The mediastinum is one anatomic region containing pathologically distinct lesions — cystic, endocrine, lymphoproliferative, neoplastic, and vascular. The surgical work here is heterogeneous: a parathyroid adenoma lying behind the sternum, a Castleman's lymph node sitting on the pulmonary artery, a fibrosing inflammatory mass mimicking a thymoma, a residual germ cell mass after chemotherapy. What unifies the work is anatomic access through a robotic platform that handles the retrosternal space with precision unavailable to either thoracotomy or VATS — not a single disease pathway.
Last reviewed: May 2026 · Mr Lawrence Okiror FRCS(CTh) FRCSEd(CTh) · GMC 6150382
A page on thymoma is a page about one disease. A page on myasthenia gravis is a page about one trial and one operation. A page on the mediastinum, by contrast, is a page about an anatomical region within which several biologically unrelated diseases happen to live. The unifying axis is not the disease. It is the access.
The retrosternal anterior mediastinum, the visceral middle mediastinum lying between the heart and the great vessels, and the paravertebral posterior mediastinum together form a narrow, deep, vascular space that is structurally hostile to open thoracotomy and limiting for traditional video-assisted thoracoscopic surgery. The robotic platform — with magnified three-dimensional vision, wristed instruments that articulate at the tip, and tremor filtration — was effectively designed for this anatomical envelope. The same platform that performs a robotic thymectomy for myasthenia gravis is the platform that resects a bronchogenic cyst from the visceral compartment, dissects an ectopic parathyroid adenoma from the perithymic fat, removes a Castleman's lymph node from the aorto-pulmonary window, and clears post-chemotherapy residual disease from a germ cell tumour. The diseases differ. The platform does not.
This page is organised accordingly. The first section establishes the anatomical framework that determines the differential diagnosis in each compartment. The second section addresses diagnostic biopsy — when EBUS is sufficient, when it is not, and what surgical alternatives still matter in an EBUS-first era. The remainder is organised by tissue type: cystic, endocrine, lymphoproliferative, germ cell, and vascular. Thymoma and myasthenia gravis are not covered here because each has its own dedicated page; they are referenced where the anatomical context demands it.
Key takeaways
The mediastinum occupies the central compartment of the chest, bounded laterally by the mediastinal pleura, anteriorly by the sternum, posteriorly by the vertebral column, superiorly by the thoracic inlet, and inferiorly by the diaphragm. In the contemporary ITMIG (International Thymic Malignancy Interest Group) framework adopted for radiological description and surgical planning, three compartments are recognised: the prevascular (anterior) compartment lying between the sternum and the anterior pericardium and great vessels; the visceral (middle) compartment containing the heart, pericardium, trachea, main bronchi, oesophagus, and the great vessels; and the paravertebral (posterior) compartment lying lateral and posterior to the vertebral bodies.
This compartmental division is not academic. Each compartment has a characteristic differential diagnosis that the experienced reader of a chest CT generates almost immediately on identifying the anatomical position of a lesion. A 4 cm mass in the prevascular compartment of a 30-year-old man is approached differently from a 4 cm mass in the paravertebral compartment of a 60-year-old woman, because the underlying pathology is overwhelmingly likely to differ.
The Carter, Marom, and Detterbeck 2014 ITMIG papers in the Journal of Thoracic Oncology (the clinician and radiologist guides) remain the practical reference framework. They define the imaging-based compartmental boundaries and the standard differential by compartment, which structures the diagnostic conversation from the first imaging review onward.
Thymic epithelial tumours (thymoma, thymic carcinoma), lymphoma (Hodgkin and primary mediastinal B-cell), retrosternal thyroid, germ cell tumours (mature teratoma, mediastinal seminoma, NSGCT), parathyroid adenoma (rare ectopic location), and the rare cohort: AVM, IgG4-related sclerosing disease, Castleman's disease.
The compartment where the mediastinal surgeon does most of the disease-specific work.
