Robotic thymectomy in myasthenia gravis: current evidence, outcomes, and future perspective

Robotic-assisted thymectomy has become a well-established treatment option for acetylcholine receptor-positive myasthenia gravis. This review provides a synthesis of current evidence regarding its technical evolution, surgical outcomes, neurological efficacy, and future directions. Robotic thymectomy, particularly using platforms such as the da Vinci system, offers high-definition three-dimensional visualization, tremor filtration, and articulating instruments that enable precise dissection within the confined space of the mediastinum. Several surgical approaches are available, including unilateral right or left transthoracic, subxiphoid, and emerging single-port techniques—each with distinct advantages. The procedure is associated with excellent safety and feasibility, characterized by low conversion rates, minimal blood loss, short hospital stays, and a low incidence of major complications. Neurological outcomes are promising, with clinical improvement observed in 75–85% of patients at five years and complete stable remission rates ranging from 18% to 40%. A consistent steroid-sparing effect has also been reported. Key prognostic factors for favorable outcomes include younger age, milder disease severity, and non-thymomatous pathology. Comparative studies indicate that robotic thymectomy offers superior perioperative outcomes relative to open sternotomy, while demonstrating comparable efficacy to video-assisted thoracoscopic surgery, with potential qualitative advantages. The procedure is increasingly being applied in special populations, including juvenile, elderly, and ocular myasthenia gravis patients. Future directions include prospective trials, biomarker research, and technological innovations such as single-port robotic platforms. In conclusion, this narrative review is based on a structured literature search of PubMed and Web of Science. While the current evidence largely derives from retrospective cohort studies and case series, the aggregated data consistently demonstrate that robotic thymectomy represents a safe and effective surgical option that effectively balances the goals of radical resection and minimal morbidity. This review uniquely integrates surgical outcomes, neurological efficacy, and patient selection criteria into a single synthesis, providing a clinically actionable framework for multidisciplinary decision-making.