Vessel Sealer-Assisted Robotic Thymectomy

Robotic thymectomy is an effective therapeutic approach for the treatment of thymic epithelial tumors, offering a low complication rate and favorable oncological outcomes (1). Several techniques have been described for performing robotic thymectomy, including unilateral, bilateral, and subxiphoid approaches (2). Commonly used instruments include the robotic hook or Maryland dissector and fenestrated bipolar forceps. 

The authors present a case of a triportal, left-sided robotic thymectomy (da Vinci Xi system) performed using the robotic vessel sealer, which enabled fast, effective, and safe dissection of mediastinal structures. 

At the beginning of the procedure, the robotic hook was used to open the mediastinal pleura, dissect the thymus from the adjacent phrenic nerve, and define the pericardial plane. The surgeons then switched to the robotic vessel sealer, which allowed for efficient coagulation and division of mediastinal fat, particularly in the upper mediastinum near the innominate vein. The dissection continued up to the bilateral thymic horns and the contralateral pleura. 

The Keynes veins were effectively sealed and divided without any issues. The patient had an uneventful postoperative course and was discharged on postoperative day three. Final histopathology revealed a Stage IIa Masaoka–Koga B1 thymoma (WHO 5th edition). 

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