Foregut duplication cysts (bronchogenic, oesophageal), pericardial cysts, lymphadenopathy of any cause (reactive, infective, metastatic, lymphomatous, Castleman's, IgG4-related), and the rarer entities: paraganglioma, lymphangioma, and ectopic parathyroid lying alongside the trachea or oesophagus.
The compartment most accessible to EBUS-TBNA and EBUS cryobiopsy.
Neurogenic tumours (schwannoma, neurofibroma, ganglioneuroma) account for the majority. Less commonly: extramedullary haematopoiesis, neurenteric cysts, paraganglioma, and the rare posterior mediastinal Castleman's lesion. Thoracic spinal pathology can also present radiologically as a paravertebral mediastinal mass.
Surgical approach is commonly robotic posterolateral with intraoperative attention to nerve root and segmental vessels.
Tissue diagnosis is the rate-limiting step for nearly every mediastinal mass. The contemporary diagnostic pathway is endoscopic-first, surgical-second, and the question is not whether to start with EBUS but when to recognise that EBUS will not be enough.
EBUS-TBNA & EBUS cryobiopsy
The endoscopic-first standardEBUS-TBNA samples paratracheal (stations 2 and 4), subcarinal (station 7), and hilar lymph nodes with high diagnostic yield for common pathology including lung cancer staging, sarcoidosis, and tuberculous lymphadenopathy. EBUS-guided transbronchial mediastinal cryobiopsy (EBUS-TMC) adds tissue architecture and is increasingly important where lymphoma or IgG4-related disease is in the differential, because immunohistochemistry and flow cytometry require more material than a fine-needle aspirate provides.
First-line for most middle mediastinal lesions and lymphadenopathy. The diagnostic-yield benchmark is >90% for common pathology.
When EBUS is not enough
The remaining surgical indicationsAnterior mediastinal masses are usually not reachable by EBUS — the trachea and the prevascular compartment sit in different anatomical planes. Lymphoma frequently requires more tissue than EBUS provides for accurate subtyping by the contemporary WHO classification. Suspected germ cell tumour requires sufficient architectural material to recognise the histological subtype and exclude transformation. Persistent diagnostic uncertainty after a non-diagnostic EBUS in a patient with progressive disease is itself an indication. Restaging of N2 disease after neoadjuvant therapy with negative EBUS in patients with high pre-test probability remains a confirmatory surgical scenario.
Surgical biopsy is no longer the first step. It is the necessary step in a defined set of clinical scenarios.
A small incision in the second or third intercostal space alongside the sternum, through which the anterior mediastinum is accessed directly. The classic approach for anterior mediastinal mass biopsy where EBUS is inaccessible, especially when generous tissue is needed for lymphoma subtyping. Performed under general anaesthetic; same-day or overnight stay. Still routinely used despite the rise of EBUS for two reasons: anatomical reach (the prevascular compartment), and tissue volume (modern lymphoma panels require a generous block rather than a needle core).
For lesions in the visceral or paravertebral compartments inaccessible to anterior mediastinotomy, a three-port video-assisted or robotic approach allows targeted biopsy of paratracheal or paravertebral masses. The robotic platform is particularly useful where the lesion sits in close anatomical proximity to the phrenic nerve, the recurrent laryngeal nerve, or the great vessels — the wristed instruments and magnified vision permit a controlled dissection that VATS cannot reliably match in those positions.
Once the universal staging technique for non-small cell lung cancer, cervical mediastinoscopy has been substantially displaced by EBUS-TBNA. It retains a confirmatory role in selected scenarios: a negative EBUS in a patient with high pre-test probability of mediastinal nodal disease, restaging after neoadjuvant therapy where endoscopic biopsy has been non-diagnostic, and the rare circumstance where a paratracheal lesion is unreachable endoscopically. The 2014 ESTS guidelines (De Leyn et al.) remain the current procedural reference.
Mediastinal cysts together account for approximately 12-20% of mediastinal masses. They are congenital foregut or mesothelial remnants — histologically benign but capable of producing significant symptoms by mass effect, infection, or rupture, and occasionally diagnostically ambiguous on imaging in ways that mandate resection rather than observation.
