Perioperative effects of da Vinci robot with totally no tube versus subxiphoid video-assisted thymectomy surgery for thymic tumors: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

DING Renquan ¹ , CHENG Ming ^1,3 , XU Shiguang ¹ , ZHANG Yinan ² , XU Wei ¹ , LIU Bo ¹ , HU Yuhang ¹ , JIN Xidong ¹ , WANG Xilong ¹ ,  WANG Shumin ¹

1. Department of Thoracic Surgery, General Hospital of Northern Theater Command, Shenyang, 110016, P. R. China;
2. Department of Anesthesiology, General Hospital of Northern Theater Command, Shenyang, 110016, P. R. China;
3. Graduate Training Base of General Hospital of Northern Theater Command, Dalian Medical University, Shenyang, 110016, P. R. China;

Corresponding?author：

WANG Shumin, Email: sureman2003congo@163.com

Keywords：

Da Vinci robot; totally no tube; thoracoscopy; thymoma; surgery; retrospective cohort study

DOI：

10.7507/1007-4848.202202029

Video：

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Objective To compare the clinical efficacy and safety of da Vinci robot with totally no tube (TNT) versus subxiphoid video-assisted thymectomy surgery (SVATS) in the treatment of thymic tumors. Methods From 2019 to 2021, a retrospective analysis was conducted on patients with thymic tumor resection in the Department of Thoracic Surgery, General Hospital of Northern Theater Command. All patients underwent total thymectomy and mediastinal fat removal, and they were divided into a TNT group and a SVATS group according to the operation method. The intraoperative blood loss, conversion rate, postoperative visual analogue score (VAS), postoperative hospital stay time and postoperative complications were compared between the two groups. Results We finally included 435 patiets. There were 168 patients with 83 males and 85 females at an average age of 61.920±9.210 years in the TNT group and 267 patients with 147 males and 120 females at an average age of 61.460±8.119 years in the SVATS group. There was no death or postoperative myasthenic crisis in both groups. There was no statistical difference in postoperative hospital stay (1.540±0.500 d vs. 3.400±0.561 d, P=0.000), intraoperative blood loss (13.450±5.498 mL vs. 108.610±54.462 mL, P=0.000), postoperative 24 h VAS score (4.960±1.757 points vs. 3.600±1.708 points, P=0.000), or postoperative complication rate (3.0% vs. 11.6%, P=0.001).Conclusion TNT is a more efficient, safe, and effective surgical approach for treating thymic tumors, which can shorten hospital stay time and reduce postoperative complications. However, SVATS can minimize postoperative pain.

Citation： DING Renquan, CHENG Ming, XU Shiguang, ZHANG Yinan, XU Wei, LIU Bo, HU Yuhang, JIN Xidong, WANG Xilong, WANG Shumin. Perioperative effects of da Vinci robot with totally no tube versus subxiphoid video-assisted thymectomy surgery for thymic tumors: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(6): 818-823. doi: 10.7507/1007-4848.202202029 Copy

