Initial outcomes of subxiphoid uniportal robotic thymectomy using the da Vinci Xi system.

Background: Thymectomy for anterior mediastinal tumors is commonly performed using thoracoscopic surgery or robotic-assisted surgery. Subxiphoid uniportal robotic thymectomy (SURT) using the da Vinci Xi system was introduced to combine the minimal invasiveness of a uniportal approach with the superior operability offered by robotic-assisted surgery. This study aimed to evaluate the safety and feasibility of SURT for anterior mediastinal tumors by reporting our initial results. Methods: This retrospective, single-center observational study included 22 patients who underwent SURT at Fujita Health University Okazaki Medical Center between March 2022 and September 2025. Surgeries were performed using either the parallel or cross methods, and initial outcomes were compared between the groups. Results: Overall, the parallel method was performed in six cases, and the cross method in 16 cases. Perioperative data for the parallel and cross methods were observed as follows, respectively: operative time (median: 114.0 and 122.0 min), console time (median: 81.5 and 83.5 min), intraoperative blood loss (median: 4 and 5 mL), combined resection rate (0% and 6.3%), timing of thoracic drain removal (postoperative day 0/1: 5/1 and 12/4), postoperative hospital stay (median: 3.5 and 3 days), and numerical rating scale score at discharge (median: 0 and 0.5). No conversion to alternative approaches or perioperative mortality occurred in either group. Conclusions: SURT using the da Vinci Xi system provides a favorable midline surgical view, minimal invasiveness through a uniportal approach, and excellent operability through a robotic system. This procedure can be performed safely with careful port positioning at the subxiphoid incision site.