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{{Short description|Surgical removal of the thymus}} |
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{{Interventions infobox | |
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{{Infobox medical intervention | |
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Name = |
Name = Thymectomy | |
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Image = | |
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Caption = | |
Caption = | |
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ICD10 = | |
ICD10 = | |
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ICD9 = 07.8 | |
ICD9 = {{ICD9proc|07.8}} | |
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MeshID = D013934 | |
MeshID = D013934 | |
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OtherCodes = | |
OtherCodes = | |
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[[File:AfterThymectomy.JPG | thumb | 220x124px | right]] |
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A '''thymectomy''' is an operation to remove the [[thymus gland]]. It usually results in remission of [[myasthenia gravis]] with the help of medication including [[steroids]]. However, this remission may not be permanent. |
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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 }}</ref> |
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==Surgical approaches== |
==Surgical approaches== |
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There are a number of |
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> |
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* The transcervical approach is a less invasive procedure that allows for removal of the entire thymus gland through a small neck incision. |
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| ⚫ | 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> |
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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> |
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* The transcervical approach is a less invasive procedure that allows for removal of the entire thymus gland through a small neck incision. It has been popularized by Joel Cooper. Because of its increased technical demands, it is performed by only a relative few surgeons in North America: Joel Cooper (University of Pennsylvania; Philadelphia, Pennsylvania), Bryan Meyers (Washington University; St. Louis, Missouri), Stephen Cassivi (Mayo Clinic; Rochester, Minnesota), Sudhir Sundaresan (University of Ottawa; Ottawa, Canada), Shaf Keshavjee (University of Toronto; Toronto, Canada). |
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==Impact of thymic loss== |
==Impact of thymic loss== |
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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> |
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A '''thymectomy''' is mainly carried out in an '''adult'''. This is because the thymus loses most of its functional capacity after '''adolescence''', but does retain a small portion of its function during adulthood. This is shown in the decreasing size of the thymus with increasing age after adolescence. |
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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> |
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The role of the thymus prior to adolescence is to educate [[T-cells]] to a specific response where they then populate the [[lymphoid organs]], for storage until needed. Removal of the thymus as an adult has little immediate effect on the immune system as its role has been completed. |
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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}}</ref> |
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Thymic hypoplasia as may be seen in [[DiGeorge Syndrome]] results in no T-cell education, and therefore a severe compromise in T [[cell mediated]] and [[humoral responses]]. |
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== See also == |
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* [[List of surgeries by type]] |
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== References == |
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{{Scholia|topic}} |
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{{reflist}} |
{{reflist}} |
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{{Lymphatic organ procedures}} |
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{{Endocrine system intervention}} |
{{Endocrine system intervention}} |
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{{Surgery-stub}} |
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[[Category:Surgical removal procedures]] |
[[Category:Surgical removal procedures]] |
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[[Category:Lymphatic organ surgery]] |
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[[ca:Timectomia]] |
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[[fr:Thymectomie]] |
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[[pt:Timectomia]] |
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Latest revision as of 22:31, 29 September 2024
| Thymectomy | |
|---|---|
| ICD-9-CM | 07.8 |
| MeSH | D013934 |
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.[1]
Surgical approaches
[edit]There are a number of surgical approaches to the removal of the thymus gland: transternal (through the breast bone), transcervical (through a small neck incision), and transthoracic (through one or both sides of the chest).[2]
- 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.[3]
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.[4]
Impact of thymic loss
[edit]Thymectomy is a treatment for myasthenia gravis, a neuromuscular disease.[5] 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.[6]
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 cells are generated. Removal of the thymus resulted in autoimmunity, in which the immune cells attack the organism's own healthy cells and tissues.[7]
Those who have had their thymus removed should not receive the Yellow Fever vaccine.[8][9]
See also
[edit]References
[edit]
Scholia has a topic profile for Thymectomy.
- ^ Cea, Gabriel; Benatar, Michael; Verdugo, Renato J; Salinas, Rodrigo A (2013-10-14). Cochrane Neuromuscular Group (ed.). "Thymectomy for non-thymomatous myasthenia gravis". Cochrane Database of Systematic Reviews (10): CD008111. doi:10.1002/14651858.CD008111.pub2. PMID 24122674.
- ^ "Thoracic Surgery – Information for patients: Having a thymectomy procedure". University College London Hospitals NHS Foundation Trust. Retrieved 2024-09-19.
- ^ Calhoun RF, Ritter JH, Guthrie TJ, Pestronk A, Meyers BF, Patterson GA, et al. (October 1999). "Results of transcervical thymectomy for myasthenia gravis in 100 consecutive patients". Annals of Surgery. 230 (4): 555–9, discussion 559–61. doi:10.1097/00000658-199910000-00011. PMC 1420904. PMID 10522725.
- ^ Ng CS, Wan IY, Yim AP (June 2010). "Video-assisted thoracic surgery thymectomy: the better approach". The Annals of Thoracic Surgery. 89 (6): S2135-41. doi:10.1016/j.athoracsur.2010.02.112. PMID 20493997.
- ^ "Thymectomy for Myasthenia Gravis". Cleveland Clinic. 14 May 2019. Retrieved 14 September 2020.
- ^ "Thymectomy information". Myaware. 4 March 2020. Retrieved 14 September 2020.
- ^ Plitas G, Rudensky AY (2020-03-09). "Regulatory T Cells in Cancer". Annual Review of Cancer Biology. 4 (1): 459–477. doi:10.1146/annurev-cancerbio-030419-033428.
- ^ "Vaccination-Yellow fever". NHS. 23 October 2017. Retrieved 4 March 2021.
- ^ Eidex, Rachel Barwick (2004-09-11). "History of thymoma and yellow fever vaccination". The Lancet. 364 (9438): 936. doi:10.1016/S0140-6736(04)17017-7. ISSN 0140-6736. PMID 15364184. S2CID 54408259.