1.	Travis WD, Brambilla E, Burke AP, et al. Introduction to the 2015 World Health Organization classification of tumors of the lung, pleura, thymus, and heart. J Thorac Oncol, 2015, 10(9): 1240-1242.
2.	Rea F, Marulli G, Girardi R, Bortolotti L, et al. Long-term survival and prognostic factors in thymic epithelial tumours. Eur J Cardiothorac Surg, 2004, 26(2): 412-418.
3.	Raza A, Woo E. Video-assisted thoracoscopic surgery versus sternotomy in thymectomy for thymoma and myasthenia gravis. Ann Cardiothorac Surg, 2016, 5(1): 33-37.
4.	Jurado J, Javidfar J, Newmark A, et al. Minimally invasive thymectomy and open thymectomy: Outcome analysis of 263 patients. Ann Thorac Surg, 2012, 94(3): 974-981.
5.	程少先, 徐文禮, 艾瑞華, 等. 胸腔鏡劍突下小切口治療雙側胸腺瘤的臨床效果. 中國當代醫藥, 2018, 25(13): 8-12.
6.	鐘斌, 童繼春, 張明, 等. 經劍突下與經側胸入路胸腔鏡手術在胸腺瘤切除中的應用比較. 廣東醫學, 2019, 40(3): 383-386.
7.	Romano G, Zirafa CC, Ceccarelli I, et al. Robotic thymectomy for thymoma in patients with myasthenia gravis: Neurological and oncological outcomes. Eur J Cardiothorac Surg, 2021, 60(4): 890-895.
8.	劉星池, 李博, 徐惟, 等. 達芬奇機器人手術系統行縱隔腫瘤切除術后不放置引流管的病例對照研究. 中國胸心血管外科臨床雜志, 2015, 22(10): 940-943.
9.	Kondo K, Monden Y. Therapy for thymic epithelial tumors: A clinical study of 1, 320 patients from Japan. Ann Thorac Surg, 2003, 76(3): 878-885.
10.	Schnabel PA, Junker K. Pulmonary neuroendocrine tumors in the new WHO 2015 classification: Start of breaking new grounds?. Pathologe. 2015, 36(3): 283-92.
11.	張云峰, 于磊, 景筠, 等. 合并重癥肌無力的胸腺瘤治療與預后特點分析. 中華外科雜志, 2015, 53(8): 612-616.
12.	方文濤, 谷志濤, 陳克能. 胸腺腫瘤微創手術研究進展. 中國肺癌雜志, 2018, 21(4): 269-272.
13.	葉敏華, 陳保富, 葉中瑞, 等. 電視胸腔鏡手術治療前縱隔小結節32例. 中國微創外科雜志, 2009, 9(7): 638-639.
14.	王貴剛, 陳椿, 鄭煒, 等. 電視胸腔鏡手術治療胸腺瘤75例. 中國微創外科雜志, 2013, 13(7): 581-583.
15.	李曉, 惠本剛, 肖蓉心, 等. 胸腔鏡治療胸腺瘤的安全性及中長期療效分析. 中國微創外科雜志, 2017, 17(3): 193-196.
16.	Zieliński M, Kuzdza? J, Szlubowski A, et al. Transcervical-subxiphoid-videothoracoscopic "maximal" thymectomy-operative technique and early results. Ann Thorac Surg, 2004, 78(2): 404-410.
17.	Lu Q, Zhao J, Wang J, et al. Subxiphoid and subcostal arch "Three ports" thoracoscopic extended thymectomy for myasthenia gravis. J Thorac Dis, 2018, 10(3): 1711-1720.
18.	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.
19.	Kawaguchi K, Fukui T, Nakamura S, et al. A bilateral approach to extended thymectomy using the da Vinci Surgical System for patients with myasthenia gravis. Surg Today, 2018, 48(2): 195-199.
20.	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.
21.	中國醫師協會醫學機器人醫師分會胸外科專業委員會籌備組. 機器人輔助縱隔腫瘤手術中國專家共識(2019版). 中國胸心血管外科臨床雜志, 2020, 27(2): 117-125.
22.	丁仁泉, 童向東, 許世廣, 等. 達芬奇機器人手術系統與電視胸腔鏡在胸內縱隔疾病手術治療中的對比研究. 中國肺癌雜志, 2014, 17(7): 557-562.
23.	沈誠, 李玨, 李鵬飛, 等. 加速康復外科評價指標: 病人報告結局在胸外科的臨床應用現狀與進展. 中國肺癌雜志, 2019, 22(3): 161-166.
24.	Murgu S, Laxmanan B, Stoy S, et al. Evaluation of safety and short-term outcomes of therapeutic rigid bronchoscopy using total intravenous anesthesia and spontaneous assisted ventilation. Respiration, 2020, 99(3): 239-247.
25.	Ozdamar D, Turna C, Kimar A, et al. Tracheal injury: Late symptom after double-lumen tube intubation-A case report. J Pak Med Assoc, 2018, 68(11): 1711-1713.
26.	葉雄, 陳剛, 唐繼鳴, 等. 胸腔鏡微創術后不留置胸腔引流管在快速康復外科中的應用. 中國胸心血管外科臨床雜志, 2014, 21(1): 112-114.
27.	唐善衛, 武強, 束余聲. 肺癌術后胸腔閉式引流管理的現狀與進展. 中華胸部外科電子雜志, 2019, 6(3): 182-186.
28.	王維, 李川, 林琳, 等. 經劍突下達芬奇機器人手術與傳統胸腔鏡手術治療重癥肌無力合并胸腺瘤的對比研究. 中國胸心血管外科臨床雜志, 2020, 27(11): 1287-1291.
29.	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.

