8 years' experience with robotic thymectomy for thymomas.
BACKGROUND
The accuracy of a three-dimensional robotic-assisted videothoracoscopic approach may favor a radical resection of thymomas. The aim of this study was to demonstrate the feasibility of the robotic approach by reporting 8 years experience in a single referral center of surgical treatment of thymomas.


METHODS
We retrospectively analyzed all consecutive patients who underwent a thymectomy from April 2004 to April 2012. We analyzed the procedure time, morbidity, mortality, conversions, hospitalization, freedom from recurrence, time to progression, and overall survival.


RESULTS
From 2004 until 2012, a total of 138 robotic procedures for mediastinal tumors were performed in our center, of which 37 patients with a mean age of 57.3 years underwent a thymectomy for a thymoma. Histological analysis revealed four type A thymomas (10.8 %), seven type AB thymomas (18.9 %), seven type B1 thymomas (18.9 %), fourteen type B2 thymomas (37.8 %), four type B3 thymomas (10.8 %), and one thymus carcinoma (2.7 %). The Masaoka–Koga stages were as follows: stage I in twenty patients (54 %), stage IIA in five patients (13.5 %), stage IIB in eight patients (21.6 %), stage III in three patients (8.1 %), and stage IVa in one patient (2.7 %). The mean overall procedure time was 149 min (range 88–353). No surgical mortality was reported, and there were no peri-operative complications. No conversions were needed for surgical complications. In three cases, a conversion to sternotomy was preferred by the surgeon because tumor invasion in greater vessels was suspected. Two patients (5.4 %) suffered from a myasthenic crisis postoperatively and required prolonged mechanical ventilation. One patient (2.7 %) underwent a procedure for a thoracic herniation 6 months following thymectomy. The median hospitalization was 3 days. The follow-up analysis showed an overall survival of 100 % and tumor recurrence in one patient (2.7 %).


CONCLUSIONS
Robotic thymectomies are safe in patients with early-stage thymomas. Robotic surgery may also be feasible for some selected advanced thymomas.
Marlies
M
Keijzers
Anne-Marie C
AM
Dingemans
Hans
H
Blaauwgeers
Robert Jan
RJ
van Suylen
Monique
M
Hochstenbag
Leen
L
van Garsse
Ryan
R
Accord
Mark
M
de Baets
Jos
J
Maessen
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009426:Netherlands / Q000453:epidemiology; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D013934:Thymectomy / Q000379:methods*; D013945:Thymoma / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D013953:Thymus Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed