8 Years’ experience with robotic thymectomy for thymomas Marlies Keijzers • Anne-Marie C. Dingemans • Hans Blaauwgeers • Robert Jan van Suylen • Monique Hochstenbag • Leen van Garsse • Ryan Accord • Mark de Baets • Jos Maessen Received: 29 July 2013 / Accepted: 24 October 2013 / Published online: 15 November 2013 Ó Springer Science+Business Media New York 2013 Abstract Background The accuracy of a three-dimensional robotic-assisted videothoracoscopic approach may favor a radical resection of thymomas. The aim of this study was to demonstrate the feasibility of the robotic approach by reporting 8 years experience in a single referral center of surgical treatment of thymomas. Methods We retrospectively analyzed all consecutive patients who underwent a thymectomy from April 2004 to April 2012. We analyzed the procedure time, morbidity, mortality, conversions, hospitalization, free- dom from recurrence, time to progression, and overall survival. Results From 2004 until 2012, a total of 138 robotic procedures for mediastinal tumors were performed in our center, of which 37 patients with a mean age of 57.3 years underwent a thymectomy for a thymoma. Histological analysis revealed four type A thymomas (10.8 %), seven type AB thymomas (18.9 %), seven type B1 thymomas (18.9 %), fourteen type B2 thymomas (37.8 %), four type B3 thymomas (10.8 %), and one thymus carcinoma (2.7 %). The Masaoka–Koga stages were as follows: stage I in twenty patients (54 %), stage IIA in five patients (13.5 %), stage IIB in eight patients (21.6 %), stage III in three patients (8.1 %), and stage IVa in one patient (2.7 %). The mean overall procedure time was 149 min (range 88–353). No surgical mortality was reported, and there were no peri-operative compli- cations. No conversions were needed for surgical com- plications. In three cases, a conversion to sternotomy was preferred by the surgeon because tumor invasion in greater vessels was suspected. Two patients (5.4 %) suffered from a myasthenic crisis postoperatively and required prolonged mechanical ventilation. One patient (2.7 %) underwent a procedure for a thoracic herniation 6 months following thymectomy. The median hospital- ization was 3 days. The follow-up analysis showed an overall survival of 100 % and tumor recurrence in one patient (2.7 %). Conclusions Robotic thymectomies are safe in patients with early-stage thymomas. Robotic surgery may also be feasible for some selected advanced thymomas. Keywords Thymoma Á Minimally invasive surgery Á Thymectomy Á Robotic surgery M. Keijzers Á L. van Garsse Á R. Accord Á J. Maessen (&) Department of Cardiothoracic Surgery, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands e-mail: j.g.maessen@mumc.nl M. Keijzers e-mail: m.keijzers@mumc.nl A.-M. C. Dingemans Á M. Hochstenbag Department of Pulmonology, Maastricht University Medical Centre, Maastricht, The Netherlands H. Blaauwgeers Department of Pathology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands R. J. van Suylen Department of Pathology, Maastricht University Medical Centre, Maastricht, The Netherlands Present Address: R. J. van Suylen Department of Pathology, Jeroen Bosch Ziekenhuis, Den Bosch, The Netherlands M. de Baets Department of Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands 123 Surg Endosc (2014) 28:1202–1208 DOI 10.1007/s00464-013-3309-5 and Other Interventional Techniques