InsideSurgery Medical Information Blog

Details of surgical procedures, pathophysiology, signs and symptoms, and treatment of medical diseases,medical and surgical eponyms, and surgeons and surgery in the news

  • Home
  • Eponyms
  • Abbreviations
  • Terms of Use
  • Privacy Policy
  • Contact

Thymectomy – Standard (Removal of Thymus)

May 19, 2007


Indications

Thymic mass – this includes thymomas and thymic cysts. The aim of resection of the thymus is to completely remove the thymic mass.

Myasthenia gravis – thymectomy is indicated for this condition when medical treatment fails, in younger patients with short duration of symptoms,

and in patients who have difficulty tolerating the side effects of the medications used to treat myasthenia gravis. Of historical note is that thymectomy for myasthenia gravis was pioneered by Alfred Blalock at Johns Hopkins Hospital in 1939.

Pre-operative Workup and Preparation

Computed tomography – this is almost always obtained pre-operatively if a mediastinal mass is suspected and includes contrast enhancement to evaluate the involvement of the nearby vascular structures.

Magnetic Resonance Imaging – most centers who perform a large volume of thymectomies also routinely obtain this imaging study.

Surgical Details of Procedure

The “standard” thymectomy uses a partial upper sternal-splitting incision in contrast to a transverse cervical (neck) incision or a complete sternotomy with cervical extension.

1. A short incision in the skin of the anterior chest wall in the midline running from just below the sternal notch to the third interspace (at the level of the space between the 3rd and 4th ribs is made with a No. 10 blade.

2. A sternal dissection is done through the subcutaneous tissues with the Bovie cautery.

3. A sternal saw is used to divide the sternum to the third intercostal space and to completely to divide the manubrium.

4. A sternal retractor is placed and opened and the top of the incision is retracted cephalad (toward the head).

5. The anterior surface of the thymus is then visualized and an inspection for a thymoma is undertaken.

6. If a thymoma is found most surgeons will do a complete sternotomy so that a radical excision of the thymus can be performed.

7. Using both blunt and sharp dissection the edges of the thymus are freed from the pericardium (sac surrounding the heart).

8. Care must be taken when removing the thymus from the bilateral mediastinal pleura (lining around the lungs).

9. Care must be taken to identified the phrenic nerves running on both sides of the surgical field and to avoid injuring these structures.

10. After mobilizing the thymus from the pericardium and pleural surfaces the lower poles should be easily retracted cephalad (toward the head).

11. At the lateral margins of the thymus the internal mammary arteries are identified.

12. These are doubly ligated (tied) with 2-0 silk ties and divided.

13. The cervical extensions of each thymic lobe are removed with the body of the thymus by gentle traction and division of the thryothymic ligament.

14. The thymic vein empyting into the innominate vein is visualized and doubly-ligated with silk ties.

15. The thymus is then removed.

16. If at any point of the dissection there is a thymic mass discovered a full sternotomy is usually done.

17. If there is is adherence or invasion of the mass into an adjacent structure the thymus tissue is removed en bloc if possible.

18. Tissue specimens should be sent to the pathology lab for frozen section analysis to assure tumor-free margins if possible.

19. Before closing a thoracostomy drainage tube is placed in the anterior mediastinum.

20. The sternum is then reapproximated with sternal wires and the subcutaneous tissue is closed with a 2-0 Vicryl stitch and the skin is closed using a running 4-0 Monocryl subcuticular suture.


Copyright 2007 InsideSurgery.com

Categories

  • Acupuncture
  • Amputation Surgery
  • Anesthesia
  • Appendix Surgery
  • Articles
  • Bird Flu
  • BP Oil Spill Health Risks
  • Breast Surgery
  • Cancer
  • Cardiac Surgery
  • Cardiology
  • Case Reports
  • Clinical Trials – Published
  • Colon Surgery
  • Complementary and Alternative Medicine
  • Coronavirus
  • Critical Care
  • Dental and Oral Surgery
  • Dermatology
  • Devices and Technology
  • Drug-Drug Interactions
  • Ebola
  • Endocrinology
  • Eye Surgery
  • For Professionals
  • Gallbladder Surgery
  • Gastroenterology
  • General
  • Grand Rounds
  • Hand Surgery
  • Head and Neck Surgery
  • Healthcare Law
  • Hematology
  • Hernia Surgery
  • Hip Surgery
  • History of Surgery and Medicine
  • Hyperbaric Oxygen
  • Infectious Disease
  • Interviews
  • Liver Surgery
  • Medical Eponym Bios
  • Medical Mnemonics
  • Medical News Wire
  • Medical Trivia
  • Medical Words and Abbreviations
  • Musings
  • Nanomedicine
  • Neck Surgery
  • Neurology
  • Nutrition
  • ObGyn Surgery
  • Oncology
  • Orthopedic surgery
  • Pancreas Surgery
  • Pediatric Surgery
  • Pediatrics
  • People
  • Pharmacology
  • Plastic Surgery
  • Pulmonology
  • Rectal Surgery
  • Rheumatology
  • Small Bowel Surgery
  • Spleen Surgery
  • Stomach Surgery
  • Surgery and Medicine Quotations
  • Surgical Procedure Videos
  • Surgpedia
  • Thoracic Surgery
  • Tip of the Day
  • Transplant Surgery
  • Trauma Surgery
  • Uncategorized
  • Urology Surgery
  • USMLE
  • Vascular Surgery

Archives

© 2021 InsideSurgery.comĀ® · All rights reserved.
This material may not be published, broadcast, rewritten, or redistributed without the express written consent of InsideSurgery.com.
This website uses cookies to improve your experience. We'll assume you're ok with this, but you can opt-out if you wish. Cookie settingsACCEPT
Privacy & Cookies Policy

Privacy Overview

This website uses cookies to improve your experience while you navigate through the website. Out of these cookies, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. We also use third-party cookies that help us analyze and understand how you use this website. These cookies will be stored in your browser only with your consent. You also have the option to opt-out of these cookies. But opting out of some of these cookies may have an effect on your browsing experience.
Necessary
Always Enabled

Necessary cookies are absolutely essential for the website to function properly. This category only includes cookies that ensures basic functionalities and security features of the website. These cookies do not store any personal information.

Non-necessary

Any cookies that may not be particularly necessary for the website to function and is used specifically to collect user personal data via analytics, ads, other embedded contents are termed as non-necessary cookies. It is mandatory to procure user consent prior to running these cookies on your website.

SAVE & ACCEPT
Inside Surgery
  • Home
  • Eponyms
  • Abbreviations
  • Terms of Use
  • Privacy Policy
  • Contact