Mediastinal and Thymic Surgery
Background
The mediastinum is a group of structures in the middle of the chest. It includes the heart, the large blood vessels to and from the heart, the oesophagus, the trachea (windpipe), nerves, the thymus, and lymph nodes.
The thymus is a small organ in the upper part of the mediastinum behind the sternum (breastbone).
It functions as part of the immune system and is important in making cells that fight infections. Thymomas are malignant tumors that arise in the thymus gland. Although considered malignant, most thymomas grow slowly and tend to spread only locally into surrounding tissues.
Myasthenia gravis is an autoimmune disease where antibodies attack the junction between nerves and muscles, causing progressive weakness. Common symptoms include fatigue, droopy eyelids (ptosis), double vision (diplopia), nasally speech (dysarthria), and a “snaring smile” (weakness of facial muscles). Some patients with myasthenia gravis may have a thymoma, and surgical removal (called thymectomy) can cause the disease to go into remission. Other patients with generalised myasthenia gravis but no thymoma, that cannot be controlled with medications, may also benefit from thymectomy.
About the surgery
Thymectomy can be performed through a number of different approaches:
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Trans-sternal – The sternum (breastbone) is split to access the thymus.
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Trans-cervical – A horizontal incision is made across the lower neck, which is less invasive than the trans-sternal approach.
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Video-assisted thoracic surgery (VATS) or robotic-assisted – Small “keyhole” incisions are used to insert instruments and a camera into the chest, which is the least-invasive approach.
The most important factor is to remove the entire thymus, and possibly some of the surrounding fat too. This ensures the best long-term results are achieved.
Recovery period
Patients usually stay in the intensive care unit for one to two days for monitoring, before being moved to the ward for four to five days. Full recovery usually takes about two months. Most patients are able to drive in about two to four weeks after surgery. Your surgeon will provide specific guidelines for your recovery and return to work.
Risks of the surgery
Your surgeon will calculate your risks specific to you, and discuss them with you.
All patients should consult their cardiothoracic surgeon for specific information about their medical condition and surgery.