Minimally invasive thymectomy: comparative analysis of short-term outcomes after video-assisted thoracoscopy and two robotic platforms

Objective – Minimally invasive thymectomy has largely replaced the traditional trans-sternal approach. Among the minimally invasive strategies, video-assisted thoracoscopic and robot-assisted thoracoscopic procedures are the most frequently used. The introduction of new robotic platforms has renewed interest in comparing different systems. This study aimed to evaluate short-term outcomes, learning curves, and surgeon workload in thymectomy performed with a video-assisted thoracoscopic technique, the Da Vinci robotic system, and the Versius robotic system. Methods – A retrospective, comparative study was conducted on 90 consecutive patients who underwent minimally invasive thymectomy between 2016 and 2025 at a single tertiary center. Thirty procedures were performed by a video-assisted thoracoscopic approach (2016–2020), and sixty with robotic assistance (2021–2025), equally divided between Da Vinci and Versius systems. The primary endpoint was postoperative hospital stay. Secondary endpoints included operative time, postoperative analgesic use, complications, conversion rate, and chest tube duration. Surgeon workload was evaluated using a validated multidimensional questionnaire assessing mental, physical, and temporal demands, performance, effort, and frustration. Results – Hospital stay was significantly shorter after robotic thymectomy compared with the video-assisted approach (3.2 ± 1.0 days for Da Vinci and 3.0 ± 1.2 days for Versius vs. 4.5 ± 1.9 days; p < 0.001). Secondary outcomes were comparable among the three techniques. Cumulative sum analysis demonstrated faster procedural stabilization with robotic systems. Workload assessment indicated higher perceived demand with the Versius system, mainly in mental and physical domains. Conclusions – In this single-center experience, robotic thymectomy was associated with shorter hospital stay and earlier procedural stabilization compared with VATS, with similar perioperative safety. Differences between robotic platforms were mainly observed in surgeon-reported workload. These findings should be interpreted within the context of surgeon experience and institutional evolution.