Da Vinci robotic versus thoracoscopic surgery via subxiphoid approach for treatment of anterior mediastinal tumor: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Xingchi , XU Shiguang , LIU Bo , LIU Dazhi , XU Wei , DING Renquan , LI Bo , LI Sitong ,  WANG Shumin

Department of Thoracic Surgery, General Hospital of Northern Theater Command, Shenyang, 110016, P. R. China;

Corresponding author：

WANG Shumin, Email: sureman2003congo@163.com

Keywords：

Da Vinci surgical system; thoracoscopy; mediastinal tumor; subxiphoid approach; pain; enhanced recovery after surgery

DOI：

10.7507/1007-4848.202112015

Video：

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Objective To compare the effects of anterior mediastinal tumor resection by the Da Vinci robot and video-assisted thoracoscopy via subxiphoid approach. Methods A retrospective cohort study was conducted to continuously enroll patients who underwent anterior mediastinal tumor resection between 2020 and 2021 in our department. They were divided into a robotic group and a subxiphoid thoracoscopic group. The differences of general indexes (intraoperative blood loss, postoperative drainage volume, postoperative catheterization time, postoperative hospital stay), postoperative pain visual analogue scale (VAS), perioperative declining levels of hemoglobin, hematocrit, serum prealbumin and serum albumin were compared and analyzed. Results A total of 113 patients were enrolled. There were 76 patients in the robotic group (46 males and 30 females, median age of 50 years) and 37 patients in the subxiphoid thoracoscopic group (21 males and 16 females, median age of 51 years). Intraoperative blood loss, postoperative drainage volume, postoperative catheterization time and postoperative hospital stay of the robotic group were better than those in the subxiphoid thoracoscopic group (P＜0.05). The postoperative VAS scores in the robotic group were lower than those in the subxiphoid thoracoscopic group, but there was no statistical difference (P＞0.05). Perioperative declining levels of hemoglobin, and hematocrit were not statistically different between the two groups (P＞0.05). Declining levels of serum prealbumin, and serum albumin in the robotic group were lower than those in the subxiphoid thoracoscopic group (P＜0.05). Conclusion Da Vinci robotic and subxiphoid video-assisted thoracoscopic surgeries for the treatment of anterior mediastinal tumors are both safe and reliable, with short postoperative hospital stay, mild postoperative pain and quick recovery. Da Vinci robot surgery has a slight advantage in the treatment outcome.

Citation： LIU Xingchi, XU Shiguang, LIU Bo, LIU Dazhi, XU Wei, DING Renquan, LI Bo, LI Sitong, WANG Shumin. Da Vinci robotic versus thoracoscopic surgery via subxiphoid approach for treatment of anterior mediastinal tumor: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(11): 1551-1555. doi: 10.7507/1007-4848.202112015 Copy

