AB042. Robotic-assisted surgery for large thymomas: preliminary results on feasibility and safety in a single center experience
Observational Retrospective Study (Original Research)

AB042. Robotic-assisted surgery for large thymomas: preliminary results on feasibility and safety in a single center experience

Beatrice Trabalza Marinucci, Fabiana Messa, Giorgia Piccioni, Matteo Tiracorrendo, Alessandra Siciliani, Erino Angelo Rendina, Mohsen Ibrahim

Division of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy

Correspondence to: Beatrice Trabalza Marinucci, MD, PhD student. Division of Thoracic Surgery, Sant’Andrea Hospital, Sapienza University of Rome, Via di Grottarossa, 1035/1039, Rome, Lazio, 189, Italy. Email: beatrice.trabalzamarinucci@uniroma1.it.

Background: Thymic tumor size has been frequently considered a factor limiting the indication for minimally invasive surgery. Robotic-assisted thoracic surgery (RATS) has been mainly offered to patients with limited thymoma up to 4 cm. However, considering increasing experience in the field and improved technical skills, RATS has proved to allow safe resection of larger lesions. To date, RATS thymectomy for large and advanced thymomas remains controversial and there is no a general consensus. The present retrospective study aims to evaluate the feasibility and the safety of RATS thymectomy for the treatment of large thymomas.

Methods: Between May 2021 and February 2025, 88 consecutive patients underwent RATS thymectomy in the Division of Thoracic Surgery of Sant’Andrea Hospital, Sapienza University of Rome, Italy. Patients older than 18 years old, with histology of thymoma, both myasthenic and non-myasthenic, with lesions larger than 5 cm were included (Figure 1), with a final sample of 70 patients. Data on lesions side, dimensions, associated resections, time of surgery, complications, conversion rate, final pathology, length of stay, adjuvant therapy and survival, were retrospectively analyzed.

Results: Mean tumor size in the study cohort was 6.69±1.92 cm (range, 5–10 cm). Five patients (7.14%) presented with myasthenia. The mean operative time excluding docking-undocking time was 52.31±16.52 minutes. Associated resections were 11 (15.71%): 3 pericardium portion, 3 pleura nodules, 4 lung resections, and 1 anonymous vein. No conversion rate was described and only 4 minor complications (atrial fibrillation, pleura effusion) were reported. Five patients received R1 resections and 3 of them underwent adjuvant radiation. A total of 7 patients (10%) received post-operative radiation. At the median follow-up of 36 months, no mortality was described.

Conclusions: Previous studies reported that the optimum diameter of resected thymomas was 4 cm, thus aiming to reduce the risk of capsule rupture during excision. According to our results, larger thymomas were successfully excised using RATS. Most of them (42.86%) were classified as Masaoka stage I, followed by 32.85% showing microscopic invasion. Importantly, no capsule ruptures were observed at pathology. Follow-up data showed excellent overall survival. Based on our preliminary results, RATS can be considered safe and feasible for large thymomas.

Keywords: Robotic-assisted thoracic surgery (RATS); thymoma; thymectomy

Figure 1 CT scan of a large thymoma. CT, computed tomography.

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-ab042/coif). B.T.M., M.I. and E.A.R. serve as members of the Resident Committee of the European Society for Cardio-Thoracic Surgery (EACTS). M.I. and E.A.R. also serve as members of the American Association for Thoracic Surgery (AATS). The other 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 regional ethics committee board of Lazio, Area 1. (No. 8066) 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-ab042
Cite this abstract as: Trabalza Marinucci B, Messa F, Piccioni G, Tiracorrendo M, Siciliani A, Rendina EA, Ibrahim M. AB042. Robotic-assisted surgery for large thymomas: preliminary results on feasibility and safety in a single center experience. Mediastinum 2025;9:AB042.

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