Dual-scopic robotic thymectomy for a large thymic malignant tumor

Minimally invasive surgery for large thymic malignant tumors remains challenging. Here, we demonstrate dual-scopic robotic thymectomy for a challenging malignant thymic tumor. An asymptomatic 70-year-old woman clinically diagnosed with a large thymic malignant tumor invading the left phrenic nerve and pericardium underwent surgery. After dissecting the left phrenic nerve and pericardium under left unilateral video-assisted thoracic surgery, a robotic subxiphoid approach was conducted to achieve complete thymectomy. During robotic surgery, the large tumor sometimes limited the surgical view. To overcome this limitation, we added a conventional thoracoscope and utilized both images of the conventional thoracoscopic view and robotic camera via TilePro display to achieve complete resection of the thymic epithelial tumor. The patient was discharged with no complications except left phrenic palsy. The pathological diagnosis was a thymic neuroendocrine tumor invading the left phrenic nerve. This approach is potentially useful in surgery for challenging thymic malignant tumors.