This is a VATS resection of thymoma in a patient with myasthenia gravis. Video shows clearly that it is not a radical thymectomy and I personally believe that it is not appropriate this approach in patients with thymoma.

We are constantly re evaluating our approaches to a condition depending the tools or techniques at our disposal. After much debate extended trans sternal thymectomy (terminology from Alfred Jaretzki in 70's) was widely accepted for patients with Thymoma and Myasthenia Gravis. Many also considered it important for people with Myasthenia Gravis without Thymoma as well.

With our increasing experience in VATS and Robotic procedures this issue needs to be reevaluated.

One strong consideration is that the procedure with the new tools should be equivalent to the previously validated approach. Often a less invasive or thoracoscopic approach is used as a marketing tool. Often these procedures discard the requirement to remove all tissue where there could be thymus present: thymus and anterior mediastinal fat from the lower margin of the thyroid to the diaphragm and from about 1 cm in front of one phrenic nerve to the other. Early results may be reasonable, but we need long term follow up and strict adherence to established criteria.

The role of surgery in Myasthenia without thymoma is being evaluated in a prospective randomized clinical trial.

Prefiero en estos casos de miastenia grave la timectomía radical ,con grasa mediastínica para asegurar que no dejo tejido tímico.