Bronchogenic cysts arise from abnormal budding of the foregut during embryogenesis and typically sit in the visceral compartment adjacent to the trachea or main bronchi. They contain mucoid or proteinaceous fluid and may be asymptomatic, but a substantial proportion eventually become symptomatic with cough, recurrent infection, dysphagia, or compression of adjacent airway. Indications for resection are symptoms, growth, diagnostic uncertainty (a cyst with thick walls, septations, or solid components on imaging), and progressive size in younger patients in whom the cumulative risk of complications across decades favours treatment over surveillance.
Pericardial cysts are mesothelial cysts of the parietal pericardium, typically in the right cardiophrenic angle, usually asymptomatic and frequently found incidentally. Surveillance is reasonable for small asymptomatic lesions. Resection is indicated for symptoms (chest pain, dyspnoea from cardiac compression), enlargement, or diagnostic uncertainty.
Thymic cysts are usually unilocular and benign but multilocular thymic cysts require careful evaluation for associated thymoma or thymic carcinoma, and resection is the default in those cases. See the thymoma surgery page for the wider thymic neoplasm framework.
For symptomatic or diagnostically uncertain cysts, complete excision is the standard. The robotic platform offers specific advantages in the visceral compartment:
A contemporary decade-of-experience series (Grawunder et al., Journal of Visualized Surgery 2024) covering 124 robotic mediastinal resections reports a complete resection rate of 96.77%, conversion rate under 1%, and a low overall complication profile across cysts, neurogenic tumours, and thymic pathology. The pattern is consistent across published series: for benign well-circumscribed mediastinal lesions, robotic resection has become the standard against which other approaches are now measured.
Primary hyperparathyroidism is usually a cervical disease. In approximately 1-2% of patients, the adenoma sits not in the neck but behind the sternum — in the prevascular mediastinum, in the perithymic fat, or alongside the trachea in the visceral compartment. The biochemical picture is identical to cervical disease; the surgical pathway is different.
The diagnosis of primary hyperparathyroidism is a biochemistry diagnosis. The triad is an inappropriately raised parathyroid hormone, raised corrected calcium, and (typically) a low-normal or low phosphate. Bone profile shows the consistent picture of elevated calcium with reciprocal phosphate suppression; a low vitamin D is common and complicates interpretation. Patients may present with the classical symptoms (renal stones, bone disease, abdominal complaints) but the contemporary picture is more often non-specific neuromuscular fatigue, intermittent weakness, lower back pain, or constitutional symptoms that prompt imaging on which the mediastinal mass is found incidentally.
When an anterior or visceral mediastinal mass is found in a patient with biochemical primary hyperparathyroidism, ectopic parathyroid adenoma rises to the top of the differential. EBUS-guided fine-needle aspiration with parathyroid hormone washout has been used to confirm the diagnosis preoperatively in selected cases. Pheochromocytoma and paraganglioma sit elsewhere in the differential for mediastinal mass and should be excluded by plasma metanephrines before any intervention on a mediastinal lesion with sympathetic chain or vascular relationships.
Accurate localisation of an ectopic parathyroid adenoma is the foundation of a focused mediastinal operation. The first-line imaging combination is technetium-99m sestamibi (MIBI) parathyroid scintigraphy with SPECT/CT, supplemented by ultrasound of the neck for any concurrent cervical pathology, and cross-sectional CT or MRI for anatomical relationships.
Where conventional imaging is inconclusive — which is the case more often for ectopic than for cervical adenomas — 18F-fluorocholine PET/CT is the contemporary modality of choice. The Kluijfhout multicentre study from the Netherlands (Nuclear Medicine Communications 2016) established that fluorocholine PET localised parathyroid pathology in patients in whom MIBI had failed, with subsequent series confirming particular value in ectopic locations including the mediastinum. The principle is metabolic: parathyroid adenomas take up choline as a marker of phospholipid synthesis in actively secreting tissue, producing focal uptake that is independent of the iodine-related limitations of MIBI.
