Thymectomy

Anatomy and Physiology

The thymus is a bilobed lymphoepithelial organ in the superior and anterior mediastinum. In the 3-compartment mediastinal classification scheme, the superior segment is part of the anterior mediastinum, bordered anteriorly by the sternum, posteriorly by the pericardium, inferiorly by the diaphragm, and superiorly by a line connecting the thoracic outlet to the fourth thoracic vertebra. Other structures in the anterior mediastinum include mediastinal fat and lymph nodes. The thymus originates embryologically from the third pharyngeal pouch and grows until puberty. Following this, thymic involution begins, with tissue replaced by fat at approximately 1% to 3% per year. Despite this involution, residual thymic function may persist throughout life. The thymus consists of 2 lobes that can extend superiorly to the thyroid gland, and ectopic thymic tissue may occur, most commonly in anterior mediastinal fat.

The thymus receives its blood supply primarily from the inferior thyroid artery and branches of the internal thoracic arteries, with minor contributions from the pericardiophrenic and intercostal arteries. Venous drainage parallels the arterial supply, with a large posterior vein draining into the left innominate vein. Lymphatic drainage follows the parasternal, tracheobronchial, and brachiocephalic lymph nodes. Posteriorly, the thymus is close to the left brachiocephalic vein and superior vena cava. Structurally, the thymus is enclosed by a fibrous capsule, which extends inward to divide the parenchyma into lobules. Each lobule is composed of an outer cortex and an inner medulla. The cortex is densely packed with immature thymic lymphocytes, or thymocytes, while the medulla contains more mature lymphocytes, thymic epithelial cells, and Hassall corpuscles.[2][3]

Physiologically, the thymus is a critical organ for cellular immunity. Immature lymphocytes from the bone marrow migrate to the thymus, where they undergo maturation and selection to become functional T-cells. Positive selection occurs in the cortex, ensuring thymocytes can recognize self-major histocompatibility complex molecules, while negative selection in the medulla eliminates autoreactive cells to prevent autoimmunity. Through this process, the thymus helps establish self-tolerance and produces cytotoxic and helper T-cells capable of initiating immune responses against pathogens. MG is the most common autoimmune disorder associated with the thymus, caused by autoantibodies to acetylcholine receptors, resulting in muscle fatigue. Thymomas, the most common anterior mediastinal tumors, are often linked to MG, which is characterized by autoantibodies to acetylcholine receptors, resulting in muscle fatigue (with continued contractions), and can also affect ocular, facial, oropharyngeal, and limb muscles.[3]

Thymic involution, a hallmark of immune system aging, is characterized by a progressive reduction in thymic epithelial cells and the replacement of thymic tissue with adipose tissue. This process begins early in life, potentially during the first year, and accelerates after puberty due to increasing levels of steroid hormones, particularly sex hormones. The link between sex hormones and thymic involution was first identified in 1904 when castrated cattle were found to have enlarged thymi. The significant loss of thymic function after puberty correlates with peak hormone production, highlighting the thymus' role in immune aging.[4] Despite involution, residual thymic tissue can persist and contribute to immune responses later in life, emphasizing the thymus' ongoing importance in human physiology.

Indications

Thymectomy, the surgical removal of the thymus gland, is performed to manage a variety of neoplastic and nonneoplastic conditions affecting the thymus and surrounding anterior mediastinal structures. Despite advancements in imaging modalities, the management of anterior mediastinal lesions remains complex due to the diverse range of underlying pathologies.

Neoplastic Indications

• Thymomas
  • Thymomas, the most common anterior mediastinal tumor, is a primary indication for thymectomy. Surgical resection is the preferred treatment for both encapsulated and invasive thymomas. However, concerns about stage progression due to pleural implantation during invasive diagnostic procedures such as core-needle biopsy have led to guidelines favoring upfront surgery when resectable thymoma is strongly suspected.
• Thymic carcinomas
  • These aggressive malignancies often require thymectomy as part of a multimodal treatment strategy, including chemotherapy and radiation.
• Thymic neuroendocrine tumors
  • Rare tumors, such as carcinoid tumors, may necessitate thymectomy to address localized disease and alleviate symptoms.
• Thymic cysts
  • While benign, thymic cysts that are symptomatic, enlarging, or have features suspicious of malignancy are indications for surgical resection.
• Other malignancies
  • Other malignancies, including lymphomas and germ cell tumors, can occur in the anterior mediastinum. These are generally managed medically or with radiation; surgical intervention is typically reserved for diagnostic or palliative purposes.

