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Thoracic surgery · London

Thymectomy for myasthenia gravis, by a specialist thoracic surgeon.

A definitive operation for thymoma and for MGTX-eligible generalised AChR-positive myasthenia gravis - done by an SCTS-registered thoracic surgeon with thymectomy volume, in an MG MDT with a specialist neurologist and HDU set up for the post-op window.

A stethoscope on a clinical desk

Indicative pricing

What a private thymectomy costs in London.

Indicative ranges across UK units.

In short

£16,000–£32,000, home in 2 to 5 days.

Procedure Indicative range
Second-opinion review of MG and CT chest £350–£600
VATS thymectomy (non-thymomatous MG or small thymoma) £16,000–£24,000
Robotic thymectomy (da Vinci) £22,000–£32,000
Transsternal thymectomy (large or invasive thymoma) £22,000–£38,000
Pre-op PLEX (per exchange, 3–5 sessions) £1,800–£2,600
Pre-op IVIg (per gram) £90–£140/g

Prices vary by unit, by which surgeon does the case, by whether the robot is used, and by lesion size and invasion.

The problem

The right patient, the right approach, the right MDT.

Thymectomy is not for every MG patient - and getting it done in a unit without a neuromuscular MDT and an ITU pathway for post-op crisis is a risk you should not take.

  • Is thymectomy right for me?

    MGTX applies to generalised AChR-positive MG in adults under 65. MuSK-positive and pure ocular MG are usually managed medically.

When it helps

When thymectomy is the right step - and when it is not.

The clinical scenarios where MGTX-informed thymectomy adds value, plus the situations where medical management is safer.

  • Thymoma on CT chest (10–15% of MG)

    A thymic mass on CT always warrants resection regardless of MG severity, for oncological control and potential MG benefit.

  • Generalised AChR-positive MG, age 18–65

    The MGTX Trial 2016 evidence base: thymectomy plus prednisolone beats prednisolone alone for quantitative MG score, steroid dose and hospitalisation.

  • Ocular AChR-positive MG progressing to generalised

    Selected patients where ocular disease is generalising within 2 years of onset and AChR antibodies are positive.

  • Selected seronegative generalised MG

    A minority of seronegative patients with generalised MG and clinical features consistent with AChR disease may benefit, decided in MDT.

  • Steroid-refractory or steroid-intolerant MG

    Patients who cannot tolerate the prednisolone dose their MG needs are prioritised for surgery to reduce long-term steroid burden.

  • NOT indicated: pure stable ocular MG

    Ocular-only MG that is stable and controlled on pyridostigmine and low-dose steroids does not benefit from thymectomy in the current evidence.

  • NOT indicated: MuSK-positive MG

    MuSK-antibody MG shows no benefit from thymectomy and the risk / benefit is unfavourable. LRP4-positive disease remains uncertain.

  • NOT indicated: age over 65 without thymoma

    Non-thymomatous MG in older patients has an unfavourable risk / benefit and is generally managed medically. Thymoma is still resected regardless of age.

Procedure options

Thymectomy is a family of approaches - the CT decides which.

What each option on the table actually involves - and which fits which pathology. Perioperative MG optimisation and post-op crisis care are as important as the operation itself.

  • Transsternal thymectomy

    Median sternotomy. The gold standard for large thymoma, invasive disease and when a complete thymectomy including cervical horns is essential. Longer recovery, higher wound morbidity.

  • VATS thymectomy

    Video-assisted thoracoscopic surgery, right or left approach. Minimally invasive. Appropriate for small thymoma or non-thymomatous MG. Shorter stay, less pain, cosmetic incisions.

  • Robotic thymectomy

    Da Vinci platform. Best three-dimensional visualisation of upper cervical horns and mediastinum. Minimally invasive with improved ergonomics. Outcomes comparable to VATS.

  • Transcervical thymectomy

    A small neck incision, historically used. Limited mediastinal exposure and rarely used today outside a small number of specialist centres.

  • Pre-op PLEX or IVIg

    Plasma exchange or intravenous immunoglobulin in the week before surgery to reduce circulating antibody load and lower the risk of post-op myasthenic crisis, especially in severe or bulbar disease.

  • Post-op HDU / ITU care

    24 to 48 hours of close monitoring for respiratory failure. Re-intubation with PLEX or IVIg is the standard response to a post-op crisis, and units set up for it matter.

  • Adjuvant treatment for thymoma

    Post-op radiotherapy for Masaoka stage II or III with capsular invasion, chemoradiotherapy for stage III or IV. Decided in a thoracic oncology MDT after histology.

  • Second-opinion review

    A specialist review of your CT chest, antibody results and neurology letters. Sometimes the answer is medical optimisation first, not immediate surgery.

Safety and recovery

What to expect afterwards - honestly.

Thymectomy is a well-established thoracic operation, but MG changes the anaesthetic plan and the first 48 hours. Plan for HDU or ITU cover, and for a slow MG improvement over months, not days.

  • Post-op myasthenic crisis

    Respiratory failure requiring re-intubation is the defining risk. Managed with ventilation and rescue PLEX or IVIg. Pre-op optimisation reduces but does not eliminate the risk.

  • Anaesthesia in MG

    Suxamethonium is avoided. Non-depolarising relaxants are minimised with train-of-four monitoring and careful neostigmine reversal. Extubation criteria are strict.

