ObjectiveTo analyze and compare the perioperative efficacy difference between full-port Da Vinci robotic surgery and thoracoscopic surgery in patients with mediastinal tumor resection. MethodsThe data of 232 patients with mediastinal tumors treated by the same operator in the Department of Thoracic Surgery of the Second Affiliated Hospital of Harbin Medical University were included. There were 103 (44.4%) males and 129 (55.6%) females, with an average age of 49.7 years. According to the surgical methods, they were divided into a robot-assisted thoracic surgery (RATS) group (n=113) and a video-assisted thoracoscopic surgery (VATS) group (n=119). After 1 : 1 propensity score matching, 57 patients in the RATS group and 57 patients in the VATS group were obtained. ResultsThe RATS group was better than the VATS group in the visual analogue scale pain score on the first day after the surgery [3.0 (2.0, 4.0) points vs. 4.0 (3.0, 5.0) points], postoperative hospital stay time [4.0 (3.0, 5.5) d vs. 6.0 (5.0, 7.0) d] and postoperative catheterization time [2.0 (2.0, 3.0) d vs. 3.0 (3.0, 4.0) d] (all P<0.05). There was no statistical difference between the two groups in terms of intraoperative blood loss, postoperative complications, postoperative thoracic closed drainage catheter placement rate or postoperative total drainage volume (all P>0.05). The total hospitalization costs [51 271.0 (44 166.0, 57 152.0) yuan vs. 35 814.0 (33 418.0, 39 312.0) yuan], operation costs [37 659.0 (32 217.0, 41 511.0) yuan vs. 19 640.0 (17 008.0, 21 421.0) yuan], anesthesia costs [3 307.0 (2 530.0, 3 823.0) yuan vs. 2 059.0 (1 577.0, 2 887.0) yuan] and drug and examination costs [9 241.0 (7 987.0, 12 332.0) yuan vs. 14 143.0 (11 620.0, 16 750.0) yuan] in the RATS group was higher than those in the VATS group (all P<0.05). ConclusionRobotic surgery and thoracoscopic surgery can be done safely and effectively. Compared with thoracoscopic surgery, robotic surgery has less postoperative pain, shorter tube-carrying time, and less postoperative hospital stay, which can significantly speed up the postoperative recovery of patients. However, the cost of robotic surgery is higher than that of thoracoscopic surgery, which increases the economic burden of patients and is also one of the main reasons for preventing the popularization of robotic surgery.
ObjectiveTo systematically evaluate of the difference in clinical outcomes between Da-Vinci robot-assisted thoracoscopic surgery (RATS) and video-assisted thoracoscopic surgery (VATS) for mediastinal tumor resection. MethodsOnline databases including The Cochrane Library, PubMed, EMbase, Web of Science, SinoMed, CNKI, and Wanfang were searched by two researchers independently from inception to October 10, 2022. 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 23 studies with 5 646 patients were enrolled in the final study. The NOS scores of the studies were≥6 points. The results of meta-analysis showed that compared with the VATS group, the blood loss was less [MD=−18.11, 95%CI (−26.12, −10.09), P＜0.001], time of postoperative drainage tube retention [MD=−0.79, 95%CI (−1.09, −0.49), P＜0.001] and postoperative hospitalization time [MD=−1.00, 95%CI (−1.36, −0.64), P＜0.001] were shorter, postoperative day 1 drainage [MD=−5.53, 95%CI (−9.94, −1.12), P=0.010] and total postoperative drainage [MD=−88.41, 95%CI (−140.85, −35.97), P=0.001] were less, the rates of postoperative complications [OR=0.66, 95%CI (0.46, 0.94), P=0.020] and conversion to thoracotomy [OR=0.32, 95%CI (0.19, 0.53), P＜0.001] were lower, and the hospitalization costs were higher [MD=2.60, 95%CI (1.40, 3.79), P＜0.001] in the RATS group. The operative time was not statistically different between the two groups [MD=5.94, 95%CI (−1.45, 13.34), P=0.120]. ConclusionRATS mediastinal tumor resection has a high safety profile. Compared with VATS, patients have less intraoperative blood loss, a lower rate of conversion to thoracotomy, and shorter postoperative tube time and hospital stay, which is more conducive to rapid postoperative recovery.
Objective To investigate the learning curve for da Vinci robot-assisted mediastinal tumor resection (DRMTR). Methods A total of 50 consecutive patients received DRMTR between March 2011 and September 2012 in our hospital. Clinical data of the 50 patients were collected and analyzed. There were 23 males, 27 females aged 46.9(17–80) years. The learning curve was evaluated by using the cumulative sum (CUSUM) analysis. Results The mean operation time was 124.6 min. The CUSUM learning curve was best modeled as a third-order polynomial curve with the equation: CUSUM=0.046×case-number3–4.681×case-number2+127.508×case-number–237.940, which had a highR2 value of 0.868. The fitting curve reached the top after the 19th case, which suggested that the surgeons master the technique after they finished 19 cases. As a cut-off point, the 19th case divided the learning curve into two phases, in which there was statistical diffference in operation time (P<0.01), intraoperative blood loss (P<0.01), the postoperative duration of chest tube drainage (P<0.01 ) and the rate of postoperative complications (P<0.05 ). Conclusion The DRMTR identified by CUSUM analysis represents two characteristic stages of DRMTR: the learning stage and the mastery stage. It is suggested from our data that the surgeons need finish about 19 cases to master DRMTR.