Nonneoplastic Indications

• MG 
  • Thymectomy is a well-established treatment for MG, particularly in the presence of thymomas. In nonthymomatous MG, thymectomy is indicated for generalized disease refractory to medical management. Evidence supports improved long-term outcomes and reduced medication dependency. Juvenile and ocular MG are additional indications for thymectomy.
• Thymic hyperplasia
  • Significant thymic hyperplasia causing mass effects or complicating associated autoimmune disorders may necessitate surgical resection.
• Ectopic parathyroid glands
  • Rarely, ectopic parathyroid tissue located within the thymus requires excision, particularly in cases of refractory hyperparathyroidism.
• Other autoimmune disorders
  • In rare cases, thymectomy may be considered for autoimmune diseases associated with thymic abnormalities, such as systemic lupus erythematosus or pure red cell aplasia.
• Diagnostic lymphoma biopsy
  • Partial thymectomy is occasionally performed for diagnostic purposes, especially in cases where lymphoma is suspected and tissue diagnosis is required.

Challenges in Diagnosis and Management

Managing anterior mediastinal lesions often balances achieving a definitive diagnosis and minimizing unnecessary surgical interventions. While core-needle biopsy is the gold standard for diagnosing locally advanced or unresectable lesions, it carries risks such as bleeding, pneumothorax, and, in the case of thymomas, pleural implantation that can lead to stage progression. Consequently, the National Comprehensive Cancer Network (NCCN) guidelines recommend tissue diagnosis with core-needle biopsy only for locally advanced or unresectable cases. When resectable thymoma is strongly suspected, the NCCN guidelines and 91% of the European Society of Thoracic Surgeons’ Centers advocate upfront surgery without biopsy.[5] This approach has contributed to a high rate (22%–68%) of nontherapeutic thymectomies, involving cases of asymptomatic benign lesions such as thymic cysts or thymic hyperplasia (without MG) and certain malignant lesions like mediastinal lymphomas that do not necessitate surgical intervention.[6]

Minimally Invasive Approaches

Minimally invasive techniques, such as video-assisted thoracoscopic surgery and robotic-assisted thymectomy, have expanded the surgical options for thymectomy. These approaches, with indications similar to open procedures, are associated with reduced morbidity, shorter hospital stays, and faster recovery times, making them an increasingly preferred option in appropriate cases.[7]

Contraindications

Thymectomy is a critical intervention for several conditions, including thymomas and MG. However, certain clinical and technical factors can make the procedure inadvisable or necessitate modifications to the surgical approach. These contraindications can be categorized into general surgical risks, specific concerns for thymectomy, and factors related to minimally invasive approaches.

General Surgical Contraindications

• Inability to tolerate general anesthesia
  • Patients with severe cardiopulmonary disease or advanced frailty may not be able to endure the physiological demands of general anesthesia.
• Hemodynamic instability
  • Patients who are acutely unstable due to conditions such as sepsis, uncontrolled arrhythmias, or profound hypotension are not candidates for elective thymectomy.
• Coagulopathy
  • Active bleeding disorders or anticoagulation that cannot be safely reversed increase the risk of intraoperative and postoperative bleeding, making surgery contraindicated until these issues are addressed.

Contraindications Specific to Thymectomy

• Advanced invasion of great vessels
  • In cases where a thymic tumor has extensively invaded the great vessels, minimally invasive techniques are not suitable, and complete resection may be impossible. Such cases often require alternative approaches, including palliative care or primary chemotherapy.
• Advanced thymic carcinoma with distant metastases
  • For metastatic thymic carcinoma, the potential benefit of thymectomy is minimal, as the disease is unlikely to be curable with surgery. Systemic therapy is prioritized in these cases.
• Nonthymomatous MG with well-controlled symptoms
  • Patients whose MG symptoms are effectively managed with medical therapy may not benefit significantly from thymectomy, especially in nonthymomatous cases.
• Pregnancy
  • While not an absolute contraindication, thymectomy is generally deferred during pregnancy unless urgently indicated, such as in rapidly growing thymomas causing compressive symptoms.
• Chemotherapy exacerbating MG symptoms
  • In cases of advanced, nonmetastatic thymoma, chemotherapy may be required to reduce tumor size and facilitate surgical resection. However, there are reports that chemotherapy can worsen MG symptoms, complicating perioperative management.[8]

