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

BACKGROUND: 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). METHODS: 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. RESULTS: 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 (−256.84 mL [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). CONCLUSIONS: 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.