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8 Years’ experience with robotic thymectomy for thymomas

Abstract

Background

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.

Methods

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.

Results

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 %).

Conclusions

Robotic thymectomies are safe in patients with early-stage thymomas. Robotic surgery may also be feasible for some selected advanced thymomas.

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Disclosures

M.J. Keijzers MD, A.M. Dingemans MD, PhD, H. Blaauwgeers MD, R.J. van Suylen MD, PhD, M. Hochstenbag MD, PhD, L. van Garsse MD, PhD, R. Accord MD, M. de Baets MD, PhD and J. Maessen MD, PhD have no conflicts of interest or financial ties to disclose related to this manuscript.

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Correspondence to Jos Maessen.

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Keijzers, M., Dingemans, A.C., Blaauwgeers, H. et al. 8 Years’ experience with robotic thymectomy for thymomas. Surg Endosc 28, 1202–1208 (2014). https://doi.org/10.1007/s00464-013-3309-5

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Keywords

  • Thymoma
  • Minimally invasive surgery
  • Thymectomy
  • Robotic surgery