Clinical efficacy of da Vinci robotic and thoracoscopic transxiphoid approach in the treatment of anterior mediastinal tumors: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Chenhan ^1,2 , WANG Feng ^1,2 , HU Wenteng ^1,2 , LIN Ruijiang ^1,2 , LIANG Qiuhao ^1,2 , YUAN Bowen ^1,2 , MA Minjie ^1,2 ,  HAN Biao ²

1. The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, P. R. China;
2. Department of Thoracic Surgery, The First Hospital of Lanzhou University, Lanzhou, 730000, P. R. China;

Corresponding author：

HAN Biao, Email: hanbiao66@163.com

Keywords：

Robot-assisted thoracoscopic surgery; video-assisted thoracoscopic surgery; subxiphoid approach; anterior mediastinal tumor

DOI：

10.7507/1007-4848.202204073

Video：

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Objective To compare the safety and efficacy of the da Vinci robot and thoracoscopic subxiphoid approach for the treatment of anterior mediastinal tumors. Methods The clinical data of patients who underwent anterior mediastinal tumor resection through the subxiphoid approach admitted to the same medical group in the Department of Thoracic Surgery of the First Hospital of Lanzhou University between June 2020 and April 2022 were retrospectively analyzed. According to the surgery approach, the patients were divided into a robot-assisted thoracoscopic surgery (RATS) group and a video-assisted thoracoscopic surgery (VATS) group. The perioperative data and the incidence of postoperative complications were compared between the two groups. Results A total of 79 patients were enrolled. There were 41 patients in the RATS group, including 13 males and 28 females, with an average age of 45.61±14.99 years. There were 38 patients in the VATS group, including 14 males and 24 females, with an average age of 47.84±15.05 years. All patients completed the surgery successfully. Hospitalization cost and operative time were higher or longer in the RATS group than those in the VATS group, and the difference was statistically significant (P<0.05). Intraoperative bleeding, postoperative hospital stay, postoperative water and food intake time, postoperative off-bed activity time, white blood cell count, neutrophil percentage and visual analogue scale (VAS) score on the first postoperative day, white blood cell count and neutrophil percentage on the third postoperative day, duration of analgesic pump use, the number of voluntary compressions of the analgesic pump, and mediastinal drainage volume were all superior to those in the VATS group (P<0.05). The differences in VAS scores on the third postoperative day, duration of drainage tube retention and postoperative complication rates were not statistically different between the two groups (P>0.05). Conclusion RATS subxiphoid anterior mediastinum tumor resection is a safe and feasible surgical method with less injury and higher safety, which is conducive to rapid postoperative recovery and has wide clinical application prospects.

Citation： WANG Chenhan, WANG Feng, HU Wenteng, LIN Ruijiang, LIANG Qiuhao, YUAN Bowen, MA Minjie, HAN Biao. Clinical efficacy of da Vinci robotic and thoracoscopic transxiphoid approach in the treatment of anterior mediastinal tumors: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(2): 236-242. doi: 10.7507/1007-4848.202204073 Copy

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11.	Park S. Robot-assisted thoracic surgery thymectomy. J Chest Surg, 2021, 54(4): 319-324.
12.	Yamashita S, Yoshida Y, Iwasaki A. Robotic surgery for thoracic disease. Ann Thorac Cardiovasc Surg, 2016, 22(1): 1-5.
13.	Eichhorn M, Haag J, Grünewald C, et al. Robot-assisted mediastinal mass resection. Zentralbl Chir, 2021, 146(1): 111-118.
14.	Wu WJ, Zhang FY, Xiao Q, et al. Does robotic-assisted thymectomy have advantages over video-assisted thymectomy in short-term outcomes? A systematic view and meta-analysis. Interact Cardiovasc Thorac Surg, 2021, 33(3): 385-394.
15.	杨煜, 章雪飞, 茅腾, 等. 达芬奇机器人辅助纵隔肿瘤切除术339例近期疗效分析: 一项单中心回顾性病例对照研究. 中华胸心血管外科杂志, 2020, 36(11): 660-663.
16.	魏光夏, 唐建, 喻本桐. 达芬奇机器人系统辅助与传统胸腔镜胸腺瘤切除术短期疗效对比. 临床外科杂志, 2019, 27(7): 610-611.
17.	Shibasaki S, Suda K, Nakauchi M, et al. Non-robotic minimally invasive gastrectomy as an independent risk factor for postoperative intra-abdominal infectious complications: A single-center, retrospective and propensity score-matched analysis. World J Gastroenterol, 2020, 26(11): 1172-1184.
18.	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.
19.	Kamel MK, Rahouma M, Stiles BM, et al. Robotic thymectomy: Learning curve and associated perioperative outcomes. J Laparoendosc Adv Surg Tech A, 2017, 27(7): 685-690.
20.	Zirafa CC, Romano G, Key TH, et al. The evolution of robotic thoracic surgery. Ann Cardiothorac Surg, 2019, 8(2): 210-217.
21.	胡英杰, 刘晓芯. 达芬奇机器人手术与胸腔镜手术治疗前纵膈肿瘤的疗效研究. 海军医学杂志, 2021, 42(1): 64-67, 89.
22.	田运, 王海霖, 段光辉, 等. 200例达芬奇机器人胃癌根治术临床疗效报道. 中国普外基础与临床杂志, 2020, 27(10): 1221-1225.