Minimally Invasive Thymectomy-Specific Contraindications

• Invasion of the great vessels
  • Extensive tumor invasion into critical structures like the superior vena cava or pulmonary arteries necessitates conversion to an open surgical approach, such as median sternotomy.
• Inability to tolerate single-lung ventilation
  • For minimally invasive approaches, single-lung ventilation is often required to optimize visualization and access to the mediastinum. Patients unable to tolerate this may require alternative methods, such as sternotomy or transcervical approaches.[7]
• Prior thoracic surgery or radiation
  • Extensive adhesions or scarring from previous surgeries or radiation can make minimally invasive approaches technically challenging or unsafe.

Relative Contraindications

• Nonsurgical lesions
  • Thymic cysts, lymphomas, and other anterior mediastinal masses often do not require surgical management. Misdiagnosis may lead to unnecessary thymectomy in such cases.
• Inadequate preoperative stabilization
  • Patients with severe MG symptoms, such as bulbar weakness or respiratory failure, should undergo preoperative optimization with plasmapheresis or intravenous immunoglobulin before considering surgery.
• Ectopic thymic tissue
  • The presence of thymic tissue outside the typical anatomical location, such as within the neck or mediastinal fat, may complicate surgical planning, particularly in minimally invasive approaches.

Equipment

Equipment required in the open approach (median sternotomy, transcervical approach) includes:

• Sternal saw
• Sternal retractor
• Energy devices (electrocautery, bipolar, ultrasonic)
• Staplers
• Sternal wires for closure

Equipment used in a thymectomy done via VATS includes:

• Surgical hooks to elevate the sternum
• 30-degree camera
• Electrocautery or ultrasonic energy devices
• Standard endoscopic instruments
• Endoscopic staplers
• An endo catch bag [9]

Robotic-assisted thymectomy needs the following equipment:

• DaVinci surgical system 
• A high-definition stereoscopic camera
• Endoscopic graspers
• Needle drivers
• Staplers
• Endocatch bag
• Electrocautery devices [7]

Personnel

Personnel required in the open approach (median sternotomy, transcervical approach) include:

• Primary surgeon
• Anesthesiologist
• Nurse anesthetist
• Surgical technologist

Personnel needed in a thymectomy done via video-assisted thoracoscopic surgery include:

• Primary surgeon
• Anesthesiologist
• Nurse anesthetist
• Surgical technologist

Robotic-assisted thymectomy needs the following personnel:

• Primary surgeon
• Anesthesiologist
• Nurse anesthetist
• Surgical technologist (trained in robotic surgery)
• This surgical system also requires a surgical assistant to help transfer instruments at the bedside.

Preparation

Preparation for thymectomy involves a thorough and multidisciplinary approach to ensure optimal patient outcomes and safe surgical intervention. The preoperative evaluation includes a comprehensive clinical assessment, imaging studies, and disease-specific considerations, particularly for conditions like MG and thymic tumors. A detailed history and physical examination are essential to identify symptoms associated with anterior mediastinal lesions and to assess for paraneoplastic syndromes such as MG or lymphoma. Laboratory tests, including a complete blood count and tumor markers (eg, alpha-fetoprotein, beta-human chorionic gonadotropin, and lactate dehydrogenase), help refine the differential diagnosis.

Advanced imaging, including computed tomography (CT) with intravenous contrast, magnetic resonance imaging (Mri), and positron emission tomography (PET)–CT, is crucial for evaluating tumor location, size, and involvement of surrounding structures, such as blood vessels (eg, the innominate vein).[7] These imaging modalities also help distinguish between thymic hyperplasia, thymomas, lymphomas, and cysts. MRI with chemical shift and CT show high sensitivity and specificity in distinguishing thymomas from thymic hyperplasia or cysts but are less effective for differentiating thymomas from lymphomas. PET–CT has also been explored for this purpose, though results have been inconsistent.[10] MRI and PET-CT scans may also benefit from differentiating between thymic hyperplasia and thymoma and identifying nodal or distant metastases. 

