The clinical efficacy of Da Vinci robot versus video-assisted thoracoscopic surgery in the treatment of posterior mediastinal tumors: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Feng ^1,2 , YUAN Yuhang ^1,2 , WANG Chenhan ^1,2 , HU Wenteng ^1,2 , HE Li ^1,2 , YANG Wenwen ^1,2 , SUN Shuo ^1,2 , ZHANG Min ^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：

Posterior mediastinal tumor; robot-assisted thoracoscopic surgery; lateral thoracic approach; video-assisted thoracoscopic surgery

DOI：

10.7507/1007-4848.202303038

Video：

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Objective To 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. Methods The 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. Results A 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. Conclusion RATS 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.

Citation： WANG Feng, YUAN Yuhang, WANG Chenhan, HU Wenteng, HE Li, YANG Wenwen, SUN Shuo, ZHANG Min, HAN Biao. The clinical efficacy of Da Vinci robot versus video-assisted thoracoscopic surgery in the treatment of posterior mediastinal tumors: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(5): 695-701. doi: 10.7507/1007-4848.202303038 Copy

1.	曾理平, 王志田, 何哲浩, 等. 達芬奇機器人與胸腔鏡下縱隔腫瘤切除術的回顧性隊列研究. 中國胸心血管外科臨床雜志, 2020, 27(3): 279-283.
2.	周振宇, 譚鋒維, 滕嘯, 等. 2022縱隔及胸壁腫瘤圍手術期及全程化綜合診治中國專家共識. 中國胸心血管外科臨床雜志, 2023, 30(3): 325-332.
3.	查健. 胸腔鏡及傳統開胸手術治療縱隔腫瘤效果對比. 醫學食療與健康, 2022, 20(1): 90-93.
4.	Sato T, Kazama T, Fukuzawa T, et al. Mediastinal tumor resection via open or video-assisted surgery in 31 pediatric cases: Experiences at a single institution. J Pediatr Surg, 2016, 51(4): 530-533.
5.	Landreneau RJ, Dowling RD, Castillo WM, et al. Thoracoscopic resection of an anterior mediastinal tumor. Ann Thorac Surg, 1992, 54(1): 142-144.
6.	Friedant AJ, Handorf EA, Su S, et al. Minimally invasive versus open thymectomy for thymic malignancies: Systematic review and meta-analysis. J Thorac Oncol, 2016, 11(1): 30-38.
7.	李卿. 單孔與三孔胸腔鏡手術治療縱隔腫瘤患者的效果比較. 中國民康醫學, 2022, 34(21): 148-150, 165.
8.	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.
9.	袁張強, 路志凱. CT掃描診斷胸部腫瘤的臨床價值分析. 影像研究與醫學應用, 2021, 5(19): 124-125.
10.	韓英杰, 張衛鋒, 任占良, 等. 單孔電視胸腔鏡手術治療后縱隔神經鞘瘤. 中國現代手術學雜志, 2020, 24(3): 183-187.
11.	王濤, 王森, 陳立材. 胸腔鏡手術與開胸術對縱隔腫瘤的療效比較. 中華心臟與心律電子雜志, 2019, 7(4): 204-207.
12.	Wu CF, Gonzalez-Rivas D, Wen CT, et al. Single-port video-assisted thoracoscopic mediastinal tumour resection. Interact Cardiovasc Thorac Surg, 2015, 21(5): 644-649.
13.	Shen C, Li J, Li J, et al. Robot-assisted thoracic surgery versus video-assisted thoracic surgery for treatment of patients with thymoma: A systematic review and meta-analysis. Thorac Cancer, 2022, 13(2): 151-161.
14.	汪明敏. 達芬奇機器人縱隔腫瘤切除術的學習曲線. 大連醫科大學, 2016.
15.	張喬冶. 達芬奇手術機器人系統及其應用. 醫療裝備, 2016, 29(9): 197-198.
16.	杜志江. 達芬奇手術機器人系統技術分析. 機器人技術與應用, 2011, 7(4): 14-16.
17.	Nakamura H, Taniguchi Y. Robot-assisted thoracoscopic surgery: Current status and prospects. Gen Thorac Cardiovasc Surg, 2013, 61(3): 127-132.
18.	Li Q, Sihoe A, Wang H, et al. Short-term outcomes of single- versus multi-port video-assisted thoracic surgery in mediastinal diseases. Eur J Cardiothorac Surg, 2018, 53(1): 216-220.
19.	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.
20.	Jessica DB, Dominic M, Geeta A. Systemic response to surgery. Surgery (Oxford), 2023, 41(2): 117-121.
21.	Zheng J, Wang Y, Zhang J, et al. 5G ultra-remote robot-assisted laparoscopic surgery in China. Surg Endosc, 2020, 34(11): 5172-5180.

