Robot-Assisted Versus Video-Assisted Thymectomy: A Narrative Review of Current Evidence.

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.