The pathway in practice is sequential: SPECT/MIBI first, and where uptake is equivocal or anatomically poorly localising, choline PET/CT next. Both studies are performed at Guy's Nuclear Medicine for patients in our service. The combined yield is high enough that an open or thoracoscopic exploration of an unlocalised mediastinal adenoma is now rarely the starting position.
Once the adenoma has been identified and resected, the surgical question becomes whether all hyperfunctioning tissue has been removed. The half-life of parathyroid hormone is short — in the order of 3 to 5 minutes — which makes serial intraoperative PTH measurement feasible during the operation itself.
The Miami criterion, sustained in the American Association of Endocrine Surgeons 2016 guidelines (Wilhelm et al., JAMA Surgery), is a greater than 50% drop in PTH at 10 minutes after adenoma excision, measured against the highest preoperative or post-induction baseline. A drop meeting this criterion has a high positive predictive value for biochemical cure. A drop that does not meet the criterion mandates further exploration — either for a second adenoma, hyperplasia, or supernumerary parathyroid tissue — before the operation is concluded.
Intraoperative PTH monitoring is performed by the on-site biochemistry laboratory with samples processed in real time during the operation; the surgical team is informed of each value within minutes of the sample being drawn. This is the standard against which mediastinal parathyroid surgery is judged in the contemporary literature.
The technical landmark for this operation is the Berlin Charité series (Ismail M, Maza S, Swierzy M et al., British Journal of Surgery 2010), which established da Vinci robotic resection of ectopic mediastinal parathyroid glands as the modern approach. The operation is performed through three small port incisions, typically right-sided, with the patient supine and the right side elevated. The robotic platform's wristed instruments and magnified three-dimensional vision are particularly suited to the narrow retrosternal and perithymic space in which the adenoma typically sits, and to the meticulous dissection required to identify and avoid the phrenic nerve, the recurrent laryngeal nerve, the internal mammary vessels, and the superior vena cava.
Subsequent published series confirm the pattern: low blood loss, hospital stay typically 1-2 days, and high biochemical cure rates with intraoperative PTH confirmation. The operation has become reliably reproducible at high-volume centres.
Mediastinal parathyroidectomy is a genuine joint operation, not a thoracic operation that happens to share a topic with endocrinology. The pathway is built around three specialty inputs.
Endocrinology reviews the biochemistry, manages the perioperative calcium and vitamin D status, plans for and treats postoperative hypocalcaemia where it occurs, and provides the long-term metabolic follow-up. Vitamin D replacement is often required preoperatively because severe deficiency complicates the postoperative biochemical picture and can mask cure.
A head-and-neck or endocrine surgical colleague brings the parathyroid-specific technical expertise: identification of normal-appearing parathyroid tissue, intraoperative PTH protocol management, recurrent laryngeal nerve handling, and the management of any concurrent cervical pathology. The combined operative team handles both compartments — mediastinal and cervical — if the imaging or intraoperative PTH response suggests disease in both.
Nuclear medicine performs the SPECT/MIBI and the 18F-fluorocholine PET/CT, both at Guy's Nuclear Medicine for our patients, and is available for intraoperative gamma probe guidance in selected cases where the adenoma is small or anatomically ambiguous.
Two distinct lymphoproliferative entities present as mediastinal masses or lymphadenopathy and can mimic neoplasia on imaging. Both require tissue diagnosis; one is surgically cured, the other is medically treated — and getting the diagnosis right matters for both reasons.
Castleman's disease is a rare benign lymphoproliferative disorder first described in 1954. Unicentric Castleman's disease (UCD), the localised form, presents as a single lymph node or nodal mass — most commonly in the mediastinum — and is surgically curable when completely resected. The hyaline-vascular histological subtype predominates in mediastinal UCD.
The dominant operative challenge is hypervascularity. UCD lesions can have brisk feeding vessels — characteristically from the bronchial, internal mammary, or intercostal arteries — producing a tumour blush on angiography that is the imaging signature of the disease. Significant intraoperative bleeding is the defining surgical risk.
