Comparative outcomes of robotic- and video-assisted thoracoscopic surgery in thymectomy: a systematic review of implications for myasthenia gravis remission and long-term oncology

Background: Thymectomy is a cornerstone in the management of thymic epithelial tumors and myasthenia gravis (MG). While minimally invasive techniques like video-assisted thoracoscopic surgery (VATS) have gained prominence, robotic-assisted thoracoscopic surgery (RATS) has emerged as a technically advanced alternative. However, comparative long-term oncological outcomes between RATS and VATS remain underexplored. This review aims to compare RATS and VATS thymectomy regarding long-term outcomes, perioperative results, and cost. Methods: A systematic review was conducted following PRISMA guidelines, with a protocol registered in PROSPERO (CRD420251126351). PubMed/MEDLINE, Web of Science, and Cochrane Library were searched for comparative studies reporting long-term outcomes (≥12 months follow-up) of RATS versus VATS thymectomy. Risk of bias was assessed using the Newcastle-Ottawa Scale. Results: ¥37,886, P