[Pubmed] Robot-Assisted Versus Video-Assisted Thymectomy: A Narrative Review of Current Evidence

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Eur J Cardiothorac Surg. 2026 Apr 1;68(Supplement_1):i1-i7. doi: 10.1093/ejcts/ezag005.

ABSTRACT

OBJECTIVES: Minimally invasive thymectomy has transformed the surgical management of thymic epithelial tumours and myasthenia gravis (MG). Video-assisted thoracoscopic surgery (VATS) is well established, whereas robot-assisted thoracoscopic surgery (RATS) provides technical and ergonomic advantages but at a higher cost. We reviewed current evidence to clarify the indications, oncological validity, perioperative performance, and economic implications of RATS compared with VATS and open thymectomy.

METHODS: A structured narrative review was conducted, drawing on multi-institutional cohorts, registry-based propensity-matched studies, and systematic reviews. Evidence was organized by tumour characteristics, special populations (MG, obesity, recurrent thymoma), perioperative and long-term outcomes, surgeon-centred considerations, and cost-effectiveness.

RESULTS: In early-stage thymoma and MG, both VATS and RATS achieve R0 resection rates ≥95% and recurrence outcomes comparable with sternotomy. Robot-assisted thoracoscopic surgery is associated with lower blood loss, fewer conversions, and signals of faster recovery, with particular advantages in obese or redo cases. Long-term survival appears equivalent across minimally invasive approaches, without evidence of oncological superiority. However, RATS incurs higher per-case costs, primarily from instrumentation and platform expenses.

CONCLUSIONS: VATS remains efficient for straightforward cases, whereas RATS may safely extend minimally invasive eligibility to anatomically complex scenarios while maintaining oncological integrity. Adoption should be indication-driven and resource-conscious. Further multicentre studies with long-term follow-up, patient-reported outcomes, and cost-effectiveness analyses are needed to define the sustainable role of RATS in thymectomy.

CLINICAL REGISTRATION NUMBER: Not applicable.

PMID:42102247 | DOI:10.1093/ejcts/ezag005


Source: https://pubmed.ncbi.nlm.nih.gov/4210224 ... 5&v=2.20.0