One surgery, three approaches: perioperative outcomes and diagnostic strategies in robotic-assisted thymectomy

This study evaluated the safety and feasibility of robot-assisted thoracic surgery (RATS) thymectomy using right-sided, left-sided, and subxiphoid approaches, and explored methods for accurate preoperative diagnosis of thymic cysts to minimize unnecessary thymectomies for benign lesions.

We retrospectively analyzed patients who underwent RATS thymectomy via different approaches from 2020 to 2025. Patient characteristics and perioperative outcomes were compared. Receiver operating characteristic analysis was used to determine the optimal cutoff value for diagnosing thymic cysts.

A total of 240 patients were included. Operative time was shortest in the right-sided group (50.9 ± 26.9 min), followed by the left-sided (62.5 ± 28.3 min) and subxiphoid (70.2 ± 35.5 min) groups (p < 0.001). Intraoperative blood loss (p = 0.29), chest tube duration (p = 0.05), hospital stay (p = 0.81), and postoperative morbidity (p = 0.95) were comparable among groups. The optimal mean CT attenuation value for diagnosing thymic cysts was 54.33 HU, with 87.8% sensitivity (95% CI 78.2-94.3%) and 94.8% specificity (95% CI 87.2-98.6%).

RATS thymectomy using different approaches (right-sided, left-sided, and subxiphoid) is safe and effective for the treatment of anterior mediastinal masses. A mean CT attenuation value of 54.33 HU provides high diagnostic accuracy for thymic cysts.