Myasthenia gravis (MG) is an auto-immune disease associated with abnormal antibodies binding to the acetylcholine receptors at the neuromuscular junction of the skeletal muscle, which causes destruction and modification of the neuromuscular junction. Thymectomy is the preferred standard treatment in younger non-thymoma patients with myasthenia gravis as well as in patients with early stage thymoma. Aim: To assess and find the more suitable and beneficial solution either VATS or trans-sternal thymectomy to manage Myasthenia gravis Methods: The study was conducted in Cardiothoracic Surgery Department, Zagazig University Hospitals in 2022, 36 cases were included as a comprehensive sample. Patients were divided into two groups, one for each of the two treatment modalities; VATS or trans-sternal thymectomy to manage Myasthenia gravis Results: Trans-sternal group showed significant longer hospital stay 5.1 days. Also, pain score in first three days postoperative was significantly higher in trans-sternal group. There were significant differences between the two groups regarding wound infection, post-operative analgesics and length of hospital stay. Patients with VATS had lower pain score, fewer wound infections and less analgesics dosage. VATS exhibited significantly shorter hospital stays. Postoperative follow up showed decrease in anti-myasthenic drugs dose in both groups without statistically significant. In trans-sternal group 3 cases need to plasmapheresis and only two cases in VATS group. Without any case of recurrent along postoperative follow up period. Conclusion:Our data suggest that VATS thymectomy has some advantages over open surgery, including shorter length of hospital stay, less pain, less need of analgesics, less trauma to chest wall, faster healing, fewer post operative complications, earlier return to normal activities and cosmotic satisfaction