  • Bleeding and chylothorax

    Bleeding from mediastinal vessels is uncommon but recognised. Chylothorax from thoracic duct injury may require dietary management or reoperation.

  • Phrenic nerve injury

    The phrenic nerves run alongside the thymus. Injury is rare in experienced hands but can cause diaphragmatic paralysis and breathlessness.

  • Wound problems and sternal dehiscence

    Wound infection and, rarely, sternal dehiscence are risks after transsternal surgery. Minimally invasive approaches carry lower wound morbidity.

  • Continue pyridostigmine and steroids

    Regular MG medications are continued through the perioperative period. Steroid stress cover may be given. Your neurologist and surgeon agree the plan in writing.

  • Recovery and return to work

    2 to 4 weeks for robotic or VATS, 6 to 12 weeks after sternotomy. No lifting more than 5 kg for 6 weeks after sternotomy. Driving when off strong analgesia and comfortable.

  • MG improvement is slow

    Benefits from thymectomy emerge over 6 to 24 months as steroid dose is titrated down. The MGTX Trial showed sustained improvement over prednisolone alone at 6 years.

  • Red flags after discharge

    Worsening breathlessness, difficulty swallowing, slurred speech, drooping eyelids, or wound infection - call the unit or go to A&E the same day.

Reading your operation note

Your thymectomy report in four parts. Read the last one first.

Whichever approach was used, the report the surgeon and neurologist send you keeps to the same shape.

A UK neurologist reviewing a thymectomy operation note and histology

A quiet reminder

Thoracic and neurology language is precise and can read coldly - ask your care team to explain anything that is unclear.

Ask your care team to explain anything that is unclear.

  1. 01 Header

    Approach, duration and antibody status

    Which approach was used (robotic, VATS, transsternal), duration under anaesthesia, and your pre-op AChR / MuSK / LRP4 antibody status.

  2. 02 Technique

    Extent of resection and cervical horns

    Whether a complete thymectomy was achieved, including the upper cervical horns and perithymic mediastinal fat, and any adhesions or invasion noted.

  3. 03 Findings

    Histology and Masaoka staging

    Thymic hyperplasia versus thymoma. If thymoma, the WHO subtype (A, AB, B1-B3, C) and Masaoka stage (I to IV), which drives adjuvant treatment.

  4. 04 Impression

    Neurology plan and steroid taper

    Read this first: the plan for tapering prednisolone over the coming months, ongoing pyridostigmine, and the interval to your next neurology review.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Cover for thymectomy varies by insurer and by indication - usually funded when medically indicated for thymoma or MGTX-eligible MG.

Frequently asked

Everything we get asked about thymectomy.

Quick answers on MGTX, MuSK, approach, cost, post-op crisis, and how long MG takes to improve.

  • What does the MGTX Trial 2016 actually show?

    The MGTX Trial was a randomised controlled trial published in the New England Journal of Medicine in 2016. In adults aged 18 to 65 with generalised AChR-antibody positive myasthenia gravis, extended transsternal thymectomy plus prednisolone was superior to prednisolone alone. It reduced the time-weighted quantitative MG score, the mean prednisolone dose, and the need for hospitalisation for MG exacerbation. Six-year extension data confirmed sustained benefit.

  • Is thymectomy right for MuSK-positive MG?

    Current evidence does not support thymectomy in MuSK-antibody positive MG. The thymus is not implicated in the same way as in AChR disease, thymic pathology is uncommon, and surgical series show no clear MG benefit. LRP4-positive disease remains uncertain and is decided case by case in MDT.

  • How much does a private thymectomy cost in the UK?

    Roughly £16,000 to £24,000 for VATS thymectomy, £22,000 to £32,000 for robotic thymectomy, and £22,000 to £38,000 for transsternal thymectomy where a large or invasive thymoma is resected. Pre-op PLEX runs £1,800 to £2,600 per exchange, and IVIg £90 to £140 per gram. A second-opinion review of your CT and antibody results is £350 to £600.

  • Which approach is best - robotic, VATS or sternotomy?

    It depends on what is in your chest. Robotic and VATS are minimally invasive with shorter stays and less pain, and are appropriate for non-thymomatous MG and small, encapsulated thymoma. Transsternal via a median sternotomy remains the gold standard for large thymoma, invasive disease, and when a complete thymectomy including both cervical horns is essential. Outcomes for robotic and VATS are comparable in experienced hands.

  • What is a post-op myasthenic crisis and how is it managed?

    A myasthenic crisis is worsening MG weakness severe enough to compromise breathing, requiring re-intubation and ventilation. It can be triggered by the physiological stress of surgery. Management is supportive ventilation on HDU or ITU plus rescue plasma exchange or IVIg to reduce circulating antibody. Pre-op PLEX or IVIg is used to reduce the risk in severe or bulbar disease.

  • How long until my MG improves after thymectomy?

    Slowly. Some patients feel better within months, but the full benefit emerges over 6 to 24 months as the immune system remodels and steroids are titrated down. MGTX showed sustained improvement over prednisolone alone at 3 years and again at 6 years. Thymectomy is not an instant cure - it is a long-term investment in lower steroid dose and fewer exacerbations.

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