Aim. In most cases, myasthenia gravis and thymoma requires complete removal of the thymus gland and resection of the pericardial fatty tissue. There is some debate however, over which surgical approach is best for thymectomy. Also the influence of the technique of thymectomy on results in the treatment of myasthenia gravis remains controversial. Methods. Results of 20 basic trans-sternal thymectomies and 18 video-assisted thymectomies were compared, during a period of 10 years, from 2002 to 2012. Data on patient characteristics, morbidity, recurrence, and survival were collected. The primary endpoint studied was overall survival. Results. Thirty-eight patients underwent either trans-sternal (N.=20) or video-assisted (N.=18) thymectomy. Patient demographics and the incidence of myasthenia gravis were similar between groups. There were no intraoperative complications or conversions to open surgery in the video-assisted group. Intraoperative blood loss was significantly higher in the trans-sternal group (135.62 vs. 52.18 mL, P=0.01). There were 9 postoperative complications and 1 postoperative death in the trans-sternal group and 1 postoperative complication in the video-assisted group (P=0.001). Hospital length of stay was 7 days (range 4-38 days) in the trans-sternal group and 3 day (range 2-9 days) in the video-assisted group (P=0.002). The median followup was 36 months. No significant differences were found in the estimated recurrence-free and overall 5-year survival rates (respectively 78-100%) between the 2 groups. Conclusion. Video-assisted resection of thymoma appears safe and feasible and was associated with a shorter hospital stay. The oncologic outcomes were comparable in the open and Video-assisted groups during intermediate-term follow-up. Additional follow-up is required to evaluate the long-term results of thoracoscopic thymectomy for thymomas.