Preoperative embolisation via interventional radiology has emerged as an important adjunct for large, hypervascular, or central UCD lesions; the procedure devascularises the lesion, reduces intraoperative blood loss, and makes VATS or robotic resection feasible in lesions that would otherwise have demanded open thoracotomy. Multiple published case series support this combined approach.
For smaller, well-circumscribed peripheral lesions, robotic or VATS resection is the standard. For large central lesions abutting the great vessels or heart, sternotomy and occasionally cardiopulmonary bypass support may be required — the decision is made on cross-sectional imaging and angiography in conjunction with the multidisciplinary team.
IgG4-related disease (IgG4-RD) is a multisystem immune-mediated fibroinflammatory disorder. Thoracic involvement is reported in up to half of patients and can manifest as interstitial lung disease, pleural thickening, airway involvement, mediastinal or hilar lymphadenopathy, or as a discrete mass-forming lesion in the anterior mediastinum that radiologically mimics thymoma.
The diagnostic framework is the 2019 ACR/EULAR classification criteria (Wallace ZS et al., Annals of the Rheumatic Diseases 2020;79:77-87) combined with the 2020 revised comprehensive diagnostic criteria. The characteristic histopathology is the triad of storiform fibrosis, lymphoplasmacytic infiltrate with IgG4-positive plasma cells, and obliterative phlebitis. Supportive features include serum IgG4 elevation, the IgG4:IgG ratio greater than 40% on immunohistochemistry, and response to corticosteroid therapy.
The surgical role is diagnostic, not therapeutic. Once the diagnosis is established, treatment is medical — corticosteroids as first-line, and increasingly B-cell-depleting therapy with rituximab where steroids fail or relapse occurs. The disease is steroid-responsive in the majority of cases and progression can be halted before irreversible organ damage develops.
The clinical importance of recognising IgG4-RD is to avoid inappropriate oncological treatment for a steroid-responsive condition that perfectly mimics neoplasia on imaging. Tissue diagnosis — by EBUS cryobiopsy, CT-guided core biopsy, or surgical biopsy where the lesion is anatomically inaccessible — is therefore the gateway to correct management.
Mediastinal germ cell tumours (MGCTs) are rare extragonadal tumours arising in the prevascular compartment, predominantly in young men. They are biologically related to but clinically distinct from gonadal germ cell tumours, and they divide for management into three groups: benign mature teratoma, pure mediastinal seminoma, and primary mediastinal nonseminomatous germ cell tumour (NSGCT), the latter classified as poor-risk in the IGCCCG framework.
Mature teratoma is the most common subtype and is chemotherapy-unresponsive; surgical resection at presentation is the standard. Pure mediastinal seminoma is sensitive to cisplatin-based chemotherapy, with residual masses smaller than 3 cm usually observed and larger residual masses assessed with FDG-PET. Primary mediastinal NSGCT — the most aggressive subtype — is managed by cisplatin-based chemotherapy followed by surgical resection of any residual mediastinal disease.
The Indiana University group (Kesler, Einhorn, and colleagues) holds the largest published institutional experience in postchemotherapy surgery for primary mediastinal NSGCT, with serial publications including the 2008 25-year experience (Journal of Thoracic and Cardiovascular Surgery) and the 2020 cisplatin-era outcomes update (JTCVS 2020;160:1556-1566) that remain the practical reference for the operative and oncological framework. The defining lessons from that work are that residual mediastinal disease after chemotherapy in NSGCT requires resection irrespective of tumour marker normalisation, because mature teratoma and non-germ-cell transformation (sarcoma, carcinoma) cannot be reliably excluded by imaging or by markers; that the operation may be technically demanding because of bulky disease, vascular invasion, or post-chemotherapy fibrosis; and that complete resection is correlated with long-term survival.
Growing teratoma syndrome — a mediastinal mass enlarging during or after chemotherapy despite normalising tumour markers — is the temporal manifestation of mature teratomatous tissue expanding while the malignant component responds to treatment. It mandates surgical resection because the mass will not regress and may produce cardiopulmonary compression. Recognition is the key clinical point: growth on chemotherapy in this population is not always treatment failure.
