Objective To compare the short term and long term efficacy of VATS thymectomy (Video-assisted thoracoscopic, VATS) and trans-sternal thymectomy for treatment of myasthenia gravis. Methods We retrospectively reviewed 53 patients with non-thymomatous Myasthenia gravis. 38 cases underwent VATS thymectomy, 15 cases underwent trans-sternal thymectomy. All patients were followed up for more than 3 year. Results There was no serious complication and perioperative death in the whole group. One case of postoperative neurological crisis was found in the VATS group. Compared with the thoracotomy group, VATS group had few amount of blood loss, (88.1±34.1) ml Vs (352.5±97.0)ml, the difference between the two groups was significant (P<0.001), shorter postoperative stay in hospital (6.8±2.0) days Vs (9.5±3.7)days, there is significantly different between two groups (P<0.001), there is no significantly difference in operating time. In VATS group, the mean follow-up was 48.3 (38-98) months. The partial remission rate was 94.7%, and the complete remission rate was 63.1%, which was not significantly different from that in thoracotomy group (80.0%, 13.3%) (P>0.05). Conclusion VATS thymetomy has a better perioperative effect than thoracotomy thymetomy, and the long-term efficacy is comparable. Standard operation is the key to ensuring the quality of surgery