Affiliation:
1. Department of Surgery, Faculty of Medicine University of Ottawa Ottawa Ontario Canada
2. Division of Thoracic Surgery The Ottawa Hospital Ottawa Ontario Canada
3. Ottawa Hospital Research Institute Ottawa Ontario Canada
4. School of Epidemiology and Public Health, Faculty of Medicine University of Ottawa Ottawa Ontario Canada
5. Ontario Health (Cancer Care Ontario) Toronto Ontario Canada
Abstract
AbstractObjectiveTo compare the safety and effectiveness of different surgical approaches in thymectomy: robotics, subxiphoid, lateral video‐assisted thoracoscopy surgery (LVATS) and open.MethodologyWe retrospectively reviewed 68 cases of thymectomy with a robot‐assisted, subxiphoid, LVATS, open sternotomy or thoracotomy approach for thymic lesions or myasthenia gravis between July 2017 and May 2023 at a single centre. Peri‐operative outcomes (operating time, estimated blood loss, conversion rates, R0 resection, adverse events and length of stay [LOS]) were collected.ResultsWe observed six conversions to open (from five LVATS and one robot assisted). The median estimated blood loss was lower for LVATS (100.00 [50.0–100.0] mL) compared with open thymectomies (200.0 [150.0–400.0]; P < .001). No intra‐operative adverse events were reported in the robotics, subxiphoid or LVATS groups. In patients with thymic tumours (n = 34), R0 resection was achieved in 100% (2/2) of robotics, 83% of subxiphoid (5/6), 93% (13/14) of LVATS and 75% (n = 9/12) of open cases. The median LOS was shortest for robot assisted (1.0 [interquartile range (IQR) 1.0–3.0]), then subxiphoid (2.0 [IQR 1.0–3.0]), LVATS (2.0 [IQR 1.0–3.0]) then open (5.0 [IQR 4.0–6.0]; P < .001).ConclusionsOur results suggest that with a shorter LOS, robotics, subxiphoid and LVATS thymectomies are safe. Larger size studies are required to compare R0 resection rates between these less invasive surgical approaches.