Robotic Extended Thymectomy

The recent increase in robotic thymectomy research has been met with great enthusiasm and expectation. Previous studies with substantial number of cases have shown that robotic extended thymectomy is a safe and alternative approach to open thymectomy, providing patients with myasthenia gravis (MG) and/or thymoma less postoperative pain, quicker postoperative recovery, and improved cosmesis. Besides, retrospective evidence has suggested efficacy of robotic extended thymectomy on MG in terms of improving symptoms and inducing remission. At present, no consensus on the ideal approach for robotic extended thymectomy has been reached. The left-sided approach might be preferable because of anatomical considerations, including better visualization of the contralateral phrenic nerve, easier management of the upper poles, and more comprehensive access to the common sites of ectopic thymic tissue. After accumulating enough experience, we have also adopted this elegant approach in some special care conditions, such as juvenile MG, elderly MG, relapse MG, and MG with a high BMI (≥30 kg/m2). In this chapter, we describe our technique of robotic extended thymectomy via the left-sided approach and discuss on patient selection, perioperative management, and current evidence and controversies.