AB012. Short-term outcome of robotic subxiphoid-optical thymectomy for malignant thymic epithelial tumors
Original Research

AB012. Short-term outcome of robotic subxiphoid-optical thymectomy for malignant thymic epithelial tumors

Masayoshi Inoue, Masanori Shimomura, Satoru Okada, Tatsuo Furuya, Chiaki Nakazono

Division of Thoracic Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan

Correspondence to: Masayoshi Inoue, MD, PhD. Division of Thoracic Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kamigyo-Ku, Kyoto 6028566, Japan. Email: mainoue@koto.kpu-m.ac.jp.

Background: Robotic thymectomy has been accepted as a minimally invasive surgery for thymic epithelial tumors (TETs). Two main different approaches via subxiphoid or lateral access into anterior mediastinum have been reported. We review our standard procedure of robotic subxiphoid-optical thymectomy (RST) and aim to show the technical advantages of the fine surgical field of view in total thymectomy and combined resection of neighboring structures for malignant TETs.

Methods: Under spine position, only robotic scope is inserted via subxiphoid port without wound retractable device and Maryland-type dissectors are applied via bilateral 6th intercostal spaces on mid-clavicular line. An assist port is placed at the right 3rd intercostal space on anterior axillar line for artificial CO2 insufflation using AirSeal® (Figure 1). RST was indicated in 54 anterior mediastinal lesions and 28 TETs cases are investigated.

Results: Pathological diagnoses are 26 thymomas [World Health Organization (WHO) type A 6, AB 7, B1 2, B2 8, B3 2, micronodular 1] and 2 thymic squamous cell carcinomas. Pathological staging was Masaoka stage I 6, II 20, III 2, and TNM stage I 26, II 1, III 1 patients. Myasthenia gravis (MG) is associated in 4 patients and 2 patients showed the elevation of serum anti-acetylcholine antibody without MG symptom. We experienced one Morvan syndrome and one Good syndrome with pure red cell aplasia cases. Total and subtotal thymectomies were performed in 27 and 1 patients, respectively. A combined resection of the innominate vein with the phrenic nerve was performed in a thymic carcinoma, and a partial pericardium resection was experienced in a B2 invasive thymoma. The median operative and console durations were 177 and 115 minutes, respectively. Neither open median sternotomy conversion nor transfusion was observed. One patient with pericardial resection showed post-pericardiotomy syndrome requiring readmission. No recurrent case was found in the short-term follow-up with the median of 2 years.

Conclusions: RST is a safe and useful procedure applicable to extended resection for TETs. The excellent surgical field of view from subxiphoid scope and exquisite manipulation could realize the similar procedure to the median sternotomy approach.

Keywords: Robotic surgery; thymic epithelial tumor (TET); thymectomy

Figure 1 Ports placement in robotic subxiphoid-optical thymectomy. ICS, intercostal space.

Acknowledgments

None.

Footnote

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://med.amegroups.com/article/view/10.21037/med-25-ab012/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study was approved by the institutional ethics board of Kyoto Prefectural University of Medicine (No. ERB-C-2718-1) and individual consent for this retrospective analysis was waived.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/med-25-ab012
Cite this abstract as: Inoue M, Shimomura M, Okada S, Furuya T, Nakazono C. AB012. Short-term outcome of robotic subxiphoid-optical thymectomy for malignant thymic epithelial tumors. Mediastinum 2025;9:AB012.

Article Options

Download Citation

Share