{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T02:23:06Z","timestamp":1768875786239,"version":"3.49.0"},"reference-count":31,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2024,3,22]],"date-time":"2024-03-22T00:00:00Z","timestamp":1711065600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction: Robotic and thoracoscopic surgery are being increasingly adopted as minimally invasive alternatives to open sternotomy for complete thymectomy. The superior maneuverability range and three-dimensional magnified vision are potential ergonomical advantages of robotic surgery. To compare the ergonomic characteristics of robotic versus thoracoscopic thymectomy, a previously developed scoring system based on impartial findings was employed. The relationship between ergonomic scores and perioperative endpoints was also analyzed. Methods: Perioperative data of patients undergoing robotic or thoracoscopic complete thymectomy between January 2014 and December 2022 at three institutions were retrospectively retrieved. Surgical procedures were divided into four standardized surgical steps: lower-horns, upper-horns, thymic veins and peri-thymic fat dissection. Three ergonomic domains including maneuverability, exposure and instrumentation were scored as excellent(score-3), satisfactory(score-2) and unsatisfactory(score-1) by three independent reviewers. Propensity score matching (2:1) was performed, including anterior mediastinal tumors only. The primary endpoint was the total maneuverability score. Secondary endpoints included the other ergonomic domain scores, intraoperative adverse events, conversion to sternotomy, operative time, post-operative complications and residual disease. Results: A total of 68 robotic and 34 thoracoscopic thymectomies were included after propensity score matching. The robotic group had a higher total maneuverability score (p = 0.039), particularly in the peri-thymic fat dissection (p = 0.003) and peri-thymic fat exposure score (p = 0.027). Moreover, the robotic group had lower intraoperative adverse events (p = 0.02). No differences were found in residual disease. Conclusions: Robotic thymectomy has shown better ergonomic maneuverability compared to thoracoscopy, leading to fewer intraoperative adverse events and comparable early oncological results.<\/jats:p>","DOI":"10.3390\/jcm13071841","type":"journal-article","created":{"date-parts":[[2024,3,25]],"date-time":"2024-03-25T12:32:36Z","timestamp":1711369956000},"page":"1841","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Ergonomic Assessment of Robotic versus Thoracoscopic Thymectomy"],"prefix":"10.3390","volume":"13","author":[{"given":"Riccardo","family":"Taje","sequence":"first","affiliation":[{"name":"Department of Thoracic Surgery, University of Rome \u201cTor Vergata\u201d, 00133 Rome, Italy"},{"name":"Doctoral School of Microbiology, Immunology, Infectious Diseases and Transplants, MIMIT, University of Rome \u201cTor Vergata\u201d, 00133 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Peer","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Ichilov Medical Center, Tel Aviv 6423906, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5579-0837","authenticated-orcid":false,"given":"Filippo Tommaso","family":"Gallina","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, IRCCS National Cancer Institute Regina Elena, 00144 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincenzo","family":"Ambrogi","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, University of Rome \u201cTor Vergata\u201d, 00133 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Azzam","family":"Sharbel","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Ichilov Medical Center, Tel Aviv 6423906, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Enrico","family":"Melis","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, IRCCS National Cancer Institute Regina Elena, 00144 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8914-8711","authenticated-orcid":false,"given":"Stefano","family":"Elia","sequence":"additional","affiliation":[{"name":"Department of Medicine and Health Sciences \u201cV. Tiberio\u201d, University of Molise, 86100 Campobasso, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matot","family":"Idit","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care, Ichilov Medical Center, Tel Aviv 6423906, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7137-8946","authenticated-orcid":false,"given":"Francesco","family":"Facciolo","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, IRCCS National Cancer Institute Regina Elena, 00144 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7409-8470","authenticated-orcid":false,"given":"Alexandro","family":"Patirelis","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, University of Rome \u201cTor Vergata\u201d, 00133 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto","family":"Sorge","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University of Rome \u201cTor Vergata\u201d, 00133 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5958-1423","authenticated-orcid":false,"given":"Eugenio","family":"Pompeo","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, University of Rome \u201cTor Vergata\u201d, 00133 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,3,22]]},"reference":[{"key":"ref_1","first-page":"CD008111","article-title":"Thymectomy for non-thymomatous myasthenia gravis","volume":"10","author":"Cea","year":"2013","journal-title":"Cochrane Database Syst. 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Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/7\/1841\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:18:19Z","timestamp":1760105899000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/7\/1841"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,22]]},"references-count":31,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2024,4]]}},"alternative-id":["jcm13071841"],"URL":"https:\/\/doi.org\/10.3390\/jcm13071841","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,22]]}}}