This is a case of a pediatric video-assisted thoracoscopic thymectomy for juvenile myasthenia gravis. The patient is a 7-year-old female with myasthenia gravis refractory to medical management. Patient continued to present with ptosis, eyelid drooping, dysarthria, and repeated hospitalizations for generalized muscle weakness requiring steroids and IVIG therapy. A preoperative CT was negative for thymoma. A VATS thymectomy was then planned. The right thorax was entered using the Optiview technique after left lung isolation ventilation was achieved. The anterior mediastinal tissue containing the thymic tissue was dissected first along the right phrenic nerve. The thymic tissue was then dissected down from the anterior chest wall. This was then taken superiorly into the cervical inlet. The right cervical horn of the thymus was bluntly dissected away from the right innominate vein and branching veins ligated. The cervical horn was then dissected as superiorly as possible and taken at its most superior margin. The left cervical horn was then taken in the same fashion. The thymic tissue was then taken off the pericardium, its inferior border ligated, and dissected off the contralateral pleura. A chest tube was left with excellent hemostasis. The patient was extubated and taken to the PICU in stable condition. The patient had a small residual left sided pneumothorax post-operatively with no clinical sequalae. The chest tube was removed post-op day 2, and patient was discharged post-op day 3. The patient recovered well with no complaints in clinic 2 weeks later.