Intraoperative complications during robotic thymectomy and their management: a narrative review

Complete thymectomy is the established treatment for thymic epithelial tumors (TET) and often included in the management of myasthenia gravis. Minimally invasive approaches, including robotic-assisted techniques, have gained acceptance for their benefits in reducing postoperative pain and recovery time. Thymectomy poses risks due to the proximity of the thymus to critical mediastinal structures, and intraoperative complications confronted on the robotic platform can be precarious. Current literature on intraoperative complications is fragmented and limited, and lacks emphasis on the nuance brought about by the robotic platform specifically. The aim of this narrative review is to comprehensively explore such possible complications and to discuss their distinct management strategies in a systematic manner.

We review the literature by examining the PubMed database between 2000 and 2024 for relevant studies that report the intraoperative and postoperative complications of robotic thymectomy. The technique of robotic thymectomy is also described.

Robotic thymectomy offers a safe and oncologically effective approach to treatment. It is met with a low complication rate that is not increased compared to the open approach. Common complications include injury to nearby structures such as the internal mammary vessels, brachiocephalic vein (BCV), superior vena cava (SVC), phrenic nerve, and recurrent laryngeal nerve. Each complication requires a distinct management strategy that is concordant with an understanding of the limitations of the robotic platform.

This narrative review focuses on the intraoperative complications encountered during robotic thymectomy and provides an in-depth review of strategies for managing these complications, emphasizing the importance of preoperative planning, understanding the robotic platform's limitations, and the need for a well-coordinated surgical team. Reviewing the complexity of such complications and their nuanced management strategies is not only beneficial for surgeons in their clinical practice, but also to develop scientific curiosities surrounding this topic to ultimately improve patient outcomes. As such, studies elaborating on the details of such complications while on the robotic platform are necessary.