# A Shift from Standard Median Sternotomy to Robotic-Assisted Thoracic Surgery for Resection of Anterior Mediastinal Tumors

## TL;DR

Robotic surgery is shown to be a safe and effective alternative to traditional chest surgery for removing certain tumors and treating Myasthenia Gravis.

## Contribution

The study demonstrates robotic-assisted thoracic surgery as a viable alternative to median sternotomy for specific mediastinal tumor cases.

## Key findings

- RATS was used in 83.8% of surgeries and resulted in a significantly shorter hospital stay compared to median sternotomy.
- Postoperative complication rate was 8.1% with no perioperative mortality observed.
- RATS achieved a 96.9% R0 resection rate for thymoma cases.

## Abstract

Objectives: Robotic-Assisted Thoracic Surgery (RATS) has emerged as a viable alternative to traditional median sternotomy for patients with anterior mediastinal tumors suspected of having thymoma or those with Myasthenia Gravis (MG). While median sternotomy remains a widely accepted standard approach, RATS has gained popularity due to its potential benefits. Methods: We retrospectively reviewed our 5 years’ experience of performing 111 surgeries for patients with anterior mediastinal tumors and patients with MG suspected of having thymoma. We performed multivariate regression models to assess the association between main demographic and clinical variables and two primary outcomes: overall complications and hospital stay. Results: Out of 111 patients, 54 were men (48.6%) and 57 were women (51.4%). The majority of surgeries (n = 93) were performed by RATS (83.8%), while the remainder were performed by either median sternotomy (n = 15, 13.5%) or by other approaches (n = 3, 2.7%). Sixty-five patients were diagnosed with thymoma (58.6%), with 96.9% R0 resection. Sixty-five patients underwent left-sided surgery (58.6%), and thirty-one underwent right-sided surgery (27.9%). The conversion rate was 2.5%. The rate of postoperative complications was 8.1 without perioperative mortality. The median hospital stay was 4.62 days, but it was significantly shorter in the RATS compared to the median sternotomy group (mean 3.64 vs. 10.67 days, p = 0.040). Conclusions: Our results suggest that RATS for patients with anterior mediastinal tumors suspected of having thymoma or for those with MG is safe and technically feasible and may be the preferred surgical approach for selected patients, whereas traditional median sternotomy remains the preferred choice for more locally advanced tumors.