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Robot-Assisted Versus Video-Assisted Thymectomy: A Narrative Review of Current Evidence
Seon Yong Bae1, Kwon Joong Na1,2
1Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul 03080, Republic of Korea.
Summary
Robot-assisted thoracoscopic surgery (RATS) offers advantages for complex thymectomy cases, matching outcomes of video-assisted thoracoscopic surgery (VATS). RATS provides benefits like less blood loss but has higher costs, requiring careful consideration for adoption.
Area of Science:
- Thoracic surgery
- Surgical oncology
- Minimally invasive procedures
Background:
- Minimally invasive thymectomy, including VATS and RATS, has advanced thymic epithelial tumor and myasthenia gravis treatment.
- RATS offers potential ergonomic benefits over VATS but at a higher cost.
- Evidence comparing RATS to VATS and open thymectomy is reviewed.
Purpose of the Study:
- To clarify indications for RATS in thymectomy.
- To evaluate oncological validity and perioperative performance of RATS versus VATS and open thymectomy.
- To assess the economic implications of RATS.
Main Methods:
- A structured narrative review of multi-institutional cohorts, registry-based studies, and systematic reviews.
- Evidence organized by tumor characteristics, special populations, outcomes, surgeon considerations, and cost-effectiveness.
- Comparison of RATS, VATS, and open thymectomy.
Main Results:
- Both VATS and RATS achieve high R0 resection rates and comparable recurrence outcomes to sternotomy for early-stage thymoma and myasthenia gravis.
- RATS shows lower blood loss, fewer conversions, and faster recovery, especially in obese or redo cases.
- Long-term survival is equivalent across minimally invasive approaches; RATS incurs higher costs.
Conclusions:
- VATS is efficient for simple cases; RATS can extend minimally invasive options to complex scenarios while preserving oncological outcomes.
- Adoption of RATS should be indication-driven and resource-aware.
- Further studies on long-term outcomes, patient-reported results, and cost-effectiveness are needed for RATS' role in thymectomy.
