ObjectiveTo investigate the safety and feasibility of thoracoscopic surgery of anterior mediastinal tumors via subxiphoid approach under scissors position (SASP) and lateral thoracic approach under lateral position (LALP).MethodsClinical data of 69 patients who received anterior mediastinal tumor excision surgery in our hospital from June 2016 to November 2019 were retrospectively analyzed, including 32 males and 37 females with an average age of 46.38±11.52 years. The clinical effects of the two groups were compared.ResultsThere was no perioperative death or conversion to thoracotomy. There was no statistically significant difference between the two groups in the operative time (123.34±12.64 min vs. 125.05±17.02 min, P=0.642), intraoperative blood loss [50.00 (73.75) mL vs. 50.00 (80.00) mL, P=0.643], tumor diameter (2.75±0.57 cm vs. 2.89±0.45 cm, P=0.787) and total hospital expenses [32.70 (5.30) thousand yuan vs. 32.90 (4.80) thousand yuan, P=0.923]. However, the postoperative catheterization time [2.00 (1.00) d vs. 4.00 (1.50) d, P=0.000], postoperative drainage [260.00 (200.00) mL vs. 400.00 (225.00) mL, P=0.031], postoperative pain index [2.00 (1.00) points vs. 4.00 (2.00) points, P=0.000], postoperative analgesic time [1.50 (1.00) d vs. 3.00 (2.00) d, P=0.000], postoperative fever time [1.50 (1.00) d vs. 2.00 (1.00) d, P=0.000] in the SASP group were better than those in the LALP group.ConclusionThoracoscopic surgery via SASP is more suitable for the treatment of anterior mediastinal tumor with rapid postoperative recovery and reduced pain, and the postoperative curative effect is definite. However, there is a high requirement for the surgical experience and techniques. It can be promoted in the clinic.
Objective To compare the safety and efficacy of the subxiphoid robot-assisted thoracoscopic surgery (SRATS) and intercostal robot-assisted thoracoscopic surgery (IRATS) for the treatment of anterior mediastinal tumors. Methods The clinical data of patients who received robot-assisted anterior mediastinal tumor resection in the same medical unit of the Department of Thoracic Surgery of Gansu Provincial Hospital from May 2020 to July 2022 were retrospectively collected. The patients were divided into a SRATS group and an IRATS group according to the surgical procedure. The perioperative data of patients were compared between the two groups. Results Finally 87 patients were collected, including 41 in the SRATS group (23 males and 18 females, mean age of 44.51±11.28 years) and 46 in the IRATS group (21 males and 25 females, mean age of 46.67±8.76 years). All 87 patients completed the surgery successfully. Compared with IRATS group, SRATS group had less intraoperative blood loss (24.41±6.67 mL vs. 37.93±9.23 mL, P=0.000), shorter postoperative catheterization time (1.73±0.59 d vs. 2.54±0.50 d, P=0.000), less postoperative drainage (94.46±34.08 mL vs. 116.72±24.90 mL, P=0.001), lower visual analogue score (VAS) on the first postoperative day (3.66±0.76 points vs. 4.15±0.84 points, P=0.005) and third postoperative day (2.41±0.59 points vs. 2.89±0.82 points, P=0.003), shorter postoperative hospital stay (4.12±0.81 d vs. 4.98±1.02 d, P=0.000) and lower hospitalization costs (45.1±6.5 thousand yuan vs. 48.6±6.8 thousand yuan, P=0.020). There was no significant difference in the operation time or the incidence of postoperative complications. Conclusion Both SRATS and IRATS have high safety and efficacy in the treatment of anterior mediastinal tumors. However, SRATS has less damage, which is more conducive to the rapid recovery of patients after surgery, and has a wide prospect of clinical application.
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.
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. ResultsA 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.
ObjectiveTo explore the clinical efficacy of two procedures in thoracoscopic anterior mediastinal tumor resection. MethodsA retrospective study was conducted on patients who underwent thoracoscopic anterior mediastinal tumor resection at the Department of Thoracic Surgery, the 910th Hospital of Joint Logistics Support Force from October 2016 to January 2024. Patients were divided into two groups according to the surgical approach: a modified approach group (bilateral intercostal ports+two subcostal ports) and a classic subxiphoid approach group (one subxiphoid port+two subcostal ports). Perioperative data and postoperative improvement of myasthenia gravis (MG) subgroup were compared between the two groups. ResultsA total of 55 patients were included, including 27 males and 28 females with a mean age of 47.5 (21-72) years. There were 23 patients in the modified approach group and 32 patients in the classic subxiphoid approach group. The modified approach group had shorter operation time (129.0±20.5 min vs. 148.9±16.7 min, P<0.001), less intraoperative blood loss (63.0±16.6 mL vs. 75.0±10.8 mL, P<0.001), shorter postoperative drainage tube removal time (3.1±0.4 d vs. 3.9±0.6 d, P<0.001) and shorter postoperative hospital stay (4.2±0.4 d vs. 5.0±0.6 d, P<0.001), and lower proportion of intraoperative cardiac dysfunction [4 (17.4%) vs. 14 (43.8%), P=0.040]. There was no statistical difference in maximum diameter of tumor resected (4.5±1.7 cm vs. 4.0±0.9 cm, P=0.193) and postoperative drainage volume (396.4±121.5 mL vs. 399.9±161.3 mL, P=0.932). There was 1 patient of perioperative collateral injury in the modified approach group (pericardial injury), and 6 patients in the classic subxiphoid approach group (1 patient of diaphragm injury, 1 patient of liver contusion, 4 patients of pericardial injury). There was no statistical difference in pain scores at 24 h, 48 h and 72 h after surgery (P>0.05). The postoperative improvement of myasthenia gravis symptoms in the modified approach group was better than that in the classic subxiphoid approach group at 1 year after surgery (complete stable remission rate: 77.8% vs. 50.0%; effective rate: 100.0% vs. 91.6%). No conversion to open chest surgery occurred in either group, and there were no postoperative rehospitalizations or deaths related to surgery within 30 days after surgery in both groups. ConclusionThe modified approach is safe and controllable with more open surgical field and more reliable complete resection range than the classic subxiphoid approach group.
