Da Vinci Xi robot -assisted subxiphoid resection of thymoma and reconstruction of the left brachiocephalic vein: A case report.

BACKGROUND

Thymomas are the most common anterior mediastinal malignancies, typically requiring surgical resection. While median sternotomy has been the traditional approach, robotic-assisted thymectomy using the Da Vinci Xi system is reshaping minimally invasive surgery. Its 12× magnification, 3D visualization, and articulating instruments with tremor suppression allow precise dissection in anatomically constrained areas, particularly in tumors with vascular invasion, compared with the more aggressive classical approach.

CASE PRESENTATION: A 67-year-old man presented with ptosis and muscle weakness, indicative of myasthenia gravis. CT imaging revealed a 4.5 × 3.0 cm anterior mediastinal mass invading the left brachiocephalic vein, superior vena cava, pericardium, and right upper lung lobe. Robotic-assisted thymectomy via a subxiphoid approach using the Da Vinci Xi system was performed. The tumor and the invaded left brachiocephalic vein were resected en bloc, followed by vascular reconstruction using a 10-mm Gore-Tex graft anastomosed end-to-end to the right atrial appendage. Robotic assistance enabled meticulous dissection and intracorporeal anastomosis. Pathology confirmed stage IVB thymic carcinoma. Recovery was uneventful, with resolution of myasthenic symptoms and graft patency on follow-up.

DISCUSSION: This case demonstrates the feasibility of robotic thymectomy with vascular reconstruction. The Da Vinci Xi system enhanced surgical precision and control. Despite a prolonged operative time and need for anticoagulation, the approach may reduce morbidity and improve tumor control, though further evaluation in advanced-stage cases is needed.

CONCLUSIONS

Robotic-assisted resection of invasive thymoma with vascular reconstruction is feasible and safe, enabling radical excision in anatomically complex scenarios.