P37: Locally advanced thymoma-robotic approach

Background: The conventional approach to locally advanced thymoma has been via a sternotomy. VATS and robotic thymectomies have been described but typically are reserved for patients with myasthenia gravis only or for small, encapsulated thymic tumors. There have been few reports of minimally invasive resection of locally advanced thymomas. Our objective is to present a case in which a large, locally advanced thymoma was resected en bloc with the pericardium employing robotic assisted thoracoscopic approach.

Methods: This case illustrates a case of an asymptomatic 29-year-old female found to have an 11 cm anterior mediastinal mass on CT scan. A right-sided, 4 port robotic approach was utilized with the camera port in the 5^th intercostal space anterior axillary line and two accessory ports for robotic arm 1 and 2 in the 3^rd intercostal space anterior axillary line and 8^th intercostal space anterior axillary line. A 5 mm port was used between the camera and 2^nd robotic arm for assistance. On exploration the mass was found to be adherent to the pericardium that was resected en bloc via anterior pericardiectomy. Her post-operative course was uncomplicated, and she was discharged home on postoperative day 1.

Results: Final pathology revealed an 11 cm × 7.5 cm × 3.0 cm WHO class B2 thymoma invading the pericardium, TNM stage T3N0M0, with negative margins. The patient was subsequently sent to receive 5,040 cGy of adjuvant radiation, and follow-up CT scan 6 months postoperatively showed no evidence of disease.

Conclusions: Very little data exist demonstrating the efficacy of resecting locally advanced thymomas utilising the minimally invasive approach. Our case demonstrates that a robotic assisted thoracoscopic approach is feasible for performing thymectomy for locally advanced thymomas. This may help limit the morbidity of a trans-sternal approach while achieving comparable oncologic results. However, further studies are needed to evaluate its efficacy and long term outcomes.

Keywords: Robotic thymectomy; thoracoscopic thymectomy; locally advanced thymoma; thymoma