8 Years’ experience with robotic thymectomy for thymomas

• DOI: 10.1007/s00464-013-3309-5
• Publication Date: 2013-11-14T15:18:44Z
• Authors: Marlies Keijzers; Anne-Marie C. Din...; Hans Blaauwgeers; Robert Jan van Su...; Monique Hochstenbag; Leen van Garsse; Ryan Accord; Mark de Baets; Jos Maessen
• Keywords: Adult; Male; Time Factors; Thymoma; Biopsy; 03 medical and health sciences; Imaging, Three-Dimensional; 0302 clinical medicine; Minimally invasive surgery; Humans; Aged; Netherlands; Retrospective Studies; Aged, 80 and over; Robotic surgery; Robotics; Thymus Neoplasms; Middle Aged; Thymectomy; 3. Good health; Survival Rate; Feasibility Studies; Female; Morbidity; Follow-Up Studies

The accuracy of a three-dimensional robotic-assisted videothoracoscopic approach may favor a radical resection of thymomas. The aim of this study was to demonstrate the feasibility of the robotic approach by reporting 8 years experience in a single referral center of surgical treatment of thymomas.We retrospectively analyzed all consecutive patients who underwent a thymectomy from April 2004 to April 2012. We analyzed the procedure time, morbidity, mortality, conversions, hospitalization, freedom from recurrence, time to progression, and overall survival.From 2004 until 2012, a total of 138 robotic procedures for mediastinal tumors were performed in our center, of which 37 patients with a mean age of 57.3 years underwent a thymectomy for a thymoma. Histological analysis revealed four type A thymomas (10.8 %), seven type AB thymomas (18.9 %), seven type B1 thymomas (18.9 %), fourteen type B2 thymomas (37.8 %), four type B3 thymomas (10.8 %), and one thymus carcinoma (2.7 %). The Masaoka–Koga stages were as follows: stage I in twenty patients (54 %), stage IIA in five patients (13.5 %), stage IIB in eight patients (21.6 %), stage III in three patients (8.1 %), and stage IVa in one patient (2.7 %). The mean overall procedure time was 149 min (range 88–353). No surgical mortality was reported, and there were no peri-operative complications. No conversions were needed for surgical complications. In three cases, a conversion to sternotomy was preferred by the surgeon because tumor invasion in greater vessels was suspected. Two patients (5.4 %) suffered from a myasthenic crisis postoperatively and required prolonged mechanical ventilation. One patient (2.7 %) underwent a procedure for a thoracic herniation 6 months following thymectomy. The median hospitalization was 3 days. The follow-up analysis showed an overall survival of 100 % and tumor recurrence in one patient (2.7 %).Robotic thymectomies are safe in patients with early-stage thymomas. Robotic surgery may also be feasible for some selected advanced thymomas.