History of thymus surgery spans nearly 130 years, and 114 years have been largely devoted to thymectomy. Symptoms of myasthenia gravis (MG) were first described in 1658, but breakthrough in defining the role of thymus in this pathology occurred in the early 20^th century. Improvements in conservative treatment for MG occurred simultaneously with development of thoracic surgery and anesthesiology. These processes converged in 1936, when Alfred Blalock performed and described in detail thymectomy and perioperative management of a patient with MG using available techniques. Despite modern advances in surgical and therapeutic treatment of MG, there is still no unified strategy based on integrative personalized approach to patient management. The article analyzes history of each component of perioperative support of thymectomy with emphasis on Blalock’s systemic approach, and also proposes the concept of MIASTOP covering all stages of management of patients with myasthenia.