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J Minim Access Surg. 2019 Apr 24. doi: 10.4103/jmas.JMAS_34_19. [Epub ahead of print]

Subxiphoid robotic extended thymectomy - The first Indian report.

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Centre for Chest Surgery, Institute of Robotic Surgery, Sir Ganga Ram Hospital, New Delhi, India.



Minimally invasive thymectomy is fast becoming the preferred approach for myasthenia gravis and non-invasive thymoma. The most commonly employed approach for minimally invasive thymectomy is the lateral thoracic approach. Safe achievement of radical resection requires adequate visualisation of both the phrenic nerves along their entire course. In our experience, such visualisation is rather difficult with unilateral transthoracic approaches. We herein describe our technique and initial experience of 25 cases with subxiphoid robotic thymectomy (SRT) for myasthenia gravis with or without thymoma. To the best of our knowledge, this is the first such report from India.

Subjects and Methods:

We retrospectively analysed data of patients who underwent SRT at our centre from June 2017 to September 2018. Twenty-five consecutive patients were analysed, and demographic data, total duration of the procedure, console time, blood transfusion requirement, duration of chest drainage, length of hospital stay, pain score on post-operative day (POD) 1 and day of discharge and post-operative morbidity and mortality within 90 days were recorded.


A total of 25 patients underwent SRT. All our patients had myasthenia gravis with 4 of them having thymoma. There were 11 males and 14 females with mean age of 29.30 years (range 23-48). The mean console time was 102.85 min (range 88-120) while the mean total operative time was 199.14 (range 180-220). On first POD 1, visual analogue scale score average was 5, and at discharge, it was 2. There was no 30-day or 90-day mortality. All cases of thymoma had a complete R0 resection.


Our experience suggests that subxiphoid approach offers a good operative view of the thymus in cervical region along with easy identification of bilateral phrenic nerves. Thus, SRT can be performed safely with comparable results.


Minimally invasive thymectomy; robotic thymectomy; subxiphoid thymectomy; thoracoscopic thymectomy; thymectomy; thymoma

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