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Radical Thymectomy

It is a surgical removal of the thymus gland, which seems to have a role in the development of myasthenia gravis.

It is considered around about 10%, with myasethenia gravis have a thymoma, or a tumour on the thymus gland, which mostly are slow growing tumours which are benign, some of them may be cancerous,or malignant.

The thymus gland, belongs, to the bodies immune system, and is a part of a person's development at an early age of the person . The removal of thymus gland does not hamper the immune system for someone after they are born.

The thymus is located at the front part of the chest, behind the breast bone, and located in front of the heart, the are known to be the anterior mediastinum, with parts(lobes) extending into the neck.

Who Needs a Thymectomy

It is recommended to patients,under the age of 60,who have a moderate to severe weakness form myasthenia gravis. This procedure is recommended for patients with mild weakness,if it impacts the breathing or swallowing , and it is recommended for anyone with a thymoma.

A surgeon who is experienced, with performing thymectomies would review your case and determine the best approach.

Benefits of Thymectomy

If the doctor has recommended Thymectomy , then the success is that the treatment, which is administered involves reducing patient weakness, reduction in the use of medications, and achieving permanent remission of the diseases. Thymectomy has been considered , as a means of helping a patient improve their condition in the long term.

Surgery

Surgical approaches for thymectomy, are in the three ways which includes:

  • Transsternal : This is a procedure, where the surgery is done from the anterior(frontal) approach that goes through the sternum, removing the thymus, and also the fat next to the thymus. Some approaches the surgeon may use is the neck to ensure the removal of all of the thymus.
  • Transcervical : This is a procedure done on the anterior transverse,(horizontal) approach, which means of the lower neck, which may involve the chest to remove fat adjacent to the thymus.
  • Videoscopic (VATS) : The surgeon uses small incisions in the chest(right side or left),the surgeon then uses thin, flexible tubes (scopes) with fibre-optics to let the surgeon, see and remove the thymus, which is necessary, adjoining the fatty tissue.

The most used procedure is the, transsternal approach, which is often used for a removal of thymoma.

Surgical approaches may vary, however the goal remains that the removal of as much of the thymus as possible, for the best possible outcome. Some of the surgeons advocate, that the removal of the fatty tissue, adjoining the thymus, while others feel the removal of the thymus which alone is sufficient. The extended form of the transsternal thymectomy, with the removal of an adjoining fatty tissue, which is most frequently used approach, than the proponents of transcervical and VATS minimally invasive approach which is said to be more effective. It is also important for a patient to discuss these surgical approaches with their doctors, to determine whether which is right for them.

Recovery

The recovery time depends on the type of surgery, and the type of condition of the patient. A ventilator may be required after the surgery. Once the breathing tube is removed, the patient will be asked to breathe deeply and cough repeatedly to clear the lungs of mucus.

During the time of recovery, the patient may have one or two chest tubes (small tubes in the chest which is attached to the drainage bottles), which will be removed shortly after the surgery. The type of pain the patient experiences, are mild after transcervical or VATS thymectomies , which whereas there is more pain felt with the trans-sternal approach, it is a temporary and may be controlled through the use of pain medications. The pain usually resolves in 3-5 days.

The patient stay at the hospital depends on the surgical approach, used, and also the weakness of the patient. As most patients are able to be discharged in a few days to a week. The surgeon would advise, time away from work and other out door activities which depends on the condition of the patient, and the type of surgery received, and also the nature of their work. The patient would need to limit himself or herself from activities, for about 3-6 weeks which is common,before performing strenuous jobs and activities which an be considered.