1. 李卫, 那兴邦, 甘鸣晓, 等. 前纵隔肿瘤患者经剑突下胸腔镜技术效果分析. 浙江创伤外科, 2021, 26(6): 1120-1121.
2. 中国医师协会医学机器人医师分会胸外科专业委员会筹备组, 谭群友, 陶绍霖, 等. 机器人辅助纵隔肿瘤手术中国专家共识(2019版). 中国胸心血管外科临床杂志, 2020, 27(2): 117-125.
3. Cooper JD. History of thymectomy for myasthenia gravis. Thorac Surg Clin, 2019, 29(2): 151-158.
4. Fiorelli A, Mazzella A, Cascone R, et al. Bilateral thoracoscopic extended thymectomy versus sternotomy. Asian Cardiovasc Thorac Ann, 2016, 24(6): 555-561.
5. 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.
6. 李子凡. 经剑突下入路胸腔镜前纵隔肿瘤切除术疗效及远期疼痛分析. 安徽医科大学, 2021.
7. Wightman SC, Shrager JB. Non-myasthenia gravis immune syndromes and the thymus: Is there a role for thymectomy? Thorac Surg Clin, 2019, 29(2): 215-225.
8. 舒涵, 梅宏, 许川, 等. 前上纵隔肿瘤外科治疗研究进展. 中国实用医药, 2021, 16(25): 206-209.
9. Fok M, Bashir M, Harky A, et al. Video-assisted thoracoscopic versus robotic-assisted thoracoscopic thymectomy: Systematic review and meta-analysis. Innovations (Phila), 2017, 12(4): 259-264.
10. Suda T, Kaneda S, Hachimaru A, et al. Thymectomy via a subxiphoid approach: Single-port and robot-assisted. J Thorac Dis, 2016, 8(Suppl 3): S265-S271.
11. Park S. Robot-assisted thoracic surgery thymectomy. J Chest Surg, 2021, 54(4): 319-324.
12. Yamashita S, Yoshida Y, Iwasaki A. Robotic surgery for thoracic disease. Ann Thorac Cardiovasc Surg, 2016, 22(1): 1-5.
13. Eichhorn M, Haag J, Grünewald C, et al. Robot-assisted mediastinal mass resection. Zentralbl Chir, 2021, 146(1): 111-118.
14. Wu WJ, Zhang FY, Xiao Q, et al. Does robotic-assisted thymectomy have advantages over video-assisted thymectomy in short-term outcomes? A systematic view and meta-analysis. Interact Cardiovasc Thorac Surg, 2021, 33(3): 385-394.
15. 杨煜, 章雪飞, 茅腾, 等. 达芬奇机器人辅助纵隔肿瘤切除术339例近期疗效分析: 一项单中心回顾性病例对照研究. 中华胸心血管外科杂志, 2020, 36(11): 660-663.
16. 魏光夏, 唐建, 喻本桐. 达芬奇机器人系统辅助与传统胸腔镜胸腺瘤切除术短期疗效对比. 临床外科杂志, 2019, 27(7): 610-611.
17. Shibasaki S, Suda K, Nakauchi M, et al. Non-robotic minimally invasive gastrectomy as an independent risk factor for postoperative intra-abdominal infectious complications: A single-center, retrospective and propensity score-matched analysis. World J Gastroenterol, 2020, 26(11): 1172-1184.
18. 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.
19. Kamel MK, Rahouma M, Stiles BM, et al. Robotic thymectomy: Learning curve and associated perioperative outcomes. J Laparoendosc Adv Surg Tech A, 2017, 27(7): 685-690.
20. Zirafa CC, Romano G, Key TH, et al. The evolution of robotic thoracic surgery. Ann Cardiothorac Surg, 2019, 8(2): 210-217.
21. 胡英杰, 刘晓芯. 达芬奇机器人手术与胸腔镜手术治疗前纵膈肿瘤的疗效研究. 海军医学杂志, 2021, 42(1): 64-67, 89.
22. 田运, 王海霖, 段光辉, 等. 200例达芬奇机器人胃癌根治术临床疗效报道. 中国普外基础与临床杂志, 2020, 27(10): 1221-1225.

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Clinical efficacy of da Vinci robotic and thoracoscopic transxiphoid approach in the treatment of anterior mediastinal tumors: A retrospective cohort study

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