Minimally Invasive Approaches for Thymectomy: A Narrative Review and Comparison of Surgical Approaches.

BACKGROUND: There are various approaches to minimally invasive thymectomy. This review discusses the various techniques and provides a comparison of risks and benefits for each approach, taking into consideration the indications and specific technical factors. METHODS: A Pubmed MEDLINE review of relevant search terms with a review of reference lists was performed and serves as the primary foundation of this article. This is supplemented by the experience of the senior author (SBK). RESULTS: Minimally invasive approaches, regardless of the specific techniques, have been shown to be safe and effective compared to open techniques with a shorter length of stay, improved pain control, and earlier return to work. A left sided approach may provide some benefit over right sided approaches, especially for Myasthenia Gravis. Subxiphoid approaches may provide superior visualization to either lateral approach. A single port robotic subxiphoid approach holds significant promise, but it remains early in its adoption. CONCLUSIONS: The use of minimally invasive surgery for thymectomy continues to expand with more complex resections being performed and ever larger tumors being removed. Techniques continue to advance with improved outcomes for all patient populations.