Video-assisted thoracoscopic surgery (VATS) provides a new approach to thymectomy. From June 1993 to December 1994, we performed a total of eight thymectomies for myasthenia gravis (MG). There were four male and four female patients with ages ranging from 9 to 76 years. Three of the eight patients had associated thymoma. We believe that complete thymectomy was accomplished in all cases by examination of the thymic bed and resected specimen. There was no mortality or intraoperative complications. The median postoperative hospital stay was 5 days (range, 2 to 37 days). One patient required ventilatory support postoperatively. Clinical improvement was observed in all patients after a mean follow-up of 10 months (range, 2 to 21 months). Compared with a comparable historical group of patients with MG who underwent transsternal thymectomy, the VATS group was associated with significantly less analgesic requirement and shortened hospital stay. We conclude that VAT thymectomy is technically feasible and is associated with a favorable postoperative course compared with the transsternal approach. We believe that complete thymectomy can be achieved by this approach. Further investigation with long-term follow-up is needed to further clarify the role of VAT thymectomy in thoracic surgery.