Surgery

April 14, 2026

Minimally invasive approaches to thymectomy have advanced over the past decade. Video‑assisted and multiport robotic techniques have achieved cancer outcomes comparable to those of open sternotomy while reducing pain, complications and length of stay.

That evolution continues. Mayo Clinic in Rochester, Minnesota, now offers a next‑generation option: a subxiphoid single‑port robotic thymectomy performed through one small incision below the diaphragm. This approach preserves oncological quality while enhancing visualization, reducing surgical trauma and, in select patients, enabling same‑day discharge.

Innovation in robotic surgery

Mayo Clinic has long been an early adopter of robotic surgical technology. Modern robotic systems offer exceptional visualization and dexterity. The advent of single-port robotics is taking minimally invasive surgery one step further.

In 2024, the FDA approved the single-port robotic platform for thoracic surgery, although only a handful of centers worldwide offer it. "Given our institutional experience with the single-port system and high volume of patients with mediastinal masses, we sought to implement single-port robotic thymectomy to provide another option for surgery," says Dennis Wigle, M.D., Ph.D., a thoracic surgeon at Mayo Clinic in Rochester, Minnesota.

Accessing the thymus through a single incision

The single-port robotic system is well designed for operating in tight spaces such as the anterior mediastinum, where the thymus is located. To perform a single-port thymectomy, the surgeon:

1. Installs the port below the xiphoid process through an incision a few centimeters long.
2. Passes the 3D, high-definition camera and two or three additional robotic arms through the diaphragm and into the thoracic cavity.
3. Spreads out the robotic arms and triangulates to the thymus.
4. Uses grasping, cutting and cauterizing tools to dissect the tissue, seal blood vessels and remove the thymus.

In general, subxiphoid single-port robotic thymectomy is appropriate for people with noninvasive tumors and other thymic abnormalities up to about 4 cm. Thoracic surgeons at Mayo Clinic have started expanding these criteria. For example, they have used the single-port system to remove a thymoma that had invaded the pericardium. The procedure required the complex task of removing and reconstructing the pericardial tissue. In other surgeries, tumors larger than 5 cm have been successfully removed. Surgeons approach these procedures thoughtfully and only when the anatomy, safety profile and surgical team's experience make single‑port access an appropriate choice.

Implementing a new type of surgery

The single-port platform is more challenging to use than a multiport platform. Because the instruments are inserted through one cut, the surgeon must keep the instruments separate as they navigate the narrow spaces.

While the surgeon sits at the console, the bedside team exchanges the instruments and ensures their proper positioning. The anesthesiologist and surgical assistants help manage the patient. As with any operation, close coordination is essential. Having a long history of performing a high volume of thymectomies using the multiport robotic system has made implementing single-port surgery quicker and easier for the entire team.

Benefits of subxiphoid single-port robotic thymectomy

The goal of performing a thymectomy through one versus multiple incisions is to further enhance recovery while achieving cancer outcomes equivalent to those of open surgery.

The team has observed rapid healing with single-port robotic surgery. "We typically don't leave chest tubes in place, and wound care is minimal. So far, a number of patients have gone home on the day of surgery, which typically doesn't happen with multiport robotic procedures," Dr. Wigle says.

This fast recovery makes the single-port approach ideal for patients who travel to Mayo Clinic for surgery. For patients who undergo this procedure, postsurgical follow-up includes a video or phone checkup at 4 to 6 weeks. Small tumors rarely require additional cancer treatment, so patients can see their local healthcare professionals for oncological surveillance, with Mayo Clinic support as needed.

Improved safety is another benefit of single-port robotic surgery. Subxiphoid access allows the surgeon to better see and avoid the phrenic nerves that control breathing. These nerves travel through the anterior mediastinum to the diaphragm. In multiport robotic surgery, the surgeon enters through the right or left side and can see only one phrenic nerve well. By bringing the camera up through the subxiphoid midline, the single‑port system re-creates the bilateral exposure of an open sternotomy. This approach gives the surgeon a full, symmetrical view of both nerves and enhances the safety of the dissection.

When it comes to oncological outcomes, single-port robotic thymectomy allows surgeons to achieve total resection of the thymus. Mayo Clinic researchers are tracking patients to assess long-term outcomes.

"As technology improves, we're able to perform more-detailed procedures through fewer incisions. We can give patients good results while allowing them to get back to their lives more quickly," Dr. Wigle says.

For more information

Refer a patient to Mayo Clinic.