Closure of a Pleural Defect Using a Collagen Pad During Robotic Thymectomy: A Preliminary Experience

Background/Objectives: Robotic thymectomy has become the preferred approach for the management of thymoma. Although robotic surgery allows for precise dissection, the contralateral pleura may accidentally be opened during thymus gland dissection, resulting in a tension pneumothorax due to the escape of CO2 through the defect into the contralateral pleura or to significant postoperative air leaks and delayed drain removal. To prevent this potential complication, closure of the pleural defect is indicated. This procedure may be challenging using stitches or clips, especially during robotic surgery, as the pleura is a thin structure. Methods: We reported our preliminary experience in closing a pleural defect through application of a collagen pad; after applying the pad over the defect, gentle and uniform pressure was applied using a dry sponge for 2 min to seal the tissue surface. The pad closed the defect and formed a barrier that blocked the escape of CO2 into the contralateral pleura. Results: This procedure was successfully performed in three consecutive patients to repair a defect in the contralateral pleura that occurred during RATS thymectomy for the management of B1 thymoma (n = 2) and B2 thymoma (n = 1). No intraoperative and postoperative complication was found, and six-month follow-up showed no recurrence. Conclusions: Closing pleural defects with a collagen pad is a promising technique to enhance safety during robotic thymectomy.