True thymic hyperplasia is often asymptomatic and typically identified incidentally during imaging performed for unrelated reasons. However, in rare instances, massive thymic enlargement can lead to acute symptoms. Radiographically, true thymic hyperplasia and thymic lymphoid hyperplasia appear as diffuse, symmetrical thymic enlargement, making differentiation challenging based on imaging alone. Some study results suggest that thymic lymphoid hyperplasia may show greater soft tissue attenuation on CT scans. While most imaging findings suggest benign processes, cases with extension into the superior mediastinum can mimic malignancy. Even a uniform increase in soft tissue density within the mediastinum can prompt a differential diagnosis that includes thymoma, lymphoma, teratoma, thymolipoma, and other mediastinal malignancies.[11] A retrospective review at Massachusetts General Hospital revealed that 17.1% of nontherapeutic thymectomies performed for suspected thymoma were ultimately attributed to thymic hyperplasia.[12]

In cases of MG, preoperative stabilization is critical to prevent a myasthenic crisis, including anticholinesterase inhibitors, plasmapheresis, and intravenous immunoglobulin. Preoperative evaluation should also include pulmonary and cardiac function tests. Even if pulmonary resection is not indicated, there is a sizeable respiratory burden following median sternotomy or at baseline from MG. Therefore, pulmonary function tests, an electrocardiogram, and a cardiac stress test may all be indicated depending on the patient's comorbidities.[13]

Surgery is preferred for thymomas and thymic carcinomas unless the lesion is locally advanced or unresectable, where a core-needle biopsy may be considered. The frequent occurrence of unnecessary thymectomies may stem from the misdiagnosis of thymic cysts, thymic hyperplasia, and lymphoma as thymomas on chest CT. Each of these conditions exhibits distinct characteristics in CT imaging. A thorough understanding of these distinguishing features can aid in reducing the rate of nontherapeutic thymectomies. By accurately identifying thymoma, lymphoma, thymic hyperplasia, and thymic cysts through imaging, clinicians can guide more patients toward alternative, less invasive diagnostic methods, potentially avoiding surgery and lowering unnecessary thymectomy rates.[12]

In the pediatric population, most chest masses are located within the mediastinum. These masses may arise from congenital anomalies, infections, or benign and malignant neoplasms.[14] Many children with mediastinal masses are asymptomatic, with the mass often discovered incidentally on chest radiographs. Diagnostic evaluation typically begins with determining the mass's anatomical location, guided by the Felson method using lateral chest radiography. According to this method, a line drawn from the diaphragm to the thoracic inlet, positioned posterior to the heart and anterior to the trachea, separates the anterior and middle mediastinal compartments. Another line, situated 1 cm behind the anterior margin of the vertebral bodies, delineates the middle and posterior compartments.[15]

While this method remains useful, particularly in pediatric cases where frontal and lateral radiographs are commonly the initial imaging studies, cross-sectional imaging such as CT or MRI provides a more detailed and specific differential diagnosis. In children younger than 5, the normal thymus typically appears in the prevascular mediastinum with convex borders and a somewhat quadrilateral shape without exerting pressure on mediastinal structures. After age 5, the thymus adopts a triangular shape, and its borders become concave following puberty. On imaging, the thymus presents as a homogeneous structure with uniform enhancement. On CT, it displays soft-tissue attenuation, while on MRI, it appears hyperintense compared to skeletal muscle on T1-weighted images and exhibits signal intensity similar to fat on T2-weighted images.[16][17]

To address this diagnostic challenge and reduce unnecessary thymectomies, Wang et al developed a predictive model that utilizes CT and PET–CT parameters along with clinical and demographic data. Based on age and maximum standardized uptake value (SUVmax), their nomogram offers a tool for distinguishing between mediastinal lymphomas and thymomas. According to their findings, anterior mediastinal masses in younger patients with higher SUVmax on PET–CT are more likely to represent lymphoma than thymoma.[18]

Technique or Treatment

The recommended preoperative measures include placing a Foley catheter to monitor urinary output, a thoracic epidural for pain control, and an arterial line for continuous hemodynamic monitoring. The patient is intubated with a left-sided double-lumen endotracheal tube to ensure proper placement, confirmed using bronchoscopy.

The choice of approach for thymectomy depends on patient-specific factors such as tumor size, location, and invasiveness. Transsternal thymectomy remains the standard for large or invasive thymomas. In contrast, transcervical and minimally invasive approaches like video-assisted thoracoscopic surgery (VATS) and robotic-assisted thymectomy are preferred for smaller tumors, thymic hyperplasia, and MG. Each technique follows a step-by-step process to ensure complete thymic resection while minimizing complications and optimizing patient outcomes.

