Editing Thymectomy

{{Short description|Surgical removal of the thymus}}
{{Infobox medical intervention |
  Name        = Thymectomy |
  Image       = |
  Caption     = |
  ICD10       = |
  ICD9        = {{ICD9proc|07.8}} |
  MeshID      = D013934 |
  OtherCodes  = |
}}
[[File:AfterThymectomy.JPG | thumb | 220x124px | right]]
A '''thymectomy''' is an operation to remove the [[thymus]]. It usually results in remission of [[myasthenia gravis]] with the help of medication including [[steroids]]. However, this remission may not be permanent. Thymectomy is indicated when [[thymoma]] are present in the thymus. Anecdotal evidence suggests MG patients with no evidence of thymoma may still benefit from thymectomy.<ref>{{Cite journal |last1=Cea |first1=Gabriel |last2=Benatar |first2=Michael |last3=Verdugo |first3=Renato J |last4=Salinas |first4=Rodrigo A |date=2013-10-14 |editor-last=Cochrane Neuromuscular Group |title=Thymectomy for non-thymomatous myasthenia gravis |url=https://doi.wiley.com/10.1002/14651858.CD008111.pub2 |journal=Cochrane Database of Systematic Reviews |issue=10 |pages=CD008111 |language=en |doi=10.1002/14651858.CD008111.pub2|pmid=24122674 |url-access=subscription }}</ref>

==Surgical approaches==
There are a number of surgical approaches to the removal of the thymus gland: transternal (through the [[Sternum|breast bone]]), transcervical (through a small neck incision), and transthoracic (through one or both sides of the chest).<ref>{{Cite web |title=Thoracic Surgery – Information for patients: Having a thymectomy procedure |url=https://www.uclh.nhs.uk/patients-and-visitors/patient-information-pages/thoracic-surgery-information-patients-having-thymectomy-procedure |access-date=2024-09-19 |website=University College London Hospitals NHS Foundation Trust |language=en}}</ref>
* The transternal approach is most common and uses the same length-wise incision through the sternum (breast bone) used for most open-heart surgery. It is espoused by surgeons such as Alfred Jaretzki and is the most commonly performed procedure due to its relative simplicity.
* The transcervical approach is a less invasive procedure that allows for removal of the entire thymus gland through a small neck incision. 

There has been no difference in success in symptom improvement between the transsternal approach and the minimally invasive transcervical approach.<ref name=Calhoun_1999>{{cite journal | vauthors = Calhoun RF, Ritter JH, Guthrie TJ, Pestronk A, Meyers BF, Patterson GA, Pohl MS, Cooper JD | display-authors = 6 | title = Results of transcervical thymectomy for myasthenia gravis in 100 consecutive patients | journal = Annals of Surgery | volume = 230 | issue = 4 | pages = 555–9; discussion 559–61 | date = October 1999 | pmid = 10522725 | pmc = 1420904 | doi = 10.1097/00000658-199910000-00011 }}</ref>

Video-assisted approaches, such as [[thoracoscopic surgery]], are increasingly prescribed since the less invasive nature of the procedure strikes a balance with the lack of actual clinical evidence supporting thymectomy in non-thymomal cases.<ref>{{cite journal | vauthors = Ng CS, Wan IY, Yim AP | title = Video-assisted thoracic surgery thymectomy: the better approach | journal = The Annals of Thoracic Surgery | volume = 89 | issue = 6 | pages = S2135-41 | date = June 2010 | pmid = 20493997 | doi = 10.1016/j.athoracsur.2010.02.112 | doi-access = free }}</ref>

==Impact of thymic loss==
Thymectomy is a treatment for [[myasthenia gravis]], a neuromuscular disease.<ref>{{cite web|url=https://my.clevelandclinic.org/health/treatments/17555-thymectomy-for-myasthenia-gravis| title=Thymectomy for Myasthenia Gravis| website=Cleveland Clinic| access-date=14 September 2020| date=14 May 2019}}</ref> For about 60% of people with myasthenia gravis, thymectomy significantly improves their symptoms of muscle weakness. In about 30% of cases, thymectomy results in permanent remission of myasthenia gravis, negating the need for any additional medication. Improvements in condition as a result of thymectomy are often delayed, typically occurring one or two years after the surgical procedure, though could be as late as five years. In some people, thymectomy does not alleviate any symptoms of myasthenia gravis.<ref>{{cite web|url=https://www.myaware.org/thymectomy-information-sheet| title=Thymectomy information| website=Myaware| date=4 March 2020| access-date=14 September 2020}}</ref>

Experiments involving thymectomy in newborn mice showed that it unexpectedly resulted in wasting disease when performed before the mouse was three days old. This is because the thymus is the site where [[T cell]]s are generated. Removal of the thymus resulted in [[autoimmunity]], in which the immune cells attack the organism's own healthy cells and tissues.<ref>{{Cite journal| vauthors = Plitas G, Rudensky AY |date=2020-03-09|title=Regulatory T Cells in Cancer |journal=Annual Review of Cancer Biology|language=en|volume=4|issue=1|pages=459–477|doi=10.1146/annurev-cancerbio-030419-033428 |doi-access=free}}</ref>

Those who have had their thymus removed should not receive the Yellow Fever vaccine.<ref>{{cite web|title=Vaccination-Yellow fever|url=https://www.nhs.uk/conditions/yellow-fever/vaccination|access-date=4 March 2021|website=NHS|date=23 October 2017}}</ref><ref>{{Cite journal|last=Eidex|first=Rachel Barwick|date=2004-09-11|title=History of thymoma and yellow fever vaccination|url=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(04)17017-7/abstract|journal=The Lancet|language=English|volume=364|issue=9438|pages=936|doi=10.1016/S0140-6736(04)17017-7|issn=0140-6736|pmid=15364184|s2cid=54408259|url-access=subscription}}</ref>

== See also ==
* [[List of surgeries by type]]

== References ==
{{Scholia|topic}}
{{reflist}}

{{Lymphatic organ procedures}}
{{Endocrine system intervention}}

[[Category:Surgical removal procedures]]
[[Category:Lymphatic organ surgery]]