title: Three-year experience with totally endoscopic robotic thymectomy.
abstract: BACKGROUND
  : Robotic technology has facilitated the evaluation and treatment of anterior mediastinal pathology. We describe a 3-year experience using the da Vinci Robotic Surgical System to perform thymectomies for a range of diseases.
  
  
  METHODS
  : From March 2002 to November 2004, 9 patients (3 myasthenia gravis, 3 mediastinal mass, 2 myasthenia gravis plus thymoma, 1 hyperparathyroidism) underwent totally endoscopic robotic thymectomy. Medical records and operative databases were reviewed. The cohort was divided into an early experience (group A) and a later experience (group B). Data were analyzed with the Fisher exact test and Mann-Whitney test.
  
  
  RESULTS
  : Complete robotic resection of the thymus was accomplished in all 9 patients. The mean age for the entire cohort was 40 ± 12 years (range 28-66 years) and 78% of the patients were women. No significant differences in age, gender, or operative conversions were detected between the groups. Patients in group A were more likely to have a bilateral approach. Group B demonstrated statistically significant reductions in operating room and operation time and a trend toward decreased chest tube days and length of stay. No morbidity or mortality associated with the procedure was noted in either group.
  
  
  CONCLUSIONS
  : Robotic thymectomy is a safe and effective procedure. Its steep learning curve promises to allow more surgeons to adopt minimally invasive approaches to the mediastinum safely and efficiently.
authors.affiliation: St. Luke's-Roosevelt Hospital Center, College of Physicians and Surgeons, Columbia University, New York, NY.
authors.forename: Charles Y
authors.initials: CY
authors.lastname: Ro
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Derose
authors.forename: Cliff P
authors.initials: CP
authors.lastname: Connery
authors.forename: Sandhya K
authors.initials: SK
authors.lastname: Balaram
authors.forename: Robert C
authors.initials: RC
authors.lastname: Ashton