Robotic-Assisted Subxiphoid Thymectomy: Double Docking Technique

Conventional robotic-assisted subxiphoid thymectomy provides excellent visualization to both the phrenic nerve and the superior horn of the thymus gland, allowing the surgeon to effectively perform a radical thymectomy. However, this technique requires a 3 cm incision for subxiphoid dissection, and VATS dissection has some risk of injury to branches of the musculophrenic artery, the rectus abdominis, and the peritoneum, and special port is required. 

 In contrast, the double docking technique can eliminate all the downsides of the conventional technique. By entering the lateral pleural cavity with only two docking ports, including a camera, the surgeon can dissect the subxiphoid area and place an 8 mm port, followed by redocking the camera into the subxiphoid port. This approach allows the thymectomy to be performed in the same effective manner with less instruments and reduced surgical risk. 

References

1. Shimomura M, Ishihara S, Okada S, Inoue M. Robotic subxiphoid-optical thymectomy. Interact Cardiovasc Thorac Surg. 2022 Jul 9;35(2):ivac104. doi: 10.1093/icvts/ivac104. PMID: 35416955; PMCID: PMC9373970.

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