Name of the Procedure:

Thymectomy, partial or total; sternal split or transthoracic approach, with radical mediastinal dissection

Summary

A thymectomy is a surgical procedure to remove part or all of the thymus gland, which is located in the upper part of the chest. The procedure may involve splitting the sternum (breastbone) or accessing the thymus via the chest (transthoracic approach) and includes extensive removal of surrounding tissue in the mediastinum.

Purpose

The procedure treats conditions like myasthenia gravis and thymoma (tumors of the thymus). The goal is to alleviate symptoms, prevent the spread of cancer (if present), and improve muscle function and breathing in patients with myasthenia gravis.

Indications

• Diagnosed thymoma
• Myasthenia gravis unresponsive to medical treatment
• Other thymus-related conditions or tumors Patient criteria include overall good health, suitability for general anesthesia, and no contraindications for thoracic surgery.

Preparation

• Fasting for at least 8 hours prior to surgery.
• Medication review and adjustments, especially if on blood thinners.
• Preoperative imaging, such as a CT scan or MRI.
• Blood tests and possibly a pulmonary function test.

Procedure Description

1. Administer general anesthesia.
2. Make an incision in the chest through a sternal split or transthoracic approach.
3. Identify and carefully dissect the thymus gland.
4. Perform radical mediastinal dissection to remove surrounding tissues.
5. Close the incision with sutures or staples. Tools: Scalpels, retractors, electrocautery devices, and sometimes robotic surgical systems. Anesthesia: General anesthesia is used.

Duration

Typically 2 to 4 hours, depending on the complexity of the case.

Setting

Performed in a hospital operating room.

Personnel

• Thoracic surgeon
• Surgical nurses
• Anesthesiologist
• Possibly a surgical technologist

Risks and Complications

• Infection
• Bleeding
• Damage to nearby organs (lungs, heart)
• Respiratory complications
• Prolonged recovery time
• Rare risk of death

Benefits

• Potential remission of myasthenia gravis symptoms.
• Prevention of tumor spread in cases of thymoma.
• Improved quality of life and overall muscle function. Benefits may be realized shortly after recovery but can vary depending on the individual case.

Recovery

• Hospital stay of 3 to 7 days.
• Pain management with medication.
• Avoid strenuous activities for several weeks.
• Follow-up appointments for wound checks and progress assessment.
• Long-term monitoring for symptoms or tumor recurrence.

Alternatives

• Medical management of myasthenia gravis.
• Minimally invasive thymectomy (video-assisted thoracoscopic surgery - VATS).
• Radiation or chemotherapy in cases of thymoma.
• Pros of alternatives: Less invasive, shorter recovery time.
• Cons of alternatives: May not be as effective or suitable for all patients.

Patient Experience

• Patients will feel drowsy and groggy post-surgery due to anesthesia.
• Significant chest pain, managed with pain medication.
• Possible feelings of tightness or discomfort in the chest area.
• Gradual improvement in symptoms related to the underlying condition. Pain management includes prescribed analgesics and supportive care by the medical team.