Efficacy and safety of robot-assisted thymectomy versus video-assisted thoracoscopic thymectomy: An updated systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HONG Ziqiang ^1,2 , JIN Dacheng ² , BAI Xiangdou ^1,2 , CHENG Tao ^1,2 , WU Xusheng ^1,2 , CUI Baiqiang ^1,2 ,  GOU Yunjiu ²

1. The First Clinical Department of Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, P. R. China;
2. Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, P. R. China;

Corresponding?author：

GOU Yunjiu, Email: gouyunjiu@163.com

Keywords：

Robot; thoracoscopy; thymoma; thymectomy; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202203037

Video：

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Objective To evaluate the efficacy and safety of robot-assisted thymectomy (RATS) versus video-assisted thoracoscopic thymectomy (VATS). Methods Web of Science, PubMed, EMbase, The Cochrane Library, Wanfang, VIP and CNKI databases were searched by computer from inception to February 2022. Relevant literatures that compared the efficacy and safety of RATS with those of VATS were screened. The Newcastle-OttawaScale (NOS) was used to evaluate the quality of included cohort studies, and Review Manager 5.4 software was utilized to perform a meta-analysis. Results A total of 16 retrospective cohort studies were included, covering a total of 1 793 patients (874 patients in the RATS group and 919 patients in the VATS group). The NOS scores of the included studies were≥7 points. Meta-analysis results revealed that RATS had less intraoperative bleeding (MD=?22.45, 95%CI ?34.16 to ?10.73, P<0.001), less postoperative chest drainage (MD=?80.29, 95%CI ?144.86 to ?15.72, P=0.010), shorter postoperative drainage time (MD=?0.69, 95%CI ?1.08 to ?0.30, P<0.001), shorter postoperative hospital stay (MD=?1.14, 95%CI ?1.55 to ?0.72, P<0.001) and fewer conversion to thoractomy (OR=0.40, 95%CI 0.23 to 0.69, P=0.001) than VATS; whereas, the operative time (MD=8.37, 95%CI ?1.21 to 17.96, P=0.090), incidence of postoperative myasthenia gravis (OR=0.85, 95%CI 0.52 to 1.40, P=0.530), overall postoperative complications rate (OR=0.80, 95%CI 0.42 to 1.50, P=0.480) and tumour size (MD=?0.18, 95%CI ?0.38 to 0.03, P=0.090) were not statistically different between the two groups. Conclusion In the aspects of intraoperative bleeding, postoperative chest drainage, postoperative drainage time, postoperative hospital stay and conversion to thoracotomy, RATS has unique advantages over the VATS.

Citation： HONG Ziqiang, JIN Dacheng, BAI Xiangdou, CHENG Tao, WU Xusheng, CUI Baiqiang, GOU Yunjiu. Efficacy and safety of robot-assisted thymectomy versus video-assisted thoracoscopic thymectomy: An updated systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(10): 1458-1466. doi: 10.7507/1007-4848.202203037 Copy

