The ideal outcome for thymectomy in MG by any approach is complete remission. This goal is realized when there is complete resolution of symptoms, enabling discontinuation of all medication. However, there remains a cohort of patients that experiences substantial reduction in symptoms after thymectomy but never achieves complete remission. There is a considerable controversy concerning the extent of thymectomy that is required to induce remission. Masaoka and colleagues performed detailed anatomic studies of the distribution of thymic tissue within the anterior mediastinum and discovered a high prevalence of ectopic thymic tissue.5 Jaretzki and colleagues confirmed this observation by noting a prevalence of ectopic thymus, either microscopic or macroscopic, in the neck in 32% and in the mediastinum in 98% of specimens resected by their technique of transcervical-transsternal maximum thymectomy.6 Unfortunately, the role of ectopic thymic deposits in the persistence of symptoms after thymectomy for MG is unknown, although the topic has fueled heated debates. Opponents of the extended transcervical approach argue that residual extracapsular rests of thymus lead to a failure of remission and suggest that maximal thymectomy should be performed in all patients with MG. Justification for this view exists in sporadic cases in which transcervical thymectomy was performed, symptoms persisted, and on transsternal exploration, residual thymus was identified and removed.7,8 However, if 98% of patients have ectopic mediastinal thymic deposits and these are missed by the transcervical approach, the procedure should yield terrible outcomes, which is not the case. In fact, complete remission rates among recipients of the transcervical approach, transsternal approach, transsternal-transcervical approach, and thoracoscopic approach appear to be equivalent (Table 134-1).