Comparing the safety and effectiveness of surgical approaches in thymectomy

Objective

To compare the safety and effectiveness of different surgical approaches in thymectomy: robotics, subxiphoid, lateral video-assisted thoracoscopy surgery (LVATS) and open.

Methodology

We retrospectively reviewed 68 cases of thymectomy with a robot-assisted, subxiphoid, LVATS, open sternotomy or thoracotomy approach for thymic lesions or myasthenia gravis between July 2017 and May 2023 at a single centre. Peri-operative outcomes (operating time, estimated blood loss, conversion rates, R0 resection, adverse events and length of stay [LOS]) were collected.

Results

We observed six conversions to open (from five LVATS and one robot assisted). The median estimated blood loss was lower for LVATS (100.00 [50.0–100.0] mL) compared with open thymectomies (200.0 [150.0–400.0]; P < .001). No intra-operative adverse events were reported in the robotics, subxiphoid or LVATS groups. In patients with thymic tumours (n = 34), R0 resection was achieved in 100% (2/2) of robotics, 83% of subxiphoid (5/6), 93% (13/14) of LVATS and 75% (n = 9/12) of open cases. The median LOS was shortest for robot assisted (1.0 [interquartile range (IQR) 1.0–3.0]), then subxiphoid (2.0 [IQR 1.0–3.0]), LVATS (2.0 [IQR 1.0–3.0]) then open (5.0 [IQR 4.0–6.0]; P < .001).

Conclusions

Our results suggest that with a shorter LOS, robotics, subxiphoid and LVATS thymectomies are safe. Larger size studies are required to compare R0 resection rates between these less invasive surgical approaches.