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Page 8 of 16 De Iaco et al. Mini-invasive Surg 2020;4:63 I http://dx.doi.org/10.20517/2574-1225.2020.37

Figure 6. Gross specimen after en bloc video-assisted thoracic surgery thymectomy

comfortable dissection of vascular and nervous structures and a better dissection in remote, fixed, and
difficult to reach areas of the neck and mediastinum [11,53-57] [Figure 6].

The main limitations of robotic surgery are the high initial costs, the lack of tactile feedback, and the need
of a large enough volume of patients to overcome the initial learning curve.

[58]
O’Sullivan et al. recently published a meta-analysis on robotic versus open and video-assisted
thoracoscopic surgery approaches for thymectomy, including 18 articles. When comparing robotic vs. open
thymectomy, evidence shows no differences in operative time, intraoperative complications, and mortality.
On the other hand, significantly lower blood loss, fewer postoperative complications, shorter length of
hospital stay, and decreased positive margin rate were reported in the robotic group. When comparing
robotic vs. VATS thymectomy, instead, the results show no differences in the two groups in terms of
operative time, blood loss, length of hospital stay, intraoperative complications, and margin rates. To date,
few authors have performed a real comparison between the two techniques, considering not only the
perioperative results but also long-term follow-ups [Table 2].

[68]
Perioperative parameters were analyzed by Qian et al. ; when comparing 123 patients with early-stages
thymoma who underwent robotic-assisted thoracoscopic surgery (RATS), VATS, or open thymectomy,
they found significant differences in blood loss volume, mean postoperative pleural drainage duration,
and duration of hospital stay. When comparing two groups for parameters, they found that the outcomes
of RATS were more favorable than those of VATS and median sternotomy, while outcomes for VATS