MGCTs are predominantly managed within NHS uro-oncology and thoracic surgical pathways at specialist centres. Mr Okiror has performed mediastinal resection for benign mature teratoma and for NSGCT post-chemotherapy residual disease, in collaboration with medical oncology colleagues; the relevant role of this page is to acknowledge the spectrum and the framework rather than to suggest that MGCT is routinely a private practice presentation.
Arteriovenous malformations are abnormal direct artery-to-vein connections without an intervening capillary bed; they are most commonly seen in skin, soft tissue, brain, and pelvis. Mediastinal AVMs are very rare — only a small number of cases of anterior mediastinal AVM have been reported in the world literature. Our group published a case report of two anterior mediastinal AVMs treated surgically at Guy's and St Thomas' (Hurley PD, Nizami M, Billé A, Okiror L, Nonaka D. Video-Assisted Thoracic Surgery 2023;8:42), illustrating two distinct presentations: one symptomatic with chest pain and night sweats requiring sternotomy and superior vena cava repair, and one asymptomatic, found incidentally and resected robotically. The histopathology was identical in both: haphazardly arranged vessels of various calibre in a fibroconnective stroma, consistent with AVM.
The clinical importance of recognising AVM in the differential of a mediastinal mass is twofold. First, CT-guided percutaneous biopsy of an undiagnosed AVM carries significant bleeding risk and may produce diagnostic uncertainty when only mesenchymal tissue is recovered. Second, intraoperative bleeding from an unsuspected AVM can be substantial, and operative planning is different when the diagnosis is known in advance — preoperative embolisation by interventional radiology is feasible and may be preferred as a primary treatment or as a preparatory step before resection.
AVMs are not the explanation for most anterior mediastinal masses. They are the rare differential that, if missed, can produce a difficult intraoperative situation — and that is why they are included on this page rather than left implicit.
The argument for robotic surgery in the mediastinum is anatomical, not procedural. The retrosternal anterior compartment, the visceral compartment lying between the heart and the great vessels, and the paravertebral compartment are all narrow, deep, and structurally hostile to the open thoracotomy that thoracic surgery historically relied on for access. Sternotomy provides exposure but at the cost of significant chest-wall morbidity. VATS in the mediastinum is feasible but limited by the rigidity of standard thoracoscopic instruments in confined retrosternal or paravertebral spaces.
The robotic platform — with three-dimensional magnified vision, wristed instrument articulation, tremor filtration, and the camera positioned within the operative field rather than over it — was effectively designed for this anatomical envelope. The same platform that performs the robotic thymectomy described on the thymoma surgery page dissects ectopic parathyroid tissue from the perithymic fat, resects a Castleman's lymph node from the aortopulmonary window, removes a bronchogenic cyst from the carinal region with airway repair if needed, and clears post-chemotherapy residual disease from a germ cell tumour.
What changes between operations is the disease and the dissection plane. What does not change is the access. That is why a robotic mediastinal practice naturally covers the spectrum — the operator who performs robotic thymectomy weekly is the operator best placed to dissect a small ectopic parathyroid adenoma from precisely the same anatomical field.
Robotic access is not universally appropriate. Large central UCD lesions abutting the heart or great vessels may require sternotomy and cardiopulmonary bypass support. Bulky post-chemotherapy NSGCT residual disease with vascular invasion is typically an open operation. Where conversion is anticipated, the operation is staged accordingly from the start. The platform is a tool, not a doctrine.
More than any other region of thoracic surgery, mediastinal pathology requires coordinated input from multiple specialties. The differential for a single mediastinal mass can span thoracic surgery (cyst, AVM), endocrinology and head-and-neck surgery (parathyroid), haematology (lymphoma), uro-oncology (germ cell tumour), rheumatology (IgG4-related disease), and infectious diseases (tuberculosis, histoplasmosis). The pathway is not a sequence; it is a parallel evaluation with multidisciplinary case discussion at each turn.
