Comparison of Short-Term Surgical Outcomes for Thymectomy With Various Minimally Invasive Approaches: A Single-Centre Experience

Abstract

Objectives: Minimally invasive thymectomy, encompassing video-assisted thoracoscopic surgery and robotic-assisted thoracic surgery, is increasingly being adopted as an alternative to sternotomy. However, comparative data on commonly used minimally invasive techniques remain limited. This study aimed to compare the short-term surgical outcomes of 3 approaches: lateral video-assisted thoracoscopic surgery, lateral robotic-assisted thoracic surgery and subxiphoid robotic-assisted thoracic surgery.

Methods: We retrospectively reviewed 292 patients who underwent minimally invasive thymectomy for anterior mediastinal masses between October 2020 and April 2024. Patients were categorized into 3 groups according to the surgical approach. Perioperative outcomes, including operating time, postoperative pain, hospital stay, and complications, were compared.

Results: Of the 292 patients, 155 underwent lateral video-assisted thoracoscopic surgery; 70 underwent lateral robotic-assisted thoracic surgery; and 67 underwent subxiphoid robotic-assisted thoracic surgery. Operative time was significantly longer in both robotic-assisted thoracic surgery groups compared to video-assisted thoracoscopic surgery (lateral robotic-assisted thoracic surgery: 118.7 min; subxiphoid robotic-assisted thoracic surgery: 116.7 min; video-assisted thoracoscopic surgery: 93.5 min; P < .001). No significant differences were observed among the 3 groups in terms of postoperative pain, chest tube duration, hospital stay, complication rate, or R0 resection. No in-hospital deaths occurred.

Conclusions: All 3 minimally invasive approaches for thymectomy demonstrated comparable short-term outcomes, although robotic-assisted thoracic surgery procedures had longer operating times. These findings suggest that lateral video-assisted thoracoscopic surgery, lateral robotic-assisted thoracic surgery, and subxiphoid robotic-assisted thoracic surgery are all safe and effective options, enabling surgeons to select the most appropriate technique based on individual patient characteristics and their surgical expertise.

Keywords: minimally invasive approach; robotic-assisted thoracic surgery; thymectomy; video-assisted thoracoscopic surgery.