Surgery is an important treatment for the anterior mediastinal disease. With the rapid development of minimally invasive techniques, complete resection of the lesion in most patients with thymic disease can be achieved through thoracoscopic surgery. Practice has proved that the three-port resection of anterior mediastinal thymus disease via the subxiphoid approach is an ideal surgical method for the treatment of anterior mediastinal thymic tumors at present, which has strong popularization and popularity and can benefit the patients. The procedure focuses primarily on the anterior and upper mediastinum and can thoroughly expose the anatomy of the mediastinum and both sides, with minimal intraoperative bleeding, high safety, minimal trauma and postoperative pain, and a short hospital stay. It has clear advantages over conventional thoracic open-heart surgery and transversal resection. However, the surgical approach and field of view, and intraoperative precautions of this procedure are completely different from those of previous thoracoscopic procedures, and from the subxiphoid single-port approach adopted by other centers. Based on 10 years of surgical experience at our center, a modular mode of surgical operation has been developed and its procedure has been standardized. This paper will share and discuss relevant operational points and experiences.
Objective To systematically evaluate the difference in clinical outcomes between subxiphoid video-assisted thoracoscopic surgery (SVATS) and intercostal video-assisted thoracoscopic surgery (IVATS) for anterior mediastinal tumor resection. Methods Online databases including The Cochrane Library, PubMed, EMbase, Web of Science, Sinomed, CNKI, Wanfang from inception to December 19, 2022 were searched by two researchers independently for literature comparing the clinical efficacy of SVATS and IVATS in treating anterior mediastinal tumors. Two researchers independently screened literature and extracted relevant data. The quality of the included literature was evaluated using the Newcastle-Ottawa Scale (NOS). The meta-analysis was performed by RevMan 5.3. ResultsA total of 12 studies with 1 517 patients were enrolled. NOS score≥6 points. The results of meta-analysis showed that compared with the IVATS, SVATS had less blood loss (MD=−17.76, 95%CI −34.21 to −1.31, P=0.030), less total postoperative drainage volume (MD=−70.46, 95%CI −118.88 to −22.03, P=0.004), shorter duration of postoperative drainage tube retention (MD=−0.84, 95%CI −1.57 to −0.10, P=0.030), lower rate of postoperative lung infections (OR=0.33, 95%CI 0.16 to 0.70, P=0.004), lower postoperative 24 h VAS pain score (MD=−1.95, 95%CI −2.64 to −1.25, P＜0.001) and 72 h VAS pain score (MD=−1.76, 95%CI −2.55 to −0.97, P＜0.001), and shorter postoperative hospital stay (MD=−1.12, 95%CI −1.80 to −0.45, P=0.001). There was no statistical difference in the operation time, the incidence of postoperative complications, incidence of postoperative phrenic nerve palsy or incidence of postoperative arrhythmia (P＞0.05). ConclusionSVATS for the treatment of anterior mediastinal tumors has high safety. Compared with the IVATS, the patients have less intraoperative blood loss and postoperative drainage volume, lower risk of postoperative pulmonary infection, less postoperative short-term pain, and shorter postoperative catheter duration and hospital stay, which is more conducive to rapid postoperative recovery.
ObjectiveTo explore the clinical application effects of using no drainage tube in mediastinal tumor resection via thoracoscopic subxiphoid approach. MethodsA retrospective analysis was conducted on the clinical data of patients who underwent mediastinal tumor resection via thoracoscopic subxiphoid approach at the Fourth People's Hospital of Zigong City from January 2020 to February 2024. Patients were divided into a non-drainage tube group and a drainage tube group, and their perioperative data were compared. ResultsA total of 149 patients were included, and there were 111 patients of thymoma, 5 patients of teratoma, and 33 patients of cyst. There were 77 patients in the non-drainage tube group, including 40 males and 37 females, aged 28-79 (53.72±13.34) years; there were 72 patients in the drainage tube group, including 33 males and 39 females, aged 26-80 (55.60±11.06) years. The differences in postoperative pain score at 48 hours, maximum postoperative pain score, postoperative hospital stay, postoperative drainage tube-related complications, and the number of temporary analgesics used after surgery between the two groups were statistically significant (P<0.05). ConclusionThe use of non-drainage tube technology in mediastinal tumor resection through thoracoscopic subxiphoid approach can reduce postoperative pain and the number of temporary analgesics used, as well as decrease the incidence of drainage tube-related complications.