Robotic vs. Thoracoscopic Thymectomy for Thymoma

Abstract

Minimally invasive approaches to mediastinal surgery have been associated with improved short term outcomes, notably less pain, fewer pulmonary complications, and shorter length of stay, while importantly demonstrating equal long-term oncologic outcomes when compared to traditional open approaches. The comparison has primarily been between median sternotomy and standard thoracoscopic approaches (VATS). The development of robotic surgery has led to an increase in robotic utilization in thoracic surgery overall, and more specifically minimally invasive thymectomy. We sought to assess whether a robotic approach offers any advantages to a VATS approach for thymectomy in patients with encapsulated thymoma. There is very little data specifically comparing these approaches in this patient population. The preponderance of evidence, most of which is from low quality, small retrospective studies, shows a slight advantage for a robotic approach driven by a shorter length of stay and lower conversion rate. This improvement in chest tube duration, conversions, and length of stay was associated with increased costs for the procedure. There were no differences in long-term outcomes seen in any of the studies reviewed.