Subxiphoid Robotic Extended Thymectomy With a Pericardial Patch Closure

The author has previously reported on cases involving trans-subxiphoid robotic thymectomy, in which the camera is inserted from the subxiphoid incision and robotic forceps are inserted from the bilateral intercostal spaces. This video presents the case of a 68-year-old female patient who was diagnosed with myasthenia gravis of MGFA class IIb. Chest CT findings led to the suspicion of thymoma infiltration into the pericardium and left brachiocephalic vein. The da Vinci Si Surgical System was docked from the cranial side. Because the tumor was in contact with the left brachiocephalic vein, the vein was controlled at the proximal and distal sides of the tumor in order to ensure the safety of the surgery. For the pericardial defect, a patch closure was performed with an interrupted suture using a Gore-Tex pericardial sheet. With the opportunity for excellent maneuverability, trans-subxiphoid robotic thymectomy is able to accomplish this complicated surgery effectively.