Robotic Resection of Large Thymoma Dr Bilal Bin Asif Unveils a Paradigm Shift at WALS 2025 скачать в хорошем качестве

Robotic Resection of Large Thymoma Dr Bilal Bin Asif Unveils a Paradigm Shift at WALS 2025

Introduction At the World Association of Laparoscopic Surgeons (WALS) 2025 conference, Dr. Bilal Bin Asif, a renowned thoracic surgeon, presented groundbreaking advancements in the robotic resection of large thymomas. His work marks a significant paradigm shift in thoracic surgery, challenging traditional approaches and demonstrating the potential of robotic-assisted thoracic surgery (RATS) for complex mediastinal tumors. This article explores the key highlights of Dr. Asif’s presentation, the technical innovations, clinical outcomes, and the broader implications for the future of thymoma treatment. Background on Thymoma and Surgical Challenges Thymomas are rare tumors of the thymus gland, located in the anterior mediastinum, with an incidence of approximately 1.5 cases per million. They are often associated with paraneoplastic syndromes, such as myasthenia gravis, affecting about one-third of patients. Historically, the gold standard for thymoma resection has been median sternotomy, an open surgical approach that ensures complete resection but is associated with significant morbidity, prolonged hospital stays, and visible scarring. Minimally invasive techniques, such as video-assisted thoracoscopic surgery (VATS), have been adopted for early-stage thymomas (Masaoka-Koga stages I and II). However, their use for large thymomas (≥5 cm) or those invading adjacent structures like the pericardium, lung, or major vessels has been controversial due to concerns about capsular rupture, incomplete resection, and local recurrence. Robotic surgery, with its enhanced 3D visualization, tremor filtration, and multi-articulated instruments, offers a promising alternative to overcome these limitations. Dr. Bilal Bin Asif’s Contribution Dr. Asif, affiliated with Sir Ganga Ram Hospital in New Delhi, has been a pioneer in advancing robotic thoracic surgery in India. His presentation at WALS 2025 focused on the feasibility and efficacy of robotic-assisted thymectomy for large thymomas, drawing from his extensive experience and a series of complex cases. A notable example is his 2016 video lecture for the Robotic Surgeons Council of India, where he demonstrated the resection of a giant thymoma with pericardial involvement, highlighting the precision and safety of the robotic approach. Technical Innovations Dr. Asif’s approach leverages the da Vinci robotic system, utilizing a three-port technique, typically from a right-sided or bilateral approach, depending on tumor location. Key technical aspects include: Port Placement and Patient Positioning: Patients are positioned in a 30-degree semi-supine position with a roll under the shoulder to optimize access. Three ports are strategically placed—camera port (12 mm), left port in the anterior axillary fossa, and right port in the 5–6th intercostal space—to avoid violating mammary tissue. En Bloc Resection: For large thymomas, Dr. Asif emphasized en bloc resection of the tumor, thymus, and adjacent structures (e.g., pericardium, lung, or phrenic nerve) to achieve R0 (complete) resection. In cases of pericardial involvement, reconstruction with a polytetrafluoroethylene (PTFE) patch was performed robotically. Phrenic Nerve Sparing: In a case of a 4 cm thymoma with pleural relapses, Dr. Asif’s team used robotic Maryland Bipolar Forceps to dissect the tumor from the phrenic nerve, preserving its function and avoiding postoperative complications like diaphragmatic paralysis. Intraoperative Adjuncts: The use of CO2 insufflation (6–8 mmHg) enhances mediastinal visualization, while tools like Harmonic ACE® shears and endoscopic staplers facilitate precise dissection and vascular control. Conclusion Dr. Bilal Bin Asif’s presentation at WALS 2025 has redefined the boundaries of robotic resection for large thymomas. By demonstrating the safety, feasibility, and efficacy of RATS in complex cases, he has ushered in a new era of thoracic surgery. His emphasis on technical precision, patient-centered outcomes, and oncologic rigor positions robotic thymectomy as a game-changer, with the potential to become the standard of care. As the global surgical community embraces these advancements, Dr. Asif’s work will continue to inspire innovation and improve lives. https://www.laparoscopyhospital.com/S... Contact us: World Laparoscopy Hospital Cyber City, Gurugram, NCR Delhi, INDIA Phone/WhatsApp: +919811416838, +919999677788 World Laparoscopy Training Institute Bld. No: 27, DHCC, Dubai, UAE Phone: +971525857874 World Laparoscopy Training Institute 8320 Inv Dr, Tallahassee, Florida, USA Phone: +1 321 250 765