1.	Zhang H, Zheng Y, Chen LQ, et al. Robotic resection of a thymoma behind the left innominate vein. Interact Cardiovasc Thorac Surg, 2019, 29(5): 813-815.
2.	Kang CH, Hwang Y, Lee HJ, et al. Robotic thymectomy in anterior mediastinal mass: Propensity score matching study with transsternal thymectomy. Ann Thorac Surg, 2016, 102(3): 895-901.
3.	Chen K, Zhang X, Jin R, et al. Robot-assisted thoracoscopic surgery for mediastinal masses: A single-institution experience. J Thorac Dis, 2020, 12(2): 105-113.
4.	茍云久, 柏啟州, 汪成風, 等. 達芬奇機器人胸外科33例手術體驗. 中國胸心血管外科臨床雜志, 2017, 24(5): 404-406.
5.	Nguyen TG, Nguyen NT, Nguyen VN, et al. Video-assisted thoracoscopic surgery for myasthenia gravis with thymoma: A six-year single-center experience. Asian J Surg, 2021, 44(1): 369-373.
6.	Sholtis C, Teymourtash M, Berry M, et al. Transcervical thymectomy is the most cost-effective surgical approach in myasthenia gravis. Ann Thorac Surg, 2020, 109(6): 1705-1712.
7.	金大成, 韓松辰, 馬繼龍, 等. 機器人輔助與胸腔鏡胸腺切除術的療效對比: 系統評價與Meta分析. 臨床薈萃, 2019, 34(2): 163-170.
8.	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
9.	傅世杰, 谷志濤, 茅騰, 等. 胸腺切除術中達芬奇機器人與傳統手術對比分析. 中華腔鏡外科雜志(電子版), 2013, 6(5): 47-50.
10.	薛志強, 初向陽, 張連斌, 等. 達芬奇機器人與電視胸腔鏡治療胸腺瘤合并重癥肌無力的效果. 中華胸心血管外科雜志, 2017, 33(3): 141-143.
11.	魏光夏, 唐建, 喻本桐. 達芬奇機器人系統輔助與傳統胸腔鏡胸腺瘤切除術短期療效對比. 臨床外科雜志, 2019, 27(7): 610-611.
12.	王兵, 金大成, 陳猛, 等. 達芬奇機器人與傳統胸腔鏡胸腺瘤切除術中的比較. 中華胸心血管外科雜志, 2020, 36(7): 420-424.
13.	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.
14.	Rückert JC, Swierzy M, Ismail M. Comparison of robotic and nonrobotic thoracoscopic thymectomy: A cohort study. J Thorac Cardiovasc Surg, 2011, 141(3): 673-677.
15.	Ye B, Tantai JC, Li W, et al. Video-assisted thoracoscopic surgery versus robotic-assisted thoracoscopic surgery in the surgical treatment of Masaoka stageⅠthymoma. World J Surg Oncol, 2013, 11: 157.
16.	Jun Y, Hao L, Demin L, et al. Da Vinci robot-assisted system for thymectomy: Experience of 55 patients in China. Int J Med Robot, 2014, 10(3): 294-299.
17.	Rowse PG, Roden AC, Corl FM, et al. Minimally invasive thymectomy: The Mayo Clinic experience. Ann Cardiothorac Surg, 2015, 4(6): 519-526.
18.	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.
19.	Qian L, Chen X, Huang J, et al. A comparison of three approaches for the treatment of early-stage thymomas: Robot-assisted thoracic surgery, video-assisted thoracic surgery, and median sternotomy. J Thorac Dis, 2017, 9(7): 1997-2005.
20.	Kamel MK, Villena-Vargas J, Rahouma M, et al. National trends and perioperative outcomes of robotic resection of thymic tumours in the United States: A propensity matching comparison with open and video-assisted thoracoscopic approaches. Eur J Cardiothorac Surg, 2019, 56(4): 762-769.
21.	?ehitogullari A, Nas?r A, Anbar R, et al. Comparison of perioperative outcomes of video thoracoscopy and robotic surgical techniques in thymoma. Asian J Surg, 2020, 43(1): 244-250.
22.	Yang CJ, Hurd J, Shah SA, et al. A national analysis of open versus minimally invasive thymectomy for stageⅠtoⅢthymoma. J Thorac Cardiovasc Surg, 2020, 160(2): 555-567.
23.	Li XK, Xu Y, Cong ZZ, et al. Comparison of the progression-free survival between robot-assisted thymectomy and video-assisted thymectomy for thymic epithelial tumors: A propensity score matching study. J Thorac Dis, 2020, 12(8): 4033-4043.
24.	El-Akkawi AI, Eckardt J. Comparison of surgical outcomes after robotic assisted thoracic surgery, video-assisted thoracic surgery and open resection of thymoma. Mediastinum, 2021, 5: 11.
25.	Shintani Y, Funaki S, Ose N, et al. Surgical management of thymic epithelial tumors. Surg Today, 2021, 51(3): 331-339.
26.	Jiang L, Chen H, Hou Z, et al. Subxiphoid versus unilateral video-assisted thoracoscopic surgery thymectomy for thymomas: A propensity score matching analysis. Ann Thorac Surg, 2022, 113(5): 1656-1662.
27.	Tseng YC, Hsu HS, Lin YH, et al. Does size affect the prognosis of resectable thymoma beyond the eighth edition TNM? Thorac Cancer, 2022, 13(3): 346-352.
28.	NCCN clinical practice guidelines in oncology: Thymomas and thymic carcinomas (2018 Version 2). URL: http://www.nccn.org.
29.	Agatsuma H, Yoshida K, Yoshino I, et al. Video-assisted thoracic surgery thymectomy versus sternotomy thymectomy in patients with thymoma. Ann Thorac Surg, 2017, 104(3): 1047-1053.
30.	Pupovac SS, Newman J, Lee PC, et al. Intermediate oncologic outcomes after uniportal video-assisted thoracoscopic thymectomy for early-stage thymoma. J Thorac Dis, 2020, 12(8): 4025-4032.
31.	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.
32.	Shen C, Che G. Tubeless minimally invasive treatment: Taking a new step in enhanced recovery after surgery (ERAS). Thorac Cancer, 2019, 10(11): 2067-2070.
33.	Li F, Ismail M, Elsner A, et al. Surgical techniques for myasthenia gravis: Robotic-assisted thoracoscopic surgery. Thorac Surg Clin, 2019, 29(2): 177-186.
34.	Kumar A, Goyal V, Asaf BB, et al. Robotic thymectomy for myasthenia gravis with or without thymoma-surgical and neurological outcomes. Neurol India, 2017, 65(1): 58-63.
35.	劉博, 汪明敏, 許世廣, 等. 達芬奇機器人縱隔腫瘤切除術的學習曲線. 中國胸心血管外科臨床雜志, 2017, 24(2): 127-131.
36.	Aramini B, Song N, Banchelli F, et al. Subxiphoid thymectomy with a double sternum retractor: A pilot study. Gland Surg, 2019, 8(6): 657-662.
37.	Park SY, Han KN, Hong JI, et al. Subxiphoid approach for robotic single-site-assisted thymectomy. Eur J Cardiothorac Surg, 2020, 58(Suppl_1): i34-i38.
38.	Seong YW, Kang CH, Choi JW, et al. Early clinical outcomes of robot-assisted surgery for anterior mediastinal mass: Its superiority over a conventional sternotomy approach evaluated by propensity score matching. Eur J Cardiothorac Surg, 2014, 45(3): e68-e73.

