A new single-center retrospective study has reported that the learning curve for a single surgeon to learn robot-assisted thymectomy (RAT) for patients with myasthenia gravis (MG) is steep, requiring 16 procedures to achieve the completion of the learning curve for the surgical time.

The study, published in Frontiers in Surgery, reported that even more procedures (46) were necessary for the robotic docking completion of the learning curve, but that the procedure was confirmed to be safe for patients even before the completion of the learning curve was achieved.

“The recently introduced robotic platform, which offers an excellent 3D visualization of the operating field, improved dexterity related to wristed instrument tips, and tremor filtration, makes the thymic dissection easier in a narrow space such as the mediastinum, driving a higher number of surgeons to consider thymectomy as the most appealing and attractive thoracic procedure to be performed by robotics,” the authors wrote. “Despite the growing interest in RAT, there is a paucity of clinical data describing the associated learning curve.”

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The research team conducted a retrospective analysis of prospectively collected data from 113 patients who underwent RAT between 2013 and 2020 by a single surgeon with very limited prior experience in robotic procedures. Patients were divided into 2 groups: myasthenic and nonmyasthenic.

The results confirmed an overall learning curve of 15 to 20 procedures, with a slightly longer learning curve (23) for myasthenic compared to nonmyasthenic (20) patients. An analysis of complications before and after the completion of the learning curve showed similar outcomes, suggesting that the RAT procedure is safe even at the beginning of the learning curve.

The authors hope that the results of this study will help with designing thoracic surgery training programs to prevent harm to patients and appropriately supervise surgeons who are new to the robotic technique.


Meacci E, Nachira D, Congedo MT, et al. Learning curve of robot-assisted thymectomy: single surgeon’s 7-year experience. Front Surg. 2022;9:860899. doi:10.3389/fsurg.2022.860899