Robotic subxiphoid radical thymectomy for a thymoma

Robotic-assisted thoracic surgery has emerged as a prominent technique for performing radical thymectomies in patients affected by early-stage thymic tumours. This technique is favoured because of its high ergonomics, superior image quality, enhanced instrument manoeuvrability and exceptional precision. Among the different surgical approaches developed, the unilateral and the bilateral intercostal approaches are the most widely diffused. The subxiphoid approach offers several advantages over these approaches, providing a wide visualization of the entire mediastinum and of both pleural cavities while enabling bilateral dissection through a single bilateral small intercostal incision. It brings an optimal central view of the mediastinum, easy control of both phrenic nerves and enhanced dissection at the level of the superior thymic horns and the left brachiocephalic vein, all while minimizing intercostal trauma. We present a robotic subxiphoid radical thymectomy using the da Vinci Xi platform, illustrated by a case involving a patient with a 5-cm thymoma close to the left phrenic nerve.