ObjectiveTo compare the short-term clinical effects of Da Vinci robot-assisted thoracic surgery (RATS) and video-assisted thoracoscopic surgery (VATS) in the treatment of posterior mediastinal tumors, and to explore the advantages of RATS posterior mediastinal tumor resection. MethodsThe clinical data of patients who underwent posterior mediastinal tumors resection through the lateral chest approach admitted to the same medical group in the Department of Thoracic Surgery of the First Hospital of Lanzhou University between January 2019 to January 2023 were retrospectively analyzed. According to the different surgical methods, the patients were divided into a RATS group and a VATS group. The clinical data were compared between the two groups. ResultsA total of 85 patients were included in this study. There were 39 patients in the RATS group, including 25 females and 14 males, with an average age of 47.6±13.0 years, and 46 patients in the VATS group, including 14 males and 32 females, with an average age of 45.3±14.7 years. All patients completed the operation successfully. The hospitalization cost in the RATS group was significantly higher than that in the VATS group (P<0.001), and the white blood cell count and neutrophilic granulocyte percentage on the first day after operation in the RATS group were lower than those in the VATS group, and the differences were statistically significant (P<0.05). The operative time, intraoperative bleeding, postoperative hospital stay, white blood cell count and neutrophil percentage on the third postoperative day, visual analogue scale score on the first and third postoperative days, duration of analgesic pump use, postoperative 12 h oxygen saturation (no oxygen inhalation), postoperative down bed time, total thoracic drainage volume, duration of drainage tube retention, and postoperative complication rates were not statistically different between the two groups (P>0.05). There was no perioperative death, conversion to thoracotomy or serious perioperative complications in both groups. ConclusionRATS resection of posterior mediastinal tumor via lateral thoracic approach is safe and feasible, and its short-term effect is similar to that of VATS via lateral thoracic single-hole approach. It is worth further comparative study to explore its benefit and cost performance.
ObjectiveTo summarize the experience of minimally invasive anterior mediastinal tumor resection in our center, and compare the Da Vinci robotic and video-assisted thoracoscopic approaches in the treatment of mediastinal tumor.MethodsA retrospective cohort study was conducted to continuously enroll 102 patients who underwent minimally invasive mediastinal tumor resection between September 2014 and November 2019 by the single medical group in our department. They were divided into two groups: a robotic group (n=47, 23 males and 24 females, average age of 52 years) and a thoracoscopic group (n=55, 29 males and 26 females, average age of 53 years). The operation time, intraoperative blood loss, postoperative thoracic drainage volume, postoperative thoracic drainage time, postoperative hospital stay, hospitalization expense and other clinical data of two groups were compared and analyzed.ResultsAll the patients successfully completed the surgery and recovered from hospital, with no perioperative death. Myasthenia gravis occurred in 4 patients of the robotic group and 5 of the thoracoscopic group. The tumor size was 2.5 (0.8-8.7) cm in the robotic group and 3.0 (0.8-7.7) cm in the thoracoscopic group. Operation time was 62 (30-132) min in the robotic group and 60 (29-118) min in the thoracoscopic group. Intraoperative bleeding volume was 20 (2-50) mL in the robotic group and 20 (5-100) mL in the thoracoscopic group. The postoperative drainage volume was 240 (20-14 130) mL in the robotic group and 295 (20-1 070) mL in the thoracoscopic group. The postoperative drainage time was 2 (1-15) days in the robotic group and 2 (1-5) days in the thoracoscopic group. There was no significant difference between the two groups in the above parameters and postoperative complications (P>0.05). The postoperative hospital stay were 3 (2-18) days in the robotic group and 4 (2-14) in the thoracoscopic group (P=0.014). The hospitalization cost was 67 489(26 486-89 570) yuan in the robotic group and 27 917 (16 817-67 603) yuan in the thoracoscopic group (P=0.000).ConclusionCompared with the video-assisted thoracoscopic surgery, Da Vinci robot-assisted surgery owns the same efficacy and safety in the treatment of mediastinal tumor, with shorter postoperative hospital stay, but higher cost.
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 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.
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.
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.
ObjectiveTo evaluate the short-term outcome of robot-assisted thoracoscopic surgery (RATS) for the treatment of posterior mediastinal neurogenic tumour. MethodsThe clinical data of consecutive patients with mediastinal neurogenic tumors who received RATS treatment completed by the same operator in the Department of Thoracic Surgery, Gansu Provincial People's Hospital from June 2016 to June 2022 were retrospectively analyzed. The tumors were preoperatively localized and evaluated using magnetic resonance imaging or enhanced CT. Results A total of 35 patients were enrolled, including 19 males and 16 females with a mean age of 34.9±7.1 years. All patients successfully completed the resection of posterior mediastinal neurogenic tumors under RATS, and no conversion to thoracotomy occurred during the operation. The average operative time was 62.3±18.0 min, docking time was 10.3±2.6 min, intraoperative bleeding was 33.9±21.6 mL, postoperative 24-hour chest drainage was 69.0±28.9 mL, postoperative chest drainage time was 2.0 (1.0, 3.0) d and the postoperative hospital stay was 3.0 (2.0, 4.0) d. Postoperative complications occurred in 3 patients, including 2 patients with transient Honor syndrome and 1 patient with transient anhidrosis of the affected upper limb. ConclusionRATS for posterior mediastinal neurogenic tumours is safe, effective and feasible, and allows the full benefit of the robotic surgical system to be exploited.