Initial results of the "lateral view preceding method" and subxiphoid robot-assisted extended thymectomy for patients...

This study evaluates the initial surgical results of our proposed minimally invasive extended thymectomy procedure using the "lateral view preceding method," which precedes dissection of the lower poles of the thymus and mediastinal fat around the cardiophrenic angles with lateral thoracoscopic views, followed by a robot-assisted subxiphoid approach for the remaining extended thymectomy.

The lateral view preceding method was introduced in October 2020. We retrospectively reviewed patients with suspected thymomas in the anterior mediastinum having anti-acetylcholine receptor antibodies who underwent minimally invasive extended thymectomy between April 2011 and April 2025. Surgical outcomes were analyzed and compared with those of conventional bilateral video-assisted thoracic surgery.

Nine patients, seven of whom had myasthenia symptoms, underwent the lateral view preceding approach. Mean operative, pre-robot, and robot console times were 261 ± 43, 79 ± 20, and 144 ± 28 min, respectively. No postoperative complications were observed. All patients with myasthenic symptoms showed improved minimal manifestations and better status. Compared with patients who underwent the lateral view preceding method, those who underwent the conventional approach (21 patients) had more ports (mean, 8.4 ± 1.3 and 4.2 ± 0.5, respectively, p < 0.001) and longer operative time (mean, 346 ± 117 min and 261 ± 43 min, respectively, p  = 0.024). Postoperative complications occurred in five (31%) patients who underwent the conventional approach.

Extended thymectomy using the lateral view preceding method resulted in safe and effective initial surgical outcomes. We believe that this is a promising and minimally invasive approach.