1. Travis WD, Brambilla E, Burke AP, et al. Introduction to the 2015 World Health Organization classification of tumors of the lung, pleura, thymus, and heart. J Thorac Oncol, 2015, 10(9): 1240-1242.
2. Rea F, Marulli G, Girardi R, Bortolotti L, et al. Long-term survival and prognostic factors in thymic epithelial tumours. Eur J Cardiothorac Surg, 2004, 26(2): 412-418.
3. Raza A, Woo E. Video-assisted thoracoscopic surgery versus sternotomy in thymectomy for thymoma and myasthenia gravis. Ann Cardiothorac Surg, 2016, 5(1): 33-37.
4. Jurado J, Javidfar J, Newmark A, et al. Minimally invasive thymectomy and open thymectomy: Outcome analysis of 263 patients. Ann Thorac Surg, 2012, 94(3): 974-981.
5. 程少先, 徐文禮, 艾瑞華, 等. 胸腔鏡劍突下小切口治療雙側胸腺瘤的臨床效果. 中國當代醫藥, 2018, 25(13): 8-12.
6. 鐘斌, 童繼春, 張明, 等. 經劍突下與經側胸入路胸腔鏡手術在胸腺瘤切除中的應用比較. 廣東醫學, 2019, 40(3): 383-386.
7. Romano G, Zirafa CC, Ceccarelli I, et al. Robotic thymectomy for thymoma in patients with myasthenia gravis: Neurological and oncological outcomes. Eur J Cardiothorac Surg, 2021, 60(4): 890-895.
8. 劉星池, 李博, 徐惟, 等. 達芬奇機器人手術系統行縱隔腫瘤切除術后不放置引流管的病例對照研究. 中國胸心血管外科臨床雜志, 2015, 22(10): 940-943.
9. Kondo K, Monden Y. Therapy for thymic epithelial tumors: A clinical study of 1, 320 patients from Japan. Ann Thorac Surg, 2003, 76(3): 878-885.
10. Schnabel PA, Junker K. Pulmonary neuroendocrine tumors in the new WHO 2015 classification: Start of breaking new grounds?. Pathologe. 2015, 36(3): 283-92.
11. 張云峰, 于磊, 景筠, 等. 合并重癥肌無力的胸腺瘤治療與預后特點分析. 中華外科雜志, 2015, 53(8): 612-616.
12. 方文濤, 谷志濤, 陳克能. 胸腺腫瘤微創手術研究進展. 中國肺癌雜志, 2018, 21(4): 269-272.
13. 葉敏華, 陳保富, 葉中瑞, 等. 電視胸腔鏡手術治療前縱隔小結節32例. 中國微創外科雜志, 2009, 9(7): 638-639.
14. 王貴剛, 陳椿, 鄭煒, 等. 電視胸腔鏡手術治療胸腺瘤75例. 中國微創外科雜志, 2013, 13(7): 581-583.
15. 李曉, 惠本剛, 肖蓉心, 等. 胸腔鏡治療胸腺瘤的安全性及中長期療效分析. 中國微創外科雜志, 2017, 17(3): 193-196.
16. Zieliński M, Kuzdza? J, Szlubowski A, et al. Transcervical-subxiphoid-videothoracoscopic "maximal" thymectomy-operative technique and early results. Ann Thorac Surg, 2004, 78(2): 404-410.
17. Lu Q, Zhao J, Wang J, et al. Subxiphoid and subcostal arch "Three ports" thoracoscopic extended thymectomy for myasthenia gravis. J Thorac Dis, 2018, 10(3): 1711-1720.
18. 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.
19. Kawaguchi K, Fukui T, Nakamura S, et al. A bilateral approach to extended thymectomy using the da Vinci Surgical System for patients with myasthenia gravis. Surg Today, 2018, 48(2): 195-199.
20. 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.
21. 中國醫師協會醫學機器人醫師分會胸外科專業委員會籌備組. 機器人輔助縱隔腫瘤手術中國專家共識(2019版). 中國胸心血管外科臨床雜志, 2020, 27(2): 117-125.
22. 丁仁泉, 童向東, 許世廣, 等. 達芬奇機器人手術系統與電視胸腔鏡在胸內縱隔疾病手術治療中的對比研究. 中國肺癌雜志, 2014, 17(7): 557-562.
23. 沈誠, 李玨, 李鵬飛, 等. 加速康復外科評價指標: 病人報告結局在胸外科的臨床應用現狀與進展. 中國肺癌雜志, 2019, 22(3): 161-166.
24. Murgu S, Laxmanan B, Stoy S, et al. Evaluation of safety and short-term outcomes of therapeutic rigid bronchoscopy using total intravenous anesthesia and spontaneous assisted ventilation. Respiration, 2020, 99(3): 239-247.
25. Ozdamar D, Turna C, Kimar A, et al. Tracheal injury: Late symptom after double-lumen tube intubation-A case report. J Pak Med Assoc, 2018, 68(11): 1711-1713.
26. 葉雄, 陳剛, 唐繼鳴, 等. 胸腔鏡微創術后不留置胸腔引流管在快速康復外科中的應用. 中國胸心血管外科臨床雜志, 2014, 21(1): 112-114.
27. 唐善衛, 武強, 束余聲. 肺癌術后胸腔閉式引流管理的現狀與進展. 中華胸部外科電子雜志, 2019, 6(3): 182-186.
28. 王維, 李川, 林琳, 等. 經劍突下達芬奇機器人手術與傳統胸腔鏡手術治療重癥肌無力合并胸腺瘤的對比研究. 中國胸心血管外科臨床雜志, 2020, 27(11): 1287-1291.
29. 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.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Perioperative effects of da Vinci robot with totally no tube versus subxiphoid video-assisted thymectomy surgery for thymic tumors: A retrospective cohort study

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