Subxiphoid approach for robotic single-site-assisted thymectomy.

Area of Science:

• Minimally Invasive Surgery
• Thoracic Surgery
• Robotic Surgery

Background:

• Previous transthoracic robotic thymectomy experience using the da Vinci Single-Site platform was reported.
• This study builds upon prior work by evaluating a novel subxiphoid approach.

Purpose of the Study:

• To describe the outcomes of robotic single-site thymectomy via a subxiphoid approach.
• To assess the safety and feasibility of this minimally invasive technique.

Main Methods:

• 13 patients underwent single-site robotic thymectomy via a subxiphoid approach between September 2018 and October 2019.
• A small vertical incision was used for port placement and CO2 insufflation.
• Robotic instruments were utilized for the procedure, with minor thoracoscopic assistance for inferior dissection.

Main Results:

• All 13 surgeries were completed successfully without conversion to open procedures.
• Mean operative time was 167.3 minutes, with an average chest drainage duration of 2.2 days.
• Histopathology confirmed thymoma in 10 patients, thymolipoma in 2, and atypical carcinoid tumor in 1, all with clear resection margins.

Conclusions:

• Robotic single-site thymectomy via the subxiphoid approach is a safe and technically feasible procedure.
• This approach offers a minimally invasive option for thymectomy.
• The technique is expected to be applicable to more complex cases with further platform development.