Thymectomy - NYSORA

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Thymectomy

Learning objectives

  • Describe the indications and techniques for thymectomy
  • Manage patients presenting for thymectomy

Definition

  • Thymectomy is the resection of the thymus gland
  • The thymus can enlarge (myasthenia gravis and thymoma) and harbor malignant cells (thymic carcinoma or neuroendocrine tumors)

Indications

  • Most common: Myasthenia gravis and thymoma 
  • Less common: Malignant tumors (thymic carcinoma, neuroendocrine tumors), benign tumors (thymic cysts), ectopic parathyroid glands

Techniques

  • Median Sternotomy
  • Video-Assisted Thoracoscopic Surgery
  • Robotic surgery

Video- and robot-assisted approaches are superior to traditional open approaches

Management

thymectomy, dysphagia, dysarthria, dysphonia, dyspnea, myasthenic crisis, autoimmune, non-steroidal immunosuppressive agents, thyroid, ECG, respiratory, anticholinesterases, glucocorticoids, anticholinergics, steroids, sedation, local, regional, amide, neuraxial, brachial plexus, neuromuscular blocking, rocuronium sugammadex, propofol, remifentanil, analgesia, normothermia, bulbar, immunoglobin, plasma exchange, cholinergic crisis, bradycardia, hypotension, bronchospasm, vomiting, diarrhea, atropine, glycopyrrolate,

Suggested reading

  • Bennett B, Rentea RM. Thymectomy. [Updated 2022 Jul 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK564302/
  • Daum P, Smelt J, Ibrahim IR. Perioperative management of myasthenia gravis. BJA Education. 2021;21(11):414-9.

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