Thymectomy is a procedure which involves the surgical removal of the thymus Gland. It is required in patients with:
• Myasthenia Gravis
• Thymoma with or without Myasthenia Gravis
Thymectomy can be done in three main ways
Open surgery requires cutting the breast bone in half (Sternotomy) and remove the thymus gland which lies between our breastbone and heart. It is the conventional method of surgery and may be required even today in cases where there is large thymic tumour or a Thymoma or a Thymic Carcinoma which has invaded into adjacent structures.
This involves the removal of the thymus gland along with thymoma using three to four small incisions (5-12mm) in size. Through this small incisons the surgeons inserts a specialised telescope to which a camera is attached. This displays the inside of the chest cavity on a display monitor the surgeon then insert two additional long specialised instruments and removes the thymus gland completely without having to cut open the breastbone. In some patients with excessive pericardial fat the procedure may require access from both sides of chest.
Robotic surgery is the latest tool in the armamentarium of surgeons for performing thymectomy. During robotic thymectomy, the surgeon sits at the console and operates using miniaturised robotic instruments which have an endo wrist and therefore become highly flexible and allows the surgeon to very precisely and delicately remove the entire thymus gland along with all the surrounding fat using just 3-4 small incisions on one side of the chest. The robotic system offers a state of art stereoscopic high definition 3D view of the inside of the chest which greatly improves the depth perception of the surgeon and thereby making surgery lot easier, safe and complete. A radical thymectomy involves removal of the entire thymus gland which extends from the thymic horns in the neck to diaphragm below and the improved vison and dexterity allows for an outstanding clearance of all the target tissue.
However not all thymomas are fit for robotic surgery. It depends on the tumour size, its invasiveness and experience of the surgeon. Dr. Belal Bin Asaf, having performed over 150 robotic thymectomy by and has one of the country's largest experience in performing robotic thymectomy. He is also the pioneer of a new approach to robotic thymectomy via sub-xiphoid route and is the first surgeon in the country to have performed this surgery successfully.