1. Zhang H, Zheng Y, Chen LQ, et al. Robotic resection of a thymoma behind the left innominate vein. Interact Cardiovasc Thorac Surg, 2019, 29(5): 813-815.
2. Kang CH, Hwang Y, Lee HJ, et al. Robotic thymectomy in anterior mediastinal mass: Propensity score matching study with transsternal thymectomy. Ann Thorac Surg, 2016, 102(3): 895-901.
3. Chen K, Zhang X, Jin R, et al. Robot-assisted thoracoscopic surgery for mediastinal masses: A single-institution experience. J Thorac Dis, 2020, 12(2): 105-113.
4. 茍云久, 柏啟州, 汪成風, 等. 達芬奇機器人胸外科33例手術體驗. 中國胸心血管外科臨床雜志, 2017, 24(5): 404-406.
5. Nguyen TG, Nguyen NT, Nguyen VN, et al. Video-assisted thoracoscopic surgery for myasthenia gravis with thymoma: A six-year single-center experience. Asian J Surg, 2021, 44(1): 369-373.
6. Sholtis C, Teymourtash M, Berry M, et al. Transcervical thymectomy is the most cost-effective surgical approach in myasthenia gravis. Ann Thorac Surg, 2020, 109(6): 1705-1712.
7. 金大成, 韓松辰, 馬繼龍, 等. 機器人輔助與胸腔鏡胸腺切除術的療效對比: 系統評價與Meta分析. 臨床薈萃, 2019, 34(2): 163-170.
8. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
9. 傅世杰, 谷志濤, 茅騰, 等. 胸腺切除術中達芬奇機器人與傳統手術對比分析. 中華腔鏡外科雜志(電子版), 2013, 6(5): 47-50.
10. 薛志強, 初向陽, 張連斌, 等. 達芬奇機器人與電視胸腔鏡治療胸腺瘤合并重癥肌無力的效果. 中華胸心血管外科雜志, 2017, 33(3): 141-143.
11. 魏光夏, 唐建, 喻本桐. 達芬奇機器人系統輔助與傳統胸腔鏡胸腺瘤切除術短期療效對比. 臨床外科雜志, 2019, 27(7): 610-611.
12. 王兵, 金大成, 陳猛, 等. 達芬奇機器人與傳統胸腔鏡胸腺瘤切除術中的比較. 中華胸心血管外科雜志, 2020, 36(7): 420-424.
13. 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.
14. Rückert JC, Swierzy M, Ismail M. Comparison of robotic and nonrobotic thoracoscopic thymectomy: A cohort study. J Thorac Cardiovasc Surg, 2011, 141(3): 673-677.
15. Ye B, Tantai JC, Li W, et al. Video-assisted thoracoscopic surgery versus robotic-assisted thoracoscopic surgery in the surgical treatment of Masaoka stageⅠthymoma. World J Surg Oncol, 2013, 11: 157.
16. Jun Y, Hao L, Demin L, et al. Da Vinci robot-assisted system for thymectomy: Experience of 55 patients in China. Int J Med Robot, 2014, 10(3): 294-299.
17. Rowse PG, Roden AC, Corl FM, et al. Minimally invasive thymectomy: The Mayo Clinic experience. Ann Cardiothorac Surg, 2015, 4(6): 519-526.
18. 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.
19. Qian L, Chen X, Huang J, et al. A comparison of three approaches for the treatment of early-stage thymomas: Robot-assisted thoracic surgery, video-assisted thoracic surgery, and median sternotomy. J Thorac Dis, 2017, 9(7): 1997-2005.
20. Kamel MK, Villena-Vargas J, Rahouma M, et al. National trends and perioperative outcomes of robotic resection of thymic tumours in the United States: A propensity matching comparison with open and video-assisted thoracoscopic approaches. Eur J Cardiothorac Surg, 2019, 56(4): 762-769.
21. ?ehitogullari A, Nas?r A, Anbar R, et al. Comparison of perioperative outcomes of video thoracoscopy and robotic surgical techniques in thymoma. Asian J Surg, 2020, 43(1): 244-250.
