[Efficacy analysis of the "six-step" robot-assisted subxiphoid extended thymectomy for myasthenia gravis]

To evaluate the clinical effect of the"six-step" robot-assisted subxiphoid extended thymectomy for myasthenia gravis. Clinical data of 45 patients with myasthenia gravis were retrospectively collected from the First Affiliated Hospital of Fujian Medical University between November 2022 and June 2025, including 22 males and 23 females, with the age of (48.0±12.0) years. Robot-assisted subxiphoid extended thymectomy was performed using a "six-step" approach. Perioperative data were collected, including operative time, intraoperative blood loss, postoperative thoracic drainage time and volume, length of postoperative hospital stay, postoperative complications, pathologic findings, and follow-up outcomes. All 45 procedures were completed without conversion or incision extension. The operation time was (158±26) min, the intraoperative blood loss was 15(8, 20) ml, the thoracic drainage time was 3(2, 3) d, and the postoperative thoracic drainage volume were 180.0(17.5, 400.0) ml on postoperative day 1, 40.0(10.0, 65.0) ml on postoperative day 2, and 15.0(7.5, 35.0) ml on postoperative day 3. The length of postoperative hospital stay was 4(3, 5) d. Postoperative complications occurred in 4 patients, including 1 case of hoarseness, 1 case of myasthenic crisis, and 2 cases of pulmonary infection, all of whom improved or recovered after symptomatic treatment. Pathology showed thymic hyperplasia in 9 cases and thymoma in 36 cases,among which ectopic thymus tissue was identified in 19 cases. Follow-up was conducted up to October 31, 2025, with a follow-up duration of 24.0(14.0, 29.0) months. No recurrence of complications, tumor recurrence or metastasis, or death was observed during follow-up."six-step" robot-assisted subxiphoid extended thymectomy is safe and feasible with favorable short-term outcomes and offers a standardized, generalizable approach for myasthenia gravis surgery.