The pathophysiological role of the thymus in myasthenia gravis, and th
e mechanism of therapeutic effect of thymectomy, are incompletely unde
rstood. Nevertheless, thymectomy is a valuable treatment modality in s
elected patients with generalised myasthenia gravis. There are several
types of thymectomy operation, but no one operative approach is clear
ly superior to the others. Total removal of the thymus gland is essent
ial. Additional excision of associated mediastinal and cervical tissue
, that may harbor ectopic thymic rests, is a controversial surgical is
sue. Surgeons that advocate thymectomy through small, cosmetically fav
ourable, incisions usually believe that simple removal of the thymus g
land is an adequate operation. Surgeons that emphasise the importance
of removing extrathymic tissue, in addition to the thymus gland, usual
ly favour greater operative exposure through a median sternotomy. To m
inimise operative morbidity, surgery for myasthenia gravis requires a
multidisciplinary (neurology, surgery, anaesthesia) approach to peri-o
perative care.