Subxiphoid Robotic Thymectomy with Superior Vena Cava Resection.

We report the surgical technique for subxiphoid robotic thymectomy with combined superior vena cava (SVC) resection. A blood-drainage cannula was inserted into the left internal jugular vein as a blood-drainage route. A blood infusion cannula was inserted into the left femoral vein. During SVC clamping, an assistant pumped blood through the circuit to prevent clotting. The tumour, SVC, thymus, part of the pericardium and part of the right lung were excised en bloc through a subxiphoid incision. We limited reconstruction to the right brachiocephalic-SVC anastomosis. Robotic-assisted thymectomy via the subxiphoid approach enables SVC replacement, which was previously feasible only with open surgery.