Thymectomy plays an important role in the treatment of myasthenia gravis, and is one of the most important measures in the treatment of myasthenia gravis. From the initial longitudinal sternotomy and small incision thymectomy to the current minimally invasive surgery (thoracoscopic thymectomy, robot-assisted thymectomy, etc.), both doctors and patients have contributed greatly to the improvement of the surgical approach. 1. Median sternotomy thymectomy After the patient’s bronchial intravenous general compound anesthesia, the skin and subcutaneous are incised sequentially, and the sternum is incised longitudinally with a sternal saw, and the thymus is exposed after propping up the sternum. The thymus gland and the fatty tissue surrounding the thymus gland are separated, and the chest is closed after careful hemostasis. The advantage of this procedure is that the thymus gland and its surrounding fatty tissue can be removed as cleanly as possible under direct vision; the disadvantage is that the surgical incision is large (about 14M), the patient has significant postoperative pain, and the postoperative hospital stay is long, and it is easy to cause infection. 2.Sternal transverse small incision thymectomy After the bronchial intravenous general anesthesia, the patient’s skin and subcutis are incised transversely between the 2nd ribs, the sternum is incised transversely with a sternal saw, the transverse sternum is propped open with a small spreader, the blood vessels of the thymus gland are severed, and the thymus gland and its surrounding fat tissue are separated, and the chest is closed after careful hemostasis. The advantage of this procedure is that the incision is smaller (6-8M long) compared with the traditional longitudinal incision, and the postoperative recovery is faster than the median incision. 3.VATS or robotic-assisted thymectomy After the patient is put under general anesthesia by bronchial vein, about 4M and 1.5M holes are made in the right chest wall between the 2nd and 4th intercostal spaces or 3 small 1M holes are made under the subxiphoid process, and the thymus and the fatty tissue around the thymus are separated in turn, and the chest is closed after careful hemostasis. The advantages of this surgical approach include small incision (about 5M in total), less postoperative pain, faster recovery, shorter hospital stay, and lower incidence of postoperative crises compared with open-heart surgery; a retrospective study of follow-up patients found that VATS can achieve the same clinical efficacy as other surgical approaches in thymectomy for severe myasthenia gravis. With the development of surgical techniques as well as surgical instruments, thymectomy has gradually embarked on the path of minimally invasive treatment from the previous open-chest surgical resection. Many researchers at home and abroad have also compared the clinical efficacy of various surgical modalities in the treatment of myasthenia gravis, and their results found that although the differences in the total efficiency of the various surgical modalities in myasthenia gravis were not significant, the minimally invasive technique was able to reduce the hospital stay and postoperative incisional pain to a greater extent, making the surgical patients more willing to choose the modality they could afford to undergo the surgery. However, minimally invasive surgery does not have the same advantages as open surgery for invasion of surrounding tissues (e.g., blood vessels, nerves, pericardium, etc.). In clinical practice, the surgeon needs to optimize the surgical plan to minimize pain and risk for the patient, taking into account the patient’s specific situation. In exceptional cases, all three surgical approaches are needed to complement each other in the hope of removing as much of the thymic tumor as possible. It should be noted that patients with myasthenia gravis are not cured of the disease after thymus gland removal and still need long-term medication from neurology, which should not be reduced or stopped without authorization to avoid bringing about an aggravation or rebound of the myasthenia gravis condition. In conclusion, myasthenia gravis is a very complex autoimmune disease that requires a combination of medical and surgical treatment.