The pathway routinely engages: specialist radiology for cross-sectional CT and MRI interpretation with compartmental localisation; nuclear medicine for SPECT/MIBI, 18F-fluorocholine PET/CT, and FDG-PET; interventional radiology for percutaneous biopsy of accessible lesions and for preoperative embolisation of hypervascular UCD or AVM; interventional pulmonology for EBUS-TBNA and EBUS-guided cryobiopsy; pathology with mediastinal subspecialty expertise (the spectrum of differential diagnoses on a single mediastinal core biopsy is wide and requires specialist interpretation); haematology for the lymphoma differential and for any concurrent lymphoproliferative finding; endocrinology for primary hyperparathyroidism workup and management; head-and-neck surgical colleagues for joint parathyroid operations; medical oncology and uro-oncology for germ cell tumours; and rheumatology for IgG4-related disease and other immune-mediated lymphadenopathy.
All cases proceed through the multidisciplinary team meeting before a surgical recommendation is finalised. Where the diagnosis is uncertain or where the surgical role is exclusively diagnostic, that uncertainty is named at the consultation rather than resolved by assumption.
Robotic mediastinal surgery is performed at London Bridge Hospital and The Lister Hospital Chelsea. Both hold the da Vinci Xi robotic platform and have access to the cross-specialty anaesthetic and perioperative infrastructure required for mediastinal cases involving close proximity to the great vessels, the phrenic nerve, the recurrent laryngeal nerve, and the pericardium.
For ectopic parathyroidectomy and joint procedures requiring endocrinology and head-and-neck collaboration, London Bridge Hospital is the typical setting because of its on-site biochemistry capacity for intraoperative PTH monitoring and its integration with HCA's joint endocrine and head-and-neck surgical services. For straightforward robotic cyst resection or biopsy, both hospitals are equally appropriate and the choice is usually a question of geography and convenience, discussed at consultation.
Mediastinal germ cell tumour surgery, post-chemotherapy residual disease resection, and complex Castleman's disease requiring cardiopulmonary bypass support are predominantly performed in the NHS setting at Guy's and St Thomas', within the thoracic surgical, uro-oncology, and cardiothoracic combined pathways.
Outpatient consultations are also available at HCA clinics in Canary Wharf and the City of London. International patients with established imaging and biochemistry can be assessed remotely before travel.
Insurance and self-pay: Mr Okiror is recognised by all major UK private medical insurers including AXA, BUPA, WPA, Vitality, Cigna, and Aviva. Self-pay and international patients are equally welcome. Transparent estimates covering surgical, hospital, anaesthetic, and where relevant nuclear medicine localisation costs are provided by Jo Mitchelson before any commitment is made — 020 7952 2882 or pa@lungsurgeon.co.uk.
Thymoma
Thymic epithelial tumours have their own pathway.Thymoma occupies the prevascular compartment and is the commonest anterior mediastinal neoplasm. Staging is by Masaoka-Koga and the IASLC/ITMIG TNM system; histology by the 2021 WHO classification; treatment by stage with robotic resection for early stage and combined modality for locally advanced disease.
Thymoma surgery page →Myasthenia Gravis
Thymectomy for MG is on a separate pathway.Robotic extended thymectomy for AChR-positive generalised myasthenia gravis follows the MGTX trial evidence, perioperative neurology partnership, plasma exchange or IVIg pathway where required, and structured respiratory monitoring after surgery.
Myasthenia gravis surgery page →Common questions from patients and referrers navigating a new mediastinal mass diagnosis or considering surgery for a known mediastinal condition.
Book a Consultation →Or call Jo Mitchelson:
020 7952 2882
Appointments within 2–3 days. Self-referrals welcome. Surgery at London Bridge Hospital and The Lister Hospital Chelsea. Imaging review before consultation arranged on request.
Jo Mitchelson, PA · 020 7952 2882 · pa@lungsurgeon.co.uk
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Staging, classification, robotic thymectomy, and multimodality treatment for Stage III and IVA thymoma
Myasthenia Gravis SurgeryRobotic thymectomy following the MGTX trial evidence, with specialist neurology partnership
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