Robotic subxiphoid-optical thymectomy for Good’s syndrome in a severely immunocompromised patient: a case reports

Background: Good’s syndrome is a rare adult-onset immunodeficiency characterized by thymoma and hypogammaglobulinemia. In this report, we describe a case of Good’s syndrome in an elderly male patient with severe hypogammaglobulinemia, who underwent robotic subxiphoid-optical thymectomy as part of a perioperative strategy aimed at reducing surgical invasiveness.

Case Description: An 80-year-old man with Good’s syndrome presented with hypogammaglobulinemia and complete absence of B cells. Given this pronounced immunodeficiency, robotic subxiphoid-optical thymectomy was indicated to minimize surgical trauma while avoiding median sternotomy. The perioperative management strategy included preoperative intravenous immunoglobulin replacement therapy, extended antibiotic prophylaxis, careful patient selection, and close perioperative monitoring. No perioperative infectious complications occurred, allowing timely initiation of cyclosporine when pure red cell aplasia developed eight weeks postoperatively.

Conclusions: This case suggests that robotic subxiphoid-optical thymectomy could be an option in selectedpatients with Good’s syndrome and severe immunodeficiency.