Minimally Invasive Techniques in Thoracic Surgery for Thymoma

Minimally invasive approaches have revolutionised the management of thymoma by reducing surgical trauma, enhancing visualisation and speeding postoperative recovery. Conventional open thymectomy via median sternotomy remains a definitive means of excising thymic epithelial tumours and peri-thymic fat, particularly in advanced disease, but carries risks of pain, blood loss and prolonged hospitalisation. Over the past two decades, video-assisted thoracoscopic surgery (VATS) techniques—including multiport, single-port and subxiphoid access—have enabled complete thymic resection through small incisions under endoscopic guidance. The emergence of robotic-assisted thoracoscopic surgery (RATS) has further refined minimally invasive thymectomy by offering three-dimensional imaging, articulated instruments and tremor filtration, permitting precise dissection in the confined anterior mediastinum. Comparative studies and meta-analyses indicate that these methods achieve oncological outcomes equivalent to open surgery while reducing intraoperative blood loss, postoperative pain and length of stay. Subxiphoid VATS, in particular, allows bilateral mediastinal exposure without intercostal nerve injury, a feature of growing interest in the treatment of thymoma-associated myasthenia gravis. As evidence accumulates, surgical teams are better equipped to tailor the choice of approach to tumour stage, cardiopulmonary reserve and patient preference, thereby extending the benefits of minimally invasive care on a global scale.

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Minimally Invasive Techniques in Thoracic Surgery for Thymoma publication trend

The graph below shows the total number of articles in minimally invasive techniques in thoracic surgery for thymoma across all publications each year (not limited to Nature Index journals).

Technical terms

Thymoma: A tumour arising from epithelial cells of the thymus gland located in the anterior mediastinum, frequently associated with myasthenia gravis.

Video-assisted thoracoscopic surgery (VATS): A minimally invasive method using an endoscope and instruments inserted through intercostal or subxiphoid ports to visualise and excise mediastinal lesions.

Robotic-assisted thoracoscopic surgery (RATS): A technique that employs a robotic system to enhance precision and dexterity via wristed instruments and three-dimensional imaging during thoracic procedures.

Subxiphoid approach: A VATS access route made below the xiphoid process, offering bilateral mediastinal exposure without the need for intercostal incisions.

Masaoka staging: A clinical classification of thymoma based on tumour invasion of capsule, surrounding tissues and distant organs, used to guide surgical strategy and adjuvant therapy.

References

1. National Multicenter Study on the Comparison of Robotic and Open Thymectomy for Thymic Neoplasms in Myasthenic Patients: Surgical, Neurological and Oncological Outcomes. Cancers (2024).
2. Effect Evaluation of Subxiphoid and Intercostal Thymectomy: A Meta-Analysis and Systematic Review. Frontiers in Surgery (2022).
3. Subxiphoid-subcostal thoracoscopic thymectomy for seropositive myasthenia offers equivalent remission rates and potentially faster recovery. Interdisciplinary CardioVascular and Thoracic Surgery (2021).