Robotic thymectomy: The Hong Kong experience.

Abstract

Thymectomy is widely employed as part of the management for generalized myasthenia gravis. The surgical approach has evolved over the years, and although there is no consensus regarding the optimal surgical approach, minimally invasive techniques such as video-assisted thoracoscopic thymectomy have gained popularity. Robotic-assisted surgical systems have been employed in recent years to perform thymectomies as the robotic arm allows extra wrist action of the instruments which provide seven degrees of movement, giving improved dexterity compared to the conventional thoracoscopic approach. Here we describe our early experience with the da Vinci system in thymectomy. Between April 2006 and November 2009, 12 robotic-assisted complete thymectomy procedures were performed with no need for conversion to open procedures. Operation times ranged from 100 minutes to 200 minutes (mean time 140 minutes). There were no intraoperative or postoperative complications. Nearly all chest drains were removed on postoperative day 1 and the mean hospital stay was 4 days. The follow-up period ranged from 2 to 44 months. Early postoperative evaluations showed one patient had complete remission of symptoms (DeFilippi class 1) and 11 patients became asymptomatic or less symptomatic with a decreased medication requirement (DeFilippi class 2 and 3). Our early experience suggests that robotic thymectomy is comparable to video-assisted thoracic surgery thymectomy, and our results appear to be comparable to those reported in the literature. A larger number of cases and more extended follow up is needed to fully evaluate the merits of robotic thymectomy.