• Median Sternotomy 
• The patient's positioning is supine.
• The bilateral chest, including the sternum, is prepped and draped.
• The surgery begins with a vertical median sternotomy, which can be either a partial or a complete incision, depending on the resection extent. The mediastinal pleura is then incised to access the anterior mediastinum. Borders of dissection extend superiorly to the thoracic inlet, specifically the innominate vein, inferiorly to the diaphragm, and laterally to the phrenic nerves. All thymic tissue is resected, including its associated mediastinal fat surrounding tissue or organs, which may also need to be removed if involved in the disease process. Next, mediastinal drains, including chest tubes, are placed into the pleural space. The sternum is then closed with sternal wires and primary closure.[19]
• Transcervical 
  • The patient's positioning is supine with a neck roll.
  • The patient is prepped and draped from the chin to the upper abdomen, including the bilateral chest.
  • A transverse incision is made in the lower neck at the suprasternal notch. The strap muscles are retracted laterally to expose the thymus, which is mobilized through the cervical incision. The upper thymic poles and veins are identified, clipped, and divided. The thymus is then gently dissected inferiorly toward the mediastinum, with limited retraction allowing for partial mobilization of the lower thymus. The gland is carefully removed through the cervical incision, and the procedure is completed by closing the strap muscles and neck incision in layers.
• VATS 
• The patient's positioning is supine.
• The bilateral chest, including the sternum, is prepped and draped.
• The VATS procedure is usually approached via a right or left thoracoscopic method (a right-sided approach may provide better exposure). The patient is placed in the right lateral 30-degree decubitus position. Selective lung ventilation may aid in exposure to the apex of the thoracic cavity (valve trocars can be used instead to allow low-pressure CO₂ insufflation into the hemithorax). The mediastinum is accessed through the right chest; all 3 trocars are placed along the submammary fold. Ports should be triangulated to improve working conditions. The 2 working ports are placed anteriorly or posteriorly to the scope port. A combination of hook cautery and scissors is utilized to incise the pleura anterior to the phrenic nerve. The phrenic nerve is the lateral border of the thymus's left lobe. Dissection of the thymus begins from the diaphragm inferiorly to the inferior portion of the thyroid superiorly and is extended laterally to the border of the phrenic nerves. Dissection is continued on the left side up to the right phrenic nerve. Once complete, a chest tube is placed on the right side, and the attention is turned towards the contralateral side. If visualization is difficult, ports can also be placed in the contralateral chest; ports are positioned similarly, and dissection continues until the thymus is free. The thymic tissue is placed in an EndoCatch bag (Covidien, Mansfield, Massachusetts), and another chest tube is placed on the right side. Each lung is allowed to reexpand under direct vision, and the procedure is completed.[20]
• Robotic-Assisted
• The patient's positioning is supine, with the right side elevated using folded blankets or a gel pad.
• The bilateral chest, including the sternum, is prepped and draped.
• The ports are positioned as such: the camera port is in the fifth intercostal space anterior/midaxillary line, the port for the left robotic arm is in the third intercostal space in the midaxillary line, the port for the right robotic arm is parasternal in the fifth intercostal space, and an assistant port is placed per surgeon preference.[21]
• Once ports are placed, the surgeon assumes control of the robot console. Any chest wall, pleura, or lung abnormalities are addressed and biopsied if necessary. Next, lysis of any adhesions from prior surgeries is performed. Once adequate visualization is achieved, dissection of the thymus begins, starting at the inferior border. This continues anteriorly to the sternal edge and then superiorly and laterally. Once to the superior edge, the right superior thymus horn is dissected free. This is followed by dissection of the left superior horn until the entire thymus has been freed. The thymus is placed in an Endocatch bag and removed from the thorax via the assistant port. Hemostasis is confirmed from the underlying and surrounding tissue and the port sites. The right lung is reinflated under direct vision, and a chest tube is placed. Port sites are closed according to the surgeon's preference.[7] The bilateral approach has been found to reduce injury to the bilateral phrenic nerves compared to a unilateral VATS approach.[22]

Special considerations during thymectomy include optimizing exposure and access to the thymus based on patient anatomy. Trocar placement should be adjusted to accommodate anatomical variations, ensuring adequate visualization and maneuverability. Single-lung ventilation is often utilized to improve the exposure of the mediastinum by collapsing the lung on the operative side. A right-sided approach is generally preferred as it offers improved access to the thoracic inlet and better visualization of the thymic veins as they drain into the innominate vein, facilitating safer and more efficient dissection.