1.	彭凯明, 康明强, 林济红, 等. 经剑突下胸腔镜手术治疗前纵隔肿瘤疗效分析. 中华胸部外科电子杂志, 2018, 5(1): 16-21.
2.	任占良, 任小朋, 张泳. 单孔胸腔镜手术治疗胸腺瘤近期临床疗效观察. 中华胸部外科电子杂志, 2018, 5(4): 230-234.
3.	潘跃天, 宋永彬, 柳立军. 剪刀位经剑突下入路与侧卧位经侧胸入路胸腔镜下治疗前纵隔肿瘤的临床分析. 中国胸心血管外科临床杂志, 2020, 27(10): 1172-1176.
4.	O'Sullivan KE, Kreaden US, Hebert AE, et al. A systematic review of robotic versus open and video assisted thoracoscopic surgery (VATS) approaches for thymectomy. Ann Cardiothorac Surg, 2019, 8(2): 174-193.
5.	Melfi FM, Fanucchi O, Mussi A. Minimally invasive mediastinal surgery. Ann Cardiothorac Surg, 2016, 5(1): 10-17.
6.	Refai M, Gonzalez-Rivas D, Guiducci GM, et al. Uniportal video-assisted thoracoscopic thymectomy: The glove-port with carbon dioxide insufflation. Gland Surg, 2020, 9(4): 879-885.
7.	Nguyen GT, Nguyen TN, Nguyen NV, et al. Video-assisted thoracoscopic thymectomy for thymoma: A single-center experience. Asian Cardiovasc Thorac Ann, 2018, 26(3): 207-211.
8.	Yoshino I, Hashizume M, Shimada M, et al. Thoracoscopic thymomectomy with the da Vinci computer-enhanced surgical system. J Thorac Cardiovasc Surg, 2001, 122(4): 783-785.
9.	Park SY, Kim HK, Jang DS, et al. Initial experiences with robotic single-site thoracic surgery for mediastinal masses. Ann Thorac Surg, 2019, 107(1): 242-247.
10.	Numanami H, Yano M, Yamaji M, et al. Thoracoscopic thymectomy using a subxiphoid approach for anterior mediastinal tumors. Ann Thorac Cardiovasc Surg, 2018, 24(2): 65-72.
11.	孟庆军, 孔繁义, 宋翔. 经剑突下及肋弓下切口胸腔镜胸腺切除术的临床分析. 中国胸心血管外科临床杂志, 2018, 25(5): 449-452.
12.	Li J, Qi G, Liu Y, et al. Meta-analysis of subxiphoid approach versus lateral approach for thoracoscopic thymectomy. J Cardiothorac Surg, 2020, 15(1): 89.
13.	Carvalheiro C, Gallego-Poveda J, Gonzalez-Rivas D, et al. Uniportal VATS lobectomy: Subxiphoid approach. Rev Port Cir Cardiotorac Vasc, 2017, 24(3-4): 141.
14.	Aramini B, Fan J. Technique for myasthenia gravis: Subxiphoid approach. Thorac Surg Clin, 2019, 29(2): 195-202.
15.	Wang BY, Chang YC, Chang YC, et al. Thoracoscopic surgery via a single-incision subxiphoid approach is associated with less postoperative pain than single-incision transthoracic or three-incision transthoracic approaches for spontaneous pneumothorax. J Thorac Dis, 2016, 8(Suppl 3): S272-S278.
16.	Yano M, Moriyama S, Haneda H, et al. The subxiphoid approach leads to less invasive thoracoscopic thymectomy than the lateral approach. World J Surg, 2017, 41(3): 763-770.
17.	曾理平, 王志田, 何哲浩, 等. 达芬奇机器人与胸腔镜下纵隔肿瘤切除术的回顾性队列研究. 中国胸心血管外科临床杂志, 2020, 27(3): 279-283.
18.	Şehitogullari A, Nasır A, Anbar R, et al. Comparison of perioperative outcomes of videothoracoscopy and robotic surgical techniques in thymoma. Asian J Surg, 2020, 43(1): 244-250.
19.	Nagano H, Suda T, Ishizawa H, et al. Video-assisted thoracoscopic surgery for ectopic mediastinal parathyroid tumor: Subxiphoid and lateral thoracic approach. J Thorac Dis, 2019, 11(7): 2932-2938.
20.	Zhao J, Wang J, Zhao Z, et al. Subxiphoid and subcostal arch thoracoscopic extended thymectomy: A safe and feasible minimally invasive procedure for selective stage Ⅲ thymomas. J Thorac Dis, 2016, 8(Suppl 3): S258-S264.
21.	岳瀚逊, 张瑜, 马敏杰, 等. Tubeless经剑突下胸腔镜前纵隔肿瘤切除手术的病例对照研究. 中国胸心血管外科临床杂志, 2019, 26(4): 353-357.
22.	Li S, Jiang L, Ang KL, et al. New tubeless video-assisted thoracoscopic surgery for small pulmonary nodules. Eur J Cardiothorac Surg, 2017, 51(4): 689-693.
23.	Blanchet MC, Frering V, Gignoux B, et al. Four-year evolution of a thrombophylaxis protocol in an enhanced recovery after surgery (ERAS) program: Recent results in 485 patients. Obes Surg, 2018, 28(7): 2140-2144.

