Early Outcomes and Learning Curve of Robotic Thymectomy via the Subxiphoid Approach Using the Single-port Robotic System

초록

Objective: Although robotic thymectomy via the subxiphoid approach using the single-port robotic system has been shown to be feasible, evidence on its perioperative outcomes and learning curve remains limited. Therefore, this study aimed to evaluate the early clinical outcomes and assess the learning curve of this minimally invasive technique. Methods: We retrospectively reviewed patients who underwent robotic thymectomy via the subxiphoid approach using the single-port robotic system between November 2020 and September 2025 at a single center. Baseline characteristics, intraoperative variables, and perioperative outcomes were collected. The learning curve for total operative time was analyzed using the cumulative sum method. Results: A total of 131 patients were included in this study. The median tumour size was 3.2 cm (IQR, 2.2–4.5 cm), and thymoma was the most common diagnosis (51.1%). Total thymectomy was performed in 125 patients (95.4%), whereas partial thymectomy was performed in six patients (4.6%). Total thymectomy was the standard procedure at our institution. The median total operative time was 118 minutes (IQR, 94–145 minutes), and the median postoperative hospital stay was 2 days (IQR, 2–3 days). R0 resection was achieved in 128 patients (97.7%). No conversion to open sternotomy was required; however, multi-port conversion (one additional port) was performed in three patients-one due to suspected invasion of the superior vena cava, one due to lung invasion, and one due to pericardial invasion. Importantly, cumulative sum curve analysis of total operative time demonstrated that 19 cases were required to achieve proficiency. Conclusions: Robotic thymectomy via the subxiphoid approach using the single-port robotic system is a safe and feasible surgical approach and showed that proficiency can be achieved after a relatively low number of cases. These findings may encourage surgeons who are beginning their robotic surgery practice to adopt this approach. However, further large-scale prospective studies are warranted to validate its efficacy and safety.