1. 曾理平, 王志田, 何哲浩, 等. 達芬奇機器人與胸腔鏡下縱隔腫瘤切除術的回顧性隊列研究. 中國胸心血管外科臨床雜志, 2020, 27(3): 279-283.
2. 周振宇, 譚鋒維, 滕嘯, 等. 2022縱隔及胸壁腫瘤圍手術期及全程化綜合診治中國專家共識. 中國胸心血管外科臨床雜志, 2023, 30(3): 325-332.
3. 查健. 胸腔鏡及傳統開胸手術治療縱隔腫瘤效果對比. 醫學食療與健康, 2022, 20(1): 90-93.
4. Sato T, Kazama T, Fukuzawa T, et al. Mediastinal tumor resection via open or video-assisted surgery in 31 pediatric cases: Experiences at a single institution. J Pediatr Surg, 2016, 51(4): 530-533.
5. Landreneau RJ, Dowling RD, Castillo WM, et al. Thoracoscopic resection of an anterior mediastinal tumor. Ann Thorac Surg, 1992, 54(1): 142-144.
6. Friedant AJ, Handorf EA, Su S, et al. Minimally invasive versus open thymectomy for thymic malignancies: Systematic review and meta-analysis. J Thorac Oncol, 2016, 11(1): 30-38.
7. 李卿. 單孔與三孔胸腔鏡手術治療縱隔腫瘤患者的效果比較. 中國民康醫學, 2022, 34(21): 148-150, 165.
8. 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.
9. 袁張強, 路志凱. CT掃描診斷胸部腫瘤的臨床價值分析. 影像研究與醫學應用, 2021, 5(19): 124-125.
10. 韓英杰, 張衛鋒, 任占良, 等. 單孔電視胸腔鏡手術治療后縱隔神經鞘瘤. 中國現代手術學雜志, 2020, 24(3): 183-187.
11. 王濤, 王森, 陳立材. 胸腔鏡手術與開胸術對縱隔腫瘤的療效比較. 中華心臟與心律電子雜志, 2019, 7(4): 204-207.
12. Wu CF, Gonzalez-Rivas D, Wen CT, et al. Single-port video-assisted thoracoscopic mediastinal tumour resection. Interact Cardiovasc Thorac Surg, 2015, 21(5): 644-649.
13. Shen C, Li J, Li J, et al. Robot-assisted thoracic surgery versus video-assisted thoracic surgery for treatment of patients with thymoma: A systematic review and meta-analysis. Thorac Cancer, 2022, 13(2): 151-161.
14. 汪明敏. 達芬奇機器人縱隔腫瘤切除術的學習曲線. 大連醫科大學, 2016.
15. 張喬冶. 達芬奇手術機器人系統及其應用. 醫療裝備, 2016, 29(9): 197-198.
16. 杜志江. 達芬奇手術機器人系統技術分析. 機器人技術與應用, 2011, 7(4): 14-16.
17. Nakamura H, Taniguchi Y. Robot-assisted thoracoscopic surgery: Current status and prospects. Gen Thorac Cardiovasc Surg, 2013, 61(3): 127-132.
18. Li Q, Sihoe A, Wang H, et al. Short-term outcomes of single- versus multi-port video-assisted thoracic surgery in mediastinal diseases. Eur J Cardiothorac Surg, 2018, 53(1): 216-220.
19. 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.
20. Jessica DB, Dominic M, Geeta A. Systemic response to surgery. Surgery (Oxford), 2023, 41(2): 117-121.
21. Zheng J, Wang Y, Zhang J, et al. 5G ultra-remote robot-assisted laparoscopic surgery in China. Surg Endosc, 2020, 34(11): 5172-5180.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The clinical efficacy of Da Vinci robot versus video-assisted thoracoscopic surgery in the treatment of posterior mediastinal tumors: A retrospective cohort study

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