Myasthenia gravis (MG) is an autoimmune neuromuscular disorder characterized by fluctuating muscular weakness. Thymectomy is beneficial for children with generalized MG and acetylcholine receptor antibodies even in the absence of thymoma. However, there is still debate on the timing of thymectomy in terms of patient age and where they are in their disease course. In addition, there are multiple surgical approaches to thymectomy for MG, all with a goal to safely remove as much thymic tissue as possible while avoiding neurovascular structures in the mediastinum. We present the case of a 19 year old female presenting with respiratory failure at age 13 and multiple hospitalizations who was later diagnosed with MG. After years of persistent symptoms on medical therapy she underwent thymectomy. In our video we demonstrate that video assisted thoracoscopic thymectomy can be performed safely and adequately via unilateral thoracoscopy and should be considered even in patients with seronegative MG without thymoma.