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Background Complete surgical excision is the most important long-term prognostic factor of thymomas. Although video-assisted thoracoscopic surgery (VATS) has been reported as an effective treatment to excise mediastinal thymic lesions, it has not replaced median sternotomy as the standard approach because of the lack of long-term follow-up studies. The objective of this study was to analyze and to compare the outcome of VATS extended thymectomy with the traditional open approach. Methods This is a single center's retrospective study of 27 patients submitted to surgery for early stage thymomas between 1995 and 2007. Histologic subtype and clinicopathologic staging were classified, respectively, according to World Health Organization and Masaoka criteria. Patients with preoperative computed tomography scan evidence of clinical Masaoka stage 1 thymomas were selected for VATS thymectomy with unilateral technique. Results All patients successfully underwent surgery: 3 with VATS and 4 with an open approach. There were no differences in time of surgery and postoperative complication between the two groups. Patients who had VATS had shorter postoperative hospital stay than patients who had open technique. After a median follow-up of 123 months, there were no postoperative recurrences. Conclusion VATS is a safe operation and has comparable effectiveness to the open technique in terms of oncological radicality for small, early stage thymoma. [ABSTRACT FROM AUTHOR]

Background Thymectomy is an essential component in the treatment of myasthenia gravis (MG) and the best treatment for localized thymoma. Minimally invasive thymectomy has advanced to include robotic-assisted techniques. The acceptance of this approach is growing rapidly, while the debate on the adequate technique for thymectomy remains open. Methods We describe the technique of robotic-assisted thymectomy and its modifications. The worldwide registries and the literature are reviewed. The experience from the largest single-center database is analyzed. Results The unilateral three-trocar approach for robotic thymectomy from either left or right side has been standardized. More than 100 centers worldwide perform robotic thymectomy. The annual number of this procedure increased steadily and reached 1,000 in 2012, while the largest single-center experiences comprise almost 500 cases. The end points improvement of MG and recurrence of thymoma are comparable to open procedures. There are special advantages of robotic assistance for complete mediastinal dissection. The perioperative complication rate is below 2%. Conclusion Robotic thymectomy combines minimal incisional discomfort with extensive mediastinal dissection. As its use expands, robotic thymectomy may become the standard for all indications of thymectomy. [ABSTRACT FROM AUTHOR]

The therapeutic effect of thymectomy on myasthenia gravis is not completely understood. Several types of thymectomy varying in approach and extent have been performed. None of these disclosed a neat superiority over others. Patients desire thymectomy through small, painless, and cosmetically favorable operations. Videoassisted thoracoscopic surgery (VATS) thymectomy fits all these requests as well as that of the surgeon. Indeed, this approach allows for ample operative space, easy maneuverability, and extended thymectomy. No mortality, low morbidity, faster recovery, short hospital stay, and small economical costs are undoubtedly advantages of VATS over transsternal and transcervical thymectomy. In the near future, the introduction of robotic devices will lead to a new era in the surgery of the thymus. Herein we analyzed our comprehensive experience. [ABSTRACT FROM AUTHOR]

The author reflects on the thymus, which is an organ that is being ignored or neglected by the health industry. Topics discussed include the involution of the thymus and its function in T-cell maturation, the risk of DiGeorge syndrome and immunodeficiency, and a discussion of volunteer Henning Gaissert on thymectomy and the treatment of thymoma and thymic cancer.