The data of thoracoscopic enlarged thymectomy for myasthenia gravis (MG) in our department and obtaining long-term follow-up were counted and compared with domestic and international literature to analyze the factors affecting the efficacy of myasthenia gravis surgery. Methods A retrospective study was conducted on 47 patients with myasthenia gravis who underwent thoracoscopic surgery from June 2000 to October 2009 at the People’s Hospital of Peking University. Cox proportional risk regression model was applied to analyze factors such as patient gender, age, preoperative course, myasthenia gravis staging, and thymic pathological changes. The χ2 test was performed to compare the efficacy of open-chest myasthenia gravis surgery with that reported in the literature. Results: 47 patients with myasthenia gravis, 20 males and 27 females, aged 14-72 years, mean age 37±13 years, were classified according to the Myasthenia Gravis Foundation of America (MGFA): 18 cases of type I; 15 cases of type IIa; 13 cases of type IIb and 1 case of type IIIa. Postoperative pathology: 24 cases of thymic hyperplasia and 23 cases of thymoma. 2 of the 47 patients were lost to follow-up, and the remaining 45 cases were followed up for a long time, with a follow-up rate of 95.74%. The follow-up period ranged from 16 to 111 months, with a mean of 51 months. According to the MGFA Post-intervention Status, 29 patients (64.4%) achieved complete stable remission (CSR), 8 patients (17.8%) achieved pharmacological remission (PR), 4 patients (8.9%) achieved minimal symptomatic manifestations (MM), 1 patient (2.2%) achieved worsening (W), 2 patients (4.4%) achieved recurrence (E), and 4.4% died (W). (4.4%); death (D of MG) 1 case, accounting for 2.2%. According to statistical analysis, age and MGFA staging were significantly associated with surgical outcome (P<0.05). There was no significant difference in the efficacy of thoracoscopic surgery for myasthenia gravis with different staging. The efficacy of thoracoscopic myasthenia gravis surgery was comparable to that of open-heart surgery. Conclusion The long-term outcome of TV thoracoscopic thymectomy for myasthenia gravis is satisfactory, and there seems to be no significant difference in the outcome of myasthenia gravis combined with thymic hyperplasia or combined with thymoma undergoing thymectomy with enlarged thymus, and there is a significant correlation between age and MGFA staging and prognosis of surgery. The significant features of the data in this group were the high follow-up rate and the long follow-up time. Their findings reaffirm that thoracoscopy is equivalent to open-heart surgery in the treatment of MG and is less invasive, less painful, and significantly reduces the mental and physical burden of patients.