Robotic thymectomy

Timothy Mark Lee, Robert J. Cerfolio


Thymectomy is performed for malignant tumors and benign tumors of the thymus or for when there is known myasthenia gravis. The traditional approach for thymectomy has been midline sternotomy. Video-assisted thoracoscopic surgery (VATS) has been utilized but with some unique difficulties due to the thymus’ location in the anterior midline position. Robotic thymectomy offers a superior approach to VATS and is less invasive compared to sternotomy. We utilize the Da Vinci Surgical System for robotic thymectomy. A right or left sided approach can be utilized. We utilize a left sided double lumen tube for intubation. Three robotic arms are utilized for the operation with a 30-degree scope. For invasive tumors, pericardiectomy and innominate vein resection can be utilized with the robot. Robotic thymectomy achieves excellent perioperative and long term outcomes. Typical postoperative stay is 1–2 days. Robotic thymectomy results in less blood loss in the OR, less drainage output, and shorter hospital length with shorter duration of chest tubes compared to sternotomy. Compared to VATS thymectomy, robotic thymectomy provides high definition 3D views, improved dexterity and precision of movement with rotating wrists. We demonstrate our technique of robotic thymectomy in written and video format. This technique permits a safe operation with minimal perioperative morbidity.