Single‑Port Robotic Thymectomy Reduces Pain and Speeds Recovery for Myasthenia Gravis Patients
Summary
- A new single‑port robotic thymectomy technique is helping patients with myasthenia gravis and other medical conditions recover faster with less post‑surgical pain.
- By entering beneath the sternum and avoiding intercostal nerves, the single‑port approach reduces the risk of long‑lasting neuropathic pain seen with traditional, multi‑port surgery.
- The University of Miami Miller School of Medicine’s Dr. Nestor Villamizar became the first surgeon in the Miami area to perform a single‑port robotic thymectomy last September. Since then, he has completed more than 120 procedures using this approach.
UHealth — University of Miami Health System has expanded minimally invasive thoracic surgical care with the introduction of single‑port robotic surgery. The minimally invasive approach allows complex procedures to be performed through a single entry point beneath the sternum. The technique is designed to reduce post‑operative pain, minimize nerve injury and support faster recovery across a range of thoracic procedures.
Nestor Villamizar, M.D., an associate professor in the DeWitt Daughtry Family Department of Surgery at the University of Miami Miller School of Medicine, became the first surgeon in the Miami area to perform a single‑port robotic thymectomy last September. He’s now deploying the single-port robotic approach for an increasing number of surgical procedures.
Multiport Robotic Thymectomy
Because the thymus sits on top of the heart, removing it once required cutting through the sternum and opening the chest, similar to open‑heart surgery. Over the past several decades, however, advances in video‑assisted and robotic surgery have made thymectomy far less invasive.
The current standard robotic approach involves placing multiple ports between the ribs — one for a camera and two for surgical instruments. While significantly less invasive than traditional surgery, multi‑port robotic thymectomy can still irritate the intercostal nerves that run along the ribs.
Although Dr. Villamizar’s team had previously developed what was considered the best available pain‑reduction protocol for multi‑port surgery, a significant number of patients still experienced neuropathic pain.
“It can be a shooting pain, and patients would notice tingling and all sorts of symptoms because the nerve was irritated,” Dr. Villamizar said. “Unfortunately, those symptoms could last for months.”
The Advantages of Single-Port Robotic Surgery
The single-port robotic system allows Dr. Villamizar to perform thymectomies through a single entry point beneath the sternum. Because of Dr. Villamizar’s extensive experience with robotic thymectomy, the manufacturer invited him to train in the technique. Since that September procedural debut, he has completed more than 120 procedures using this approach.
“Of all the patients I’ve operated on using the new single‑port surgical approach, not a single one has come to the clinic for their two‑week post‑op complaining of neuropathic pain,” he said. “That’s why I’m so encouraged to continue doing this.”
Based on early outcomes, Dr. Villamizar suspects that the single‑port technique leads to faster recovery and less post‑operative neuropathic pain. He is currently leading a study comparing patient recovery data from single‑port versus multi‑port robotic thymectomy.
Dr. Villamizar is also using the single-port approach for procedures beyond thymectomies.
“Operations now done with the multiport robot could be done with the single-port robot, depending on each surgeon’s experience,” Dr. Villamizar said. “I started with simpler operations like thymectomy for myasthenia gravis and wedge resections for metastatic cancer to lung. However, I have already used it for tumors of the thymus and also for anatomic resections for lung cancer.”
A Patient’s Perspective on Recovery
Oliver Wechsler, one of Dr. Villamizar’s recent patients, had tried multiple nonsurgical treatments after being diagnosed with myasthenia gravis, with only limited success.
A Miami‑based attorney, Wechsler first noticed blurred vision while driving home from work in fall 2022. After several medical evaluations across the country, he was diagnosed and began medication and other therapies. Although they helped temporarily, his symptoms persisted.
After consulting with Dr. Villamizar, Wechsler elected to undergo thymectomy in mid‑December. Typically, patients are kept overnight following the procedure, but Wechsler felt well enough to be discharged the same day.
“I remember looking at the buildings from the car after my surgery and feeling like my double vision should be worse,” he said. “It almost felt weird. I had a bit of incisional pain, so for a week driving was difficult. But I feel pretty great now.”
Tags: DeWitt Daughtry Family Department of Surgery, Dr. Nestor Villamizar, myasthenia gravis, robotic surgery, surgery