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OBJECTIVE: Robotic thymectomy has been well described for the management of myasthenia gravis (MG) and thymic tumors. A radical “phrenic-to-phrenic” thymectomy is the standard of care for MG patients. Robotic-assisted thoracoscopic thymectomy provides a minimally invasive platform for this goal that avoids the morbidity of a median sternotomy and provides better visualization and a more delicate dissection in comparison to other minimally invasive techniques. We decided to start our robotic surgery program with mediastinal surgery and the aim of this study was to assess the results.
METHODS: Fifteen patients who underwent robotic mediastinal tumor resection and thymectomy at our institution were reviewed. We pursued a robotic approach to thymectomy because the small compact space of the anterior mediastinum is ideally suited for a robotic approach given the 10x magnification and end wrist movements. MG patients with and without thymomas and patients with mediastinal tumors without MG were included in the study. Intraoperative data were reviewed from operative records and postoperative outcomes from hospital charts. Disease response in MG cases was evaluated before and after surgery in cooperation with a neurologist specialized in MG.
RESULTS: Fifteen patients were reviewed; 9 left sided and 6 right sided approaches were done. Eight patients suffered from MG and 7 from other mediastinal tumors without MG. MG patients were medically treated before surgery. Mean operative time was 90 minutes, mean intraoperative blood loss 20 milliliter, mean chest drainage postoperatively for 1.5 days and on postoperative day 2.5 all the patients were discharged home uneventfully. The pathology in MG patients was thymic hyperplasia (6 patients), Masaoka A/B type thymomas (2 patients). In the other 7 patients the pathology was thymic benign tumor in 5 and carcinoma of metastatic origin in 2.
CONCLUSIONS: Robotic-assisted mediastinal surgery is safe and effective for MG patients and patients with other mediastinal tumors. No morbidity, mortality, complications or conversion rates were recorded in our series We are completing the building of institutional guidelines for our mediastinal robotic surgery program based on the recent recommendations in the field and have decided to continue the program with other surgical procedures.