Pardolesi A, Ferrari M, Leuzzi G, Cioffi U, Cioffi G, Solli P. Robotic subxiphoid surgical approach for mediastinal lesions: One-year experience. World J Clin Cases 2025; 13(35): 115700 [DOI: 10.12998/wjcc.v13.i35.115700]
Corresponding Author of This Article
Ugo Cioffi, Department of Surgery, University of Milan, Via Festa Del Perdono 7, Milan 20122, Lombardy, Italy. ugocioffi5@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 16, 2025 (publication date) through Dec 16, 2025
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Publication Name
World Journal of Clinical Cases
ISSN
2307-8960
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Pardolesi A, Ferrari M, Leuzzi G, Cioffi U, Cioffi G, Solli P. Robotic subxiphoid surgical approach for mediastinal lesions: One-year experience. World J Clin Cases 2025; 13(35): 115700 [DOI: 10.12998/wjcc.v13.i35.115700]
Alessandro Pardolesi, Michele Ferrari, Giovanni Leuzzi, Piergiorgio Solli, Department of Thoracic Surgery, Istituto Nazionale Tumori, Milan 20133, Lombardy, Italy
Ugo Cioffi, Department of Surgery, University of Milan, Milan 20122, Lombardy, Italy
Gerardo Cioffi, Department of Sciences and Technologies, University of Sannio, Benevento 82100, Campania, Italy
Co-first authors: Alessandro Pardolesi and Michele Ferrari.
Author contributions: Pardolesi A and Ferrari M contributed to formal analysis, and they contributed equally to this manuscript and are co-first authors; Pardolesi A, Ferrari M, Leuzzi G, and Solli P contributed to data interpretation; Pardolesi A, Ferrari M, Leuzzi G, Cioffi U, Cioffi G, and Solli P contributed to writing - original draft and writing – review & editing; Pardolesi A, Ferrari M, and Solli P contributed to conceptualization; Pardolesi A and Solli P contributed to methodology; Ferrari M contributed to data curation. All authors read and accepted the final version.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Fondazione IRCCS Istituto Nazionale dei Tumori.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement:
No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ugo Cioffi, Department of Surgery, University of Milan, Via Festa Del Perdono 7, Milan 20122, Lombardy, Italy. ugocioffi5@gmail.com
Received: October 24, 2025 Revised: November 26, 2025 Accepted: December 10, 2025 Published online: December 16, 2025 Processing time: 54 Days and 18.3 Hours
Abstract
BACKGROUND
Median sternotomy has been considered the gold standard approach for anterior mediastinal tumor resection. However, recent advances in video-assisted thoracoscopic surgery and robotic-assisted thoracoscopic surgery with carbon dioxide insufflation have allowed minimally invasive approaches even for large and locally invasive tumors of the upper-anterior mediastinum. The subxiphoid robotic optical approach is a recently developed technique for accessing the mediastinum. The trans-subxiphoid technique offers excellent exposure of the surgical field, reduces postoperative pain, facilitates specimen retrieval even for large tumors, and potentially improves early surgical outcomes.
AIM
To evaluate the safety, feasibility, and outcomes of a robotic subxiphoid approach for the resecting of large/invasive mediastinal tumors.
METHODS
Between July 2024 and September 2025, 12 patients underwent subxiphoid robotic mediastinal resection. The diameter of the operated lesions ranged from 30 mm to 70 mm. A 3 cm subxiphoid incision was made at the subxiphoid level for GelPort placement, allowing for optical port access. Two operating ports were placed at the sixth intercostal space bilaterally. Carbon dioxide insufflations (8-10 mmHg) enlarged the surgical field, improving visualization of critical anatomical landmarks, such as the internal mammary arteries and phrenic nerves. This approach allowed complete resection of large or invasive tumors, preserving thoracic stability and reducing the risk of postoperative myasthenic crisis.
RESULTS
The mean operating time was 170.2 minutes, and the median hospital stay was 3.5 days. No major postoperative complications occurred. Two conversions were necessary: One with a lateral robotic approach due to previous abdominal surgery, and one with a sternotomy for tumor invasion of the aortic arch. Histopathological analysis identified nine thymomas and one solitary fibrous tumor.
CONCLUSION
Subxiphoid robotic approach is a safe, effective technique for extended thymectomy, fulfilling both oncological and myasthenia gravis surgical objectives.
Core Tip: The subxiphoid robotic-assisted thoracic approach is an excellent alternative to traditional unilateral robotic and video-assisted minimally invasive techniques for the treatment of anterior mediastinal tumors. This method provides an unobstructed view of the mediastinal structures, allowing for the safe removal of larger lesions while maintaining direct control over both phrenic nerves. Furthermore, it is associated with less postoperative pain and better cosmetic outcomes. Based on our initial experience with 10 patients, the subxiphoid approach is a feasible, safe, and oncologically sound option for mediastinal dissection, even in cases where lesions exceed 5 cm in diameter.
