Robot-Assisted Thoracoscopic Resection of Thymus in a Child with Thymic Cyst

Thymic cysts are rare lesions of the thymus gland. Open surgical resection is associated with trauma and may lead to postoperative complications such as pain, blood loss, and wound infection. Over the past decades, minimally invasive surgical techniques have been actively developed. The authors conducted a retrospective review of the medical history of a 15-year-old adolescent with a thymic cyst accompanied by exertional pain. The final diagnosis was established using contrast-enhanced computed tomography of the chest. The surgical intervention was performed using a robot-assisted technique. The Versius surgical robot (Cambridge Medical Robotics, UK) was used. Partial thymectomy of the left lobe was employed as the surgical technique. Following adhesiolysis between the tumor and the upper lobe of the left lung, adequate visualization of the tumor was achieved. The inferior horn of the thymus, together with the cyst, was isolated. The thymic tissue at the level of the left upper horn was then transected at the border of healthy tissue and extracted from the thoracic cavity through an enlarged incision at the assistant port site using an Endocatch bag. The operation was successfully performed without intraoperative difficulties or complications, with total duration was 120 minutes. Of this, 20 minutes were required for docking the robot. The procedure was fully robot-assisted with no conversion to thoracoscopic or open surgery. Histological examination revealed a cyst wall lined with simple squamous epithelium and filled with detritus showing signs of infection. The patient remained in the intensive care unit for 20 hours. Tracheal extubation was performed shortly after surgery, and the patient was discharged home on postoperative day 12. The chest drain was removed by the end of the first postoperative day. Robot-assisted thoracoscopic partial thymectomy is a safe and effective minimally invasive approach for the treatment of congenital thymic cysts, which is accompanied by a favorable postoperative course.