1. 彭凯明, 康明强, 林济红, 等. 经剑突下胸腔镜手术治疗前纵隔肿瘤疗效分析. 中华胸部外科电子杂志, 2018, 5(1): 16-21.
2. 任占良, 任小朋, 张泳. 单孔胸腔镜手术治疗胸腺瘤近期临床疗效观察. 中华胸部外科电子杂志, 2018, 5(4): 230-234.
3. 潘跃天, 宋永彬, 柳立军. 剪刀位经剑突下入路与侧卧位经侧胸入路胸腔镜下治疗前纵隔肿瘤的临床分析. 中国胸心血管外科临床杂志, 2020, 27(10): 1172-1176.
4. O'Sullivan KE, Kreaden US, Hebert AE, et al. A systematic review of robotic versus open and video assisted thoracoscopic surgery (VATS) approaches for thymectomy. Ann Cardiothorac Surg, 2019, 8(2): 174-193.
5. Melfi FM, Fanucchi O, Mussi A. Minimally invasive mediastinal surgery. Ann Cardiothorac Surg, 2016, 5(1): 10-17.
6. Refai M, Gonzalez-Rivas D, Guiducci GM, et al. Uniportal video-assisted thoracoscopic thymectomy: The glove-port with carbon dioxide insufflation. Gland Surg, 2020, 9(4): 879-885.
7. Nguyen GT, Nguyen TN, Nguyen NV, et al. Video-assisted thoracoscopic thymectomy for thymoma: A single-center experience. Asian Cardiovasc Thorac Ann, 2018, 26(3): 207-211.
8. Yoshino I, Hashizume M, Shimada M, et al. Thoracoscopic thymomectomy with the da Vinci computer-enhanced surgical system. J Thorac Cardiovasc Surg, 2001, 122(4): 783-785.
9. Park SY, Kim HK, Jang DS, et al. Initial experiences with robotic single-site thoracic surgery for mediastinal masses. Ann Thorac Surg, 2019, 107(1): 242-247.
10. Numanami H, Yano M, Yamaji M, et al. Thoracoscopic thymectomy using a subxiphoid approach for anterior mediastinal tumors. Ann Thorac Cardiovasc Surg, 2018, 24(2): 65-72.
11. 孟庆军, 孔繁义, 宋翔. 经剑突下及肋弓下切口胸腔镜胸腺切除术的临床分析. 中国胸心血管外科临床杂志, 2018, 25(5): 449-452.
12. Li J, Qi G, Liu Y, et al. Meta-analysis of subxiphoid approach versus lateral approach for thoracoscopic thymectomy. J Cardiothorac Surg, 2020, 15(1): 89.
13. Carvalheiro C, Gallego-Poveda J, Gonzalez-Rivas D, et al. Uniportal VATS lobectomy: Subxiphoid approach. Rev Port Cir Cardiotorac Vasc, 2017, 24(3-4): 141.
14. Aramini B, Fan J. Technique for myasthenia gravis: Subxiphoid approach. Thorac Surg Clin, 2019, 29(2): 195-202.
15. Wang BY, Chang YC, Chang YC, et al. Thoracoscopic surgery via a single-incision subxiphoid approach is associated with less postoperative pain than single-incision transthoracic or three-incision transthoracic approaches for spontaneous pneumothorax. J Thorac Dis, 2016, 8(Suppl 3): S272-S278.
16. Yano M, Moriyama S, Haneda H, et al. The subxiphoid approach leads to less invasive thoracoscopic thymectomy than the lateral approach. World J Surg, 2017, 41(3): 763-770.
17. 曾理平, 王志田, 何哲浩, 等. 达芬奇机器人与胸腔镜下纵隔肿瘤切除术的回顾性队列研究. 中国胸心血管外科临床杂志, 2020, 27(3): 279-283.
18. Şehitogullari A, Nasır A, Anbar R, et al. Comparison of perioperative outcomes of videothoracoscopy and robotic surgical techniques in thymoma. Asian J Surg, 2020, 43(1): 244-250.
19. Nagano H, Suda T, Ishizawa H, et al. Video-assisted thoracoscopic surgery for ectopic mediastinal parathyroid tumor: Subxiphoid and lateral thoracic approach. J Thorac Dis, 2019, 11(7): 2932-2938.
20. Zhao J, Wang J, Zhao Z, et al. Subxiphoid and subcostal arch thoracoscopic extended thymectomy: A safe and feasible minimally invasive procedure for selective stage Ⅲ thymomas. J Thorac Dis, 2016, 8(Suppl 3): S258-S264.
21. 岳瀚逊, 张瑜, 马敏杰, 等. Tubeless经剑突下胸腔镜前纵隔肿瘤切除手术的病例对照研究. 中国胸心血管外科临床杂志, 2019, 26(4): 353-357.
22. Li S, Jiang L, Ang KL, et al. New tubeless video-assisted thoracoscopic surgery for small pulmonary nodules. Eur J Cardiothorac Surg, 2017, 51(4): 689-693.
23. Blanchet MC, Frering V, Gignoux B, et al. Four-year evolution of a thrombophylaxis protocol in an enhanced recovery after surgery (ERAS) program: Recent results in 485 patients. Obes Surg, 2018, 28(7): 2140-2144.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Da Vinci robotic versus thoracoscopic surgery via subxiphoid approach for treatment of anterior mediastinal tumor: A retrospective cohort study

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