Wathieu Natacha, Ajouz Hana, Abbas Abbas E
Department of Thoracic Surgery, Brown University Health Rhode Island Hospital/The Warren Alpert Medical School of Brown University, Providence, RI, USA.
Mediastinum. 2025 Jun 25;9:19. doi: 10.21037/med-24-43. eCollection 2025.
Complete thymectomy is the established treatment for thymic epithelial tumors (TET) and often included in the management of myasthenia gravis. Minimally invasive approaches, including robotic-assisted techniques, have gained acceptance for their benefits in reducing postoperative pain and recovery time. Thymectomy poses risks due to the proximity of the thymus to critical mediastinal structures, and intraoperative complications confronted on the robotic platform can be precarious. Current literature on intraoperative complications is fragmented and limited, and lacks emphasis on the nuance brought about by the robotic platform specifically. The aim of this narrative review is to comprehensively explore such possible complications and to discuss their distinct management strategies in a systematic manner.
We review the literature by examining the PubMed database between 2000 and 2024 for relevant studies that report the intraoperative and postoperative complications of robotic thymectomy. The technique of robotic thymectomy is also described.
Robotic thymectomy offers a safe and oncologically effective approach to treatment. It is met with a low complication rate that is not increased compared to the open approach. Common complications include injury to nearby structures such as the internal mammary vessels, brachiocephalic vein (BCV), superior vena cava (SVC), phrenic nerve, and recurrent laryngeal nerve. Each complication requires a distinct management strategy that is concordant with an understanding of the limitations of the robotic platform.
This narrative review focuses on the intraoperative complications encountered during robotic thymectomy and provides an in-depth review of strategies for managing these complications, emphasizing the importance of preoperative planning, understanding the robotic platform's limitations, and the need for a well-coordinated surgical team. Reviewing the complexity of such complications and their nuanced management strategies is not only beneficial for surgeons in their clinical practice, but also to develop scientific curiosities surrounding this topic to ultimately improve patient outcomes. As such, studies elaborating on the details of such complications while on the robotic platform are necessary.
完整胸腺切除术是胸腺上皮肿瘤（TET）的既定治疗方法，常用于重症肌无力的治疗。包括机器人辅助技术在内的微创方法因其在减轻术后疼痛和缩短恢复时间方面的优势而被广泛接受。由于胸腺靠近重要的纵隔结构，胸腺切除术存在风险，在机器人平台上遇到的术中并发症可能很危险。目前关于术中并发症的文献零散且有限，尤其缺乏对机器人平台所带来细微差别的关注。本叙述性综述的目的是全面探讨此类可能的并发症，并系统地讨论其独特的管理策略。
我们通过查阅2000年至2024年期间的PubMed数据库，检索报告机器人胸腺切除术术中及术后并发症的相关研究。同时描述了机器人胸腺切除术的技术。
机器人胸腺切除术提供了一种安全且肿瘤学上有效的治疗方法。其并发症发生率较低，与开放手术相比并未增加。常见并发症包括对附近结构的损伤，如胸廓内血管、头臂静脉（BCV）、上腔静脉（SVC）、膈神经和喉返神经。每种并发症都需要一种独特的管理策略，这与对机器人平台局限性的理解相一致。
本叙述性综述聚焦于机器人胸腺切除术术中遇到的并发症，并深入回顾了管理这些并发症的策略，强调了术前规划、理解机器人平台局限性以及手术团队协调配合的重要性。审视此类并发症的复杂性及其细微的管理策略不仅有助于外科医生的临床实践，还能激发围绕该主题的科学探索欲，最终改善患者预后。因此，有必要开展关于机器人平台上此类并发症细节的研究。
