title: Comparison of robotic and nonrobotic thoracoscopic thymectomy: a cohort study.
abstract: OBJECTIVE
  Radical thymectomy has become more popular in the comprehensive treatment of myasthenia gravis. Minimally invasive techniques are increasingly used for thymectomy. The most recent development in robotic thoracoscopic surgery has been successfully applied for mediastinal pathologies. To establish robotic technique as a standard, the results of high-volume centers and comparison with traditional surgery are mandatory.
  
  
  METHODS
  In a retrospective cohort study, the results of 79 thoracoscopic thymectomies (October 1994 to December 2002) were compared with the results of 74 robotic thoracoscopic thymectomies (January 2003 to August 2006). Data from both series were collected prospectively. In both groups, all patients had myasthenia gravis. Both cohorts were compared with respect to severity of disease, gender, age, histology, and postoperative morbidity. All patients were analyzed for quantification of improvement of disease according to the Myasthenia Gravis Foundation of America.
  
  
  RESULTS
  There were no differences in age distribution and severity of myasthenia gravis. The dominant histologic finding was follicular hyperplasia of the thymus in both groups with a significantly higher percentage in the thoracoscopic thymectomy series (68% vs 45%, P < .001). After a follow-up of 42 months, the cumulative complete remission rate of myasthenia gravis for robotic and nonrobotic thymectomy was 39.25% and 20.3% (P = .01), respectively.
  
  
  CONCLUSIONS
  There is an improved outcome for myasthenia gravis after robotic thoracoscopic thymectomy compared with thoracoscopic thymectomy.
authors.affiliation: Department of General, Visceral, Vascular and Thoracic Surgery, Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany. jens-c.rueckert@charite.de
authors.forename: Jens C
authors.initials: JC
authors.lastname: Rückert
authors.forename: Marc
authors.initials: M
authors.lastname: Swierzy
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Ismail
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001284:Atrophy; D002648:Child; D005260:Female; D005858:Germany; D006801:Humans; D006965:Hyperplasia; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012371:Robotics; D012720:Severity of Illness Index; D025321:Surgery, Computer-Assisted / Q000009:adverse effects; D013906:Thoracoscopy / Q000009:adverse effects; D013934:Thymectomy / Q000009:adverse effects / Q000379:methods*; D013950:Thymus Gland / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult