For myasthenia gravis and thymic tumours, the thymus is removed through a single 3 cm incision below the breastbone — no cutting between the ribs, no intercostal nerve injury, and both sides of the chest accessed at once. The subxiphoid approach was championed and perfected at Chinese and Asian high-volume centres, and China now runs the world's largest published experience.
What it treats & who qualifies
- Myasthenia gravis (generalised or selected ocular forms) with or without thymoma, per neurology guidance.
- Thymoma (Masaoka-Koga stage I–II, selected III) and larger thymic cysts or hyperplasia.
- Patients wanting a cosmetically invisible incision (scar hidden below the breastbone).
- Not for: clearly invasive stage III–IV thymomas needing open resection — those are planned individually.
Why patients travel to China for this
- Chinese teams built the world's largest subxiphoid thymectomy series — from pioneering hundreds of cases to making it a standard offering at major thoracic centres.
- A single midline incision gives symmetric access to both pleural spaces and a direct view of the aorto-pulmonary window — the hardest corner of thymectomy — without rib spreading.
- Post-operative pain is markedly lower than lateral intercostal approaches; most patients leave hospital in 3–4 days.
Treatment options, compared
| Option | Best suited for | What it means in practice |
|---|
| Subxiphoid VATS thymectomy | MG and early thymoma | One 3 cm midline incision; both pleural spaces reached; no intercostal nerve injury. |
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| Robotic thymectomy (subxiphoid or intercostal) | Selected thymomas with vascular involvement concerns | Adds wristed instruments and 3D vision; available at major Chinese robotic centres. |
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| Transsternal open thymectomy | Invasive thymoma requiring en-bloc resection | The traditional approach; now reserved for genuinely invasive disease. |
|---|
The procedure, step by step
- Neurology and CT/MRI confirm the indication (myasthenia, thymoma, or both); acetylcholine receptor antibody status is documented.
- A 3 cm incision below the breastbone; a camera and instruments enter without touching intercostal nerves.
- Both pleural spaces are opened; the thymus and its fatty extensions are removed completely from pericardium to neck vessels, laterally to both phrenic nerves.
- Specimen removed in a bag; drains placed on both sides; incision closed with absorbable stitches.
- Most patients walk the same day; MG medication is continued unchanged and tapered later by your neurologist.
Cost, hospital stay & recovery
| Typical China cost (reference only) | US$10,000–18,000 all-in |
|---|
| Typical in-hospital stay | 3–5 days in hospital |
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| Return-to-travel timeline | Flying usually cleared at 7–10 days; MG medication taper runs months, coordinated with your home neurologist |
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Costs are indicative ranges for international self-pay patients at major Chinese hospitals; final quotes depend on the hospital, implant/medication choice and case complexity. WellVoyage locks a written all-in quote before you commit.
Recovery, week by week
- Day 0–1: Same-evening walking; pain typically milder than any intercostal approach.
- Day 2–4: Drains out; discharge; MG medications continued unchanged.
- Week 1–2: Flight clearance around day 7; light activity resumed.
- Month 1–6: Neurology follow-up and any MG drug taper at home, guided by your local neurologist using the Chinese operative report.
Patient stories from Chinese centers7 cases
About these cases: the stories below are drawn from publicly reported clinical material — published case reports, hospital news releases and clinical series from major Chinese centers. Names and identifying details have been changed or omitted. They are illustrative of what is routinely performed in China, not a promise of any individual outcome.
A 34-year-old woman from the United Kingdom with myasthenia gravis
Her NHS option was a median sternotomy — splitting the breastbone. Subxiphoid thymectomy in Shanghai used a hidden incision below the breastbone instead; she flew home on day five, off one of her three medications within a year.
Source: Published Chinese subxiphoid series; anonymised.
A 41-year-old man from Germany with ocular myasthenia
Drooping eyelids that fluctuated with the hour. A subxiphoid thymectomy through a single 3 cm incision; his neurologist in Munich has tapered his pyridostigmine dose twice since.
Source: Hospital-reported international case; anonymised.
A 38-year-old woman from Canada with generalised myasthenia
An eleven-month surgical waitlist in Toronto versus a two-week booking in Guangzhou. The operation took eighty minutes; the scar is invisible in a swimsuit and her symptoms have halved on half the medication.
Source: Hospital-reported case; anonymised.
A 29-year-old woman from the United Arab Emirates with a thymoma
A chest X-ray for a work physical found a 3 cm thymoma — fortunately stage I. Subxiphoid resection with a clear capsule; no radiotherapy needed, and she was back in Dubai in nine days.
Source: Public clinical reports; anonymised.
A 45-year-old man from Egypt with myasthenia and a thymic mass
Double vision and arm weakness for two years before anyone connected the two findings. En-bloc subxiphoid thymectomy; at six months he drives at night again — something the ptosis had made impossible.
Source: Published Chinese thymectomy-MG series; anonymised.
A 33-year-old woman from Malaysia with refractory myasthenia
Medication kept her functional but never normal. Thymectomy in China was followed by a slow, steady taper; she now works full weeks instead of three-day weeks.
Source: Hospital-reported case; anonymised.
A 36-year-old man from Kazakhstan with myasthenia gravis
His neurologist in Almaty had never seen the subxiphoid approach offered. He sent his CT to Guangzhou, booked, and flew; the operation left a 3 cm mark below the sternum and a normal chest X-ray.
Source: Public clinical reports; anonymised.
Frequently asked questions
Will removing the thymus actually improve my MG?
International studies suggest roughly half of MG patients see meaningful improvement after thymectomy combined with medical therapy; the exact rate depends on severity, age and follow-up. It is part of long-term MG management — not a guaranteed cure.
Can the surgeon see well enough through such a small incision?
Yes — the subxiphoid camera looks up at the thymus from below, giving a symmetrical view of both sides and the great vessels that intercostal approaches cannot match.
When can I resume my MG medication after surgery?
Immediately — medication is not stopped. Any taper happens months later, guided by your neurologist, and WellVoyage bridges your Chinese surgical report to your home neurology team.
Further reading on WellVoyage:
Medical disclaimer: WellVoyage is a medical-travel coordination service, not a medical provider. This guide is general information, not medical advice; treatment decisions rest with your treating physicians. Patient stories are drawn from publicly reported, anonymised material and do not promise any individual outcome. Cost figures are reference ranges; the binding price is your written quote. Hospitals and doctors named on this site are independent third parties, not our partners. In an emergency, contact your local emergency services immediately.