Neurologists and surgeons still debate the role of surgery in the management of myasthenia gravis, an autoimmune disorder of neuromuscular transmission affecting 2 out of every 100,000 people. Further adding to the controversy is the lack of randomized controlled trials comparing surgery, medical therapy, and the natural history of the disease and disagreement among surgeons as to what constitutes the best surgical therapy. Most surgeons agree that improved clinical outcomes correlate with completeness of thymectomy. But increased morbidity associated with increasingly invasive approaches, though aimed at improving outcomes by maximizing resection of thymic tissue, may ultimately deprive many patients of the benefits of surgical therapy owing to the unwillingness of patients and referring neurologists to consider surgery. Less invasive surgical approaches to thymectomy seek to minimize procedural morbidity, hasten recovery, and improve cosmesis while achieving equivalent outcomes by performing as complete a thymectomy as with conventional techniques. A number of minimally invasive approaches for thymectomy have been described, including both left and right thoracoscopic, bilateral alone, and thymectomy combined with a cervical incision. We have adopted and refined a right-sided video-assisted thoracic surgery (VATS) thymectomy as our preferred approach because of the superior exposure and facility with which the operative maneuvers can be performed. This chapter outlines the important technical details, rationale, and lessons learned in the development of our current technique of VATS thymectomy. It also touches briefly on the alternative VATS approaches and concludes with a report of our clinical outcomes.