title: Robot-aided thoracoscopic thymectomy for early-stage thymoma: a multicenter European study.
abstract: OBJECTIVE
  Minimally invasive thymectomy for stage I to stage II thymoma has been suggested in recent years and considered technically feasible. However, because of the lack of data on long-term results, controversies still exist on surgical access indication. We sought to evaluate the results after robot-assisted thoracoscopic thymectomy in early-stage thymoma.
  
  
  METHODS
  Data were collected from 4 European centers. Between 2002 and 2011, 79 patients (38 men and 41 women; median age, 57 years) with early-stage thymoma were operated by left-sided (82.4%), right-sided (12.6%), or bilateral (5%) robotic thoracoscopic approach. Forty-five patients (57%) had associated myasthenia gravis.
  
  
  RESULTS
  Average operative time was 155 minutes (range, 70-320 minutes). One patient needed open conversion, in 1 patient a standard thoracoscopy was performed after robotic system breakdown, and in 5 patients an additional access was required. No vascular and nervous injuries were recorded, and no perioperative mortality occurred. Ten patients (12.7%) had postoperative complications. Median hospital stay was 3 days (range, 2-15 days). Median diameter of tumor resected was 3 cm (range, 1-12 cm), and Masaoka stage was stage I in 30 patients (38%) and stage II in 49 patients (62%). At a median follow-up of 40 months, 74 patients were alive and 5 had died (4 patients from nonthymoma-related causes and 1 from a diffuse intrathoracic recurrence), with a 5-year survival rate of 90%.
  
  
  CONCLUSIONS
  Our data indicate that robot-enhanced thoracoscopic thymectomy for early-stage thymoma is a technically sound and safe procedure with a low complication rate and a short hospital stay. Oncologic outcome seems good, but a longer follow-up is needed to consider this as a standard approach definitively.
authors.affiliation: Thoracic Surgery Division, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy. giuseppe.marulli@unipd.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Marulli
authors.forename: Federico
authors.initials: F
authors.lastname: Rea
authors.forename: Franca
authors.initials: F
authors.lastname: Melfi
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Schmid
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Ismail
authors.forename: Olivia
authors.initials: O
authors.lastname: Fanucchi
authors.forename: Florian
authors.initials: F
authors.lastname: Augustin
authors.forename: Marc
authors.initials: M
authors.lastname: Swierzy
authors.forename: Francesco
authors.initials: F
authors.lastname: Di Chiara
authors.forename: Alfredo
authors.initials: A
authors.lastname: Mussi
authors.forename: Jens C
authors.initials: JC
authors.lastname: Rueckert
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005060:Europe; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D012371:Robotics; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000401:mortality; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000401:mortality; D013934:Thymectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D013953:Thymus Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult