terms of short-term recovery following the operation, according to a new study published in Updates in Surgery.

However, the transsternal approach “is still the best choice for ectopic thymectomy while thoracoscopic subxiphoid approach show the potential as an alternative way,” the researchers said.

Extended thymectomy, which removes the ectopic thymus, is the standard surgical treatment for MG. Residues of the ectopic thymus are thought to contribute to poor response to surgical treatment.

In the present study, a team of researchers led by Jianyong Zou, MD, from the First Affiliated Hospital of Sun Yat-Sen University in Guangzhou, China assessed the efficacy of 3 surgical approaches to ectopic thymectomy in patients with nonthymomatous MG. 

Read more about the treatment of MG

The researchers reviewed 155 patients who underwent extended thymectomy using the trans-sternum, right unilateral thoracoscopic, and thoracoscopic subxiphoid approaches.

They found that the amount of blood loss, the length of operation and hospitalization, and the duration and volume of thoracic drainage were all different between the 3 approaches. Moreover, the efficiency of the surgery and the detection rate of ectopic thymus were also different between the approaches.

Statistical analysis showed that transsternal and thoracoscopic subxiphoid approaches were associated with higher surgical efficiency. Moreover, the transsternal approach was an independent protective factor for the efficiency of ectopic thymectomy.

The researchers concluded that both right unilateral thoracoscopy has advantages in short-term recovery over the trans-sternum approach but that the latter is still the best option for increased efficacy.

MG is a rare autoimmune disorder affecting the neuromuscular junction, and extended thymectomy is defined as thymectomy including adipose tissue clearance in the anterior mediastinum.


Zhang S, Chen Z, Li B, et al. Efficiency of ectopic thymectomy by three surgical approaches in non-thymomatous myasthenia gravis. Updates Surg. Published online June 23, 2022. doi:10.1007/s13304-022-01295-5