Thymectomy via open surgery or robotic video assisted thoracic surgery: Can a recommendation already be made?

Robot-assisted minimally invasive surgery (RVATS) is a relatively new technique applied for thymectomies. Only few studies directly compare RVATS to the mainstay therapy, open surgery (sternotomy). A systematic search of the literature was performed in October 2016. The meta-analysis includes studies comparing robotassisted and open thymectomy regarding operation time, length of hospitalization, intraoperative blood loss, and chest-in-tube days, postoperative complications, reoperation, arrhythmic events, pleural effusion, and postoperative bleeding. Of 626 studies preliminary screened, 7 articles were included. There were no significant differences in comparison of operation time (3.19 minutes [95% confidence interval, 95% CI 112.43 to 106.05]; P=.94), but patients undergoing RVATS spent significantly less time in hospital (4.06 days [95% CI 7.98 to 0.13], P=.046). There were fewer chests-in-tube days (2.50 days [95% CI 15.01 to 10.01]; P=.24) and less intraoperative blood loss (256.84mL [95% CI 627.47 to 113.80]; P=.10) observed in the RVATS group; due to a small number of studies, these results were not statistically significant. There were also less post-operative complications in the RVATS group (12 complications in 209 patients vs 51 complications in 259 patients); however, this difference was not statistical significant (odds ratio 0.27, 95% CI 0.07 – 1.12; P=.06). Patients undergoing RVATS spent less time in hospital than patients treated by open surgery (sternotomy). These patients tended to have less postoperative complications, less intraoperative blood loss, and fewer chest-in-tube days. We found evidence for the safety and feasibility of RVATS compared with open surgery, which has to be further confirmed in randomised controlled trials.