Traditionally, thymoma surgery is performed with a longitudinal split sternal incision to remove the tumor and thymus (transverse sternal bilateral open sternal incision is rarely used), and for patients with severe myasthenia gravis, the adipose tissue around the thymus should be cleared at the same time. For huge thymic tumors or invasive thymic tumors with obvious external invasion using a longitudinal split sternal incision is more appropriate and can provide sufficient visual exposure. However, for smaller thymic tumors with less obvious invasion, especially those that are judged to be benign (non-invasive), such a huge incision is undoubtedly more traumatic to the patient, so clinically some surgeons are willing to choose semi-cleft sternal surgery or open sternum on one side to perform thymoma and total thymectomy, which can somewhat reduce the damage to the patient from the open sternal surgery approach. The development of thoracoscopy has provided an additional minimally invasive platform that can replace the trauma of splitting the sternum and intercostal dissection with a minimal cost. Moreover, thoracoscopy can provide good visual field exposure, which can smoothly perform total thymectomy, thymoma resection and peripheral fat clearance, especially for the surgical treatment of non-invasive thymoma, and many people currently advocate thoracoscopic total thymectomy for patients with severe myasthenia gravis to achieve better results. Thoracoscopic total thymectomy is not complicated, and familiarity with the anatomy of thymus and surrounding tissues and organs is the key. The surgical approach is decided according to the location of thymus, and trans-left thoracic surgery can be considered if the main body is located on the left side, while trans-right thoracic surgery can be chosen in more cases to avoid the possibility of aortic occlusion. During surgery, the whole thymus, ipsilateral adipose tissue and some contralateral adipose tissue can be removed completely, and if necessary, the contralateral fat can be cleared with the aid of poking holes in the contralateral thorax. The thymic vein, unnamed meridian and superior vena cava are clearly revealed. Intraoperative observation of whether the tumor envelope is intact and whether it invades the surrounding tissues and organs can help determine whether the tumor is invasive or not, but the accurate judgment depends on the postoperative pathology. Since intraoperative visual observation cannot be fully relied on, most doctors do not recommend simple thymus tumor resection. Surgery is less invasive, with faster recovery and better results, providing patients with a more minimally invasive option. Patients are advised to choose under the guidance of their physicians. However, open-heart surgery is still appropriate for thymoma with severe external invasion.