Complications

Complications that may arise during a thymectomy include bleeding and damage to surrounding structures, which are among the most significant risks. Bleeding may result from small thymic veins or larger vessels such as the innominate vein, and injury to Keynes great vein, the largest thymic vein originating from the left brachiocephalic vein, can lead to massive hemorrhage. In such cases, conversion from a minimally invasive approach to an open median sternotomy may become necessary. Pneumothorax or persistent air leaks are other possible complications that may arise in the postoperative period, potentially requiring prolonged tube thoracostomy for management.

Chylothorax can occur due to inadvertent damage to underlying lymphatic tissue, particularly near the thymus poles. Pericardial injury, as well as injury to the heart or the closely associated phrenic nerves, can also occur during dissection. Damage to the phrenic nerve may result in postoperative diaphragmatic dysfunction, leading to respiratory compromise. Additionally, incomplete resection of the thymus during thymectomy can lead to persistent symptoms in patients with MG or recurrence of thymoma. Ensuring meticulous surgical dissection is critical to avoiding these complications and achieving optimal outcomes.  

Clinical Significance

Thymectomy holds significant clinical importance, particularly in managing conditions such as thymoma, MG, and other thymic pathologies. The procedure can be performed using several techniques, from traditional open approaches to minimally invasive ones. Historically, the gold standard for thymectomy involved a median sternotomy, which provides excellent exposure of the anterior mediastinum and surrounding structures. However, recent advancements in minimally invasive approaches, such as VATS and robotic-assisted thymectomy, have increasingly been adopted due to their numerous advantages.

Robotic-assisted thymectomy has demonstrated several key benefits over open sternotomy, including lower operative blood loss, reduced rates of postoperative complications, and shorter hospital stays. Furthermore, study results have shown that robotic thymectomy achieves comparable or superior oncologic outcomes, with high complete resection rates and negative margins.[23][20] Similar advantages have been observed with VATS, where outcomes such as perioperative morbidity, recovery time, and oncologic efficacy closely parallel those seen in robotic-assisted thymectomy.[24] Notably, there is no significant difference between VATS and robotic-assisted thymectomy regarding clinical outcomes, although the robotic approach may offer enhanced dexterity and visualization for complex resections.

These minimally invasive techniques have revolutionized thymectomy by improving patient recovery and reducing surgical trauma, particularly in patients with early-stage thymoma and nonthymomatous MG. Minimally invasive approaches are now preferred in many centers for their ability to minimize complications while maintaining oncologic integrity. However, patient-specific factors, such as tumor size, anatomical challenges, and surgeon expertise, continue to influence the choice of surgical technique. Ultimately, the evolution of thymectomy techniques underscores the importance of individualized surgical planning to optimize outcomes for patients with thymic pathologies.

Enhancing Healthcare Team Outcomes

Successful thymectomy requires a multidisciplinary, interprofessional approach to optimize patient-centered care, outcomes, and safety. Clinicians, including surgeons, anesthesiologists, and medical specialists (eg, neurologists for myasthenia gravis), must coordinate preoperative planning, operative strategy, and postoperative management. Surgeons must possess expertise in open and minimally invasive techniques, adapting their approach based on the patient's anatomy and pathology. Advanced clinicians and nurses play critical roles in preoperative education, perioperative monitoring, and postoperative care, including identifying complications such as bleeding, pneumothorax, or myasthenic crisis. Anesthesiologists ensure appropriate airway management, such as single-lung ventilation, and address intraoperative hemodynamic stability, which is particularly important when dealing with vascular structures like the innominate vein.

Pharmacists contribute by managing medications, particularly for patients with myasthenia gravis, ensuring anticholinesterase therapy and immunomodulatory treatments are optimized preoperatively and tapered postoperatively to prevent a crisis. Effective interprofessional communication is essential for seamless care coordination, especially in complex cases involving comorbidities or advanced thymic pathologies. Daily team rounds, standardized handoffs, and clear role delineation ensure timely identification and management of complications while enhancing patient safety and recovery. Collaborative efforts between all healthcare professionals improve team performance and enhance patient outcomes by fostering a cohesive approach to care, addressing the surgical and medical needs of patients undergoing thymectomy.