The expanding role of robotic surgery in thymectomy: a narrative review

Surgical resection for thymic epithelial tumors has traditionally been performed via a median sternotomy or video-assisted thoracoscopic surgery (VATS). In recent years, however, robot-assisted thoracoscopic surgery (RATS) has been increasingly adopted as a minimally invasive alternative, with a growing number of reports. This review summarizes the progress achieved to date and outlines future perspectives in robot-assisted thymectomy.

This narrative review was conducted through a structured literature search of PubMed, including articles published up to November 2025. The search strategy combined the terms ("thymectomy"[MeSH] OR thymectomy) AND ("video-assisted thoracoscopic surgery" OR VATS OR "robot-assisted thoracoscopic surgery" OR RATS OR "robotic surgery"). Eligible articles included original clinical studies, comparative analyses, large case series, and selected case reports evaluating robotic approaches to thymectomy. Both retrospective and prospective studies were considered. Non-English-language publications were excluded. Reference lists of relevant articles were also manually screened to identify additional pertinent studies. Given the narrative nature of this review, no formal meta-analysis was performed.

This review traces the evolution of robotic surgery in thymectomy, evaluates current evidence regarding indications and perioperative/oncologic outcomes, and examines the expanding array of surgical approaches enabled by contemporary robotic platforms. It also highlights emerging technologies and future directions that may shape the continued advancement of robotic thymectomy. By integrating these themes, the review synthesizes the existing evidence base and provides a framework for anticipating the future trajectory of this technique.

Accumulating evidence on robot-assisted thymectomy suggests that further innovations and refinements in surgical techniques will continue to emerge. As the technology evolves and surgical expertise deepens, these advancements are expected not only to enhance operative precision and safety but also to broaden the indications of the robotic approach, potentially allowing its application to more extensive and complex procedures in the future.