22. Yang CJ, Hurd J, Shah SA, et al. A national analysis of open versus minimally invasive thymectomy for stageⅠtoⅢthymoma. J Thorac Cardiovasc Surg, 2020, 160(2): 555-567.
23. Li XK, Xu Y, Cong ZZ, et al. Comparison of the progression-free survival between robot-assisted thymectomy and video-assisted thymectomy for thymic epithelial tumors: A propensity score matching study. J Thorac Dis, 2020, 12(8): 4033-4043.
24. El-Akkawi AI, Eckardt J. Comparison of surgical outcomes after robotic assisted thoracic surgery, video-assisted thoracic surgery and open resection of thymoma. Mediastinum, 2021, 5: 11.
25. Shintani Y, Funaki S, Ose N, et al. Surgical management of thymic epithelial tumors. Surg Today, 2021, 51(3): 331-339.
26. Jiang L, Chen H, Hou Z, et al. Subxiphoid versus unilateral video-assisted thoracoscopic surgery thymectomy for thymomas: A propensity score matching analysis. Ann Thorac Surg, 2022, 113(5): 1656-1662.
27. Tseng YC, Hsu HS, Lin YH, et al. Does size affect the prognosis of resectable thymoma beyond the eighth edition TNM? Thorac Cancer, 2022, 13(3): 346-352.
28. NCCN clinical practice guidelines in oncology: Thymomas and thymic carcinomas (2018 Version 2). URL: http://www.nccn.org.
29. Agatsuma H, Yoshida K, Yoshino I, et al. Video-assisted thoracic surgery thymectomy versus sternotomy thymectomy in patients with thymoma. Ann Thorac Surg, 2017, 104(3): 1047-1053.
30. Pupovac SS, Newman J, Lee PC, et al. Intermediate oncologic outcomes after uniportal video-assisted thoracoscopic thymectomy for early-stage thymoma. J Thorac Dis, 2020, 12(8): 4025-4032.
31. 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.
32. Shen C, Che G. Tubeless minimally invasive treatment: Taking a new step in enhanced recovery after surgery (ERAS). Thorac Cancer, 2019, 10(11): 2067-2070.
33. Li F, Ismail M, Elsner A, et al. Surgical techniques for myasthenia gravis: Robotic-assisted thoracoscopic surgery. Thorac Surg Clin, 2019, 29(2): 177-186.
34. Kumar A, Goyal V, Asaf BB, et al. Robotic thymectomy for myasthenia gravis with or without thymoma-surgical and neurological outcomes. Neurol India, 2017, 65(1): 58-63.
35. 劉博, 汪明敏, 許世廣, 等. 達芬奇機器人縱隔腫瘤切除術的學習曲線. 中國胸心血管外科臨床雜志, 2017, 24(2): 127-131.
36. Aramini B, Song N, Banchelli F, et al. Subxiphoid thymectomy with a double sternum retractor: A pilot study. Gland Surg, 2019, 8(6): 657-662.
37. Park SY, Han KN, Hong JI, et al. Subxiphoid approach for robotic single-site-assisted thymectomy. Eur J Cardiothorac Surg, 2020, 58(Suppl_1): i34-i38.
38. Seong YW, Kang CH, Choi JW, et al. Early clinical outcomes of robot-assisted surgery for anterior mediastinal mass: Its superiority over a conventional sternotomy approach evaluated by propensity score matching. Eur J Cardiothorac Surg, 2014, 45(3): e68-e73.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Efficacy and safety of robot-assisted thymectomy versus video-assisted thoracoscopic thymectomy: An updated systematic review and meta-analysis

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