Da Vinci robot-assisted surgery versus video-assisted thoracoscopic surgery for resection of mediastinal tumors: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZENG Liping , WANG Zhitian , HE Zhehao , ZHU Linhai , WANG Luming , ZHANG Chong ,  HU Jian

Department of Thoracic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, P.R.China;

Corresponding?author：

HU Jian, Email: dr_hujian@zju.edu.cn

Keywords：

Da Vinci robot system; video-assisted thoracoscopy; mediastinal tumors; minimally invasive surgery

DOI：

10.7507/1007-4848.201912063

Video：

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Objective To 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.Methods A 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.Results All 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).Conclusion Compared 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.

Citation： ZENG Liping, WANG Zhitian, HE Zhehao, ZHU Linhai, WANG Luming, ZHANG Chong, HU Jian. Da Vinci robot-assisted surgery versus video-assisted thoracoscopic surgery for resection of mediastinal tumors: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(3): 279-283. doi: 10.7507/1007-4848.201912063 Copy

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11.	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.
12.	Buentzel J, Heinz J, Hinterthaner M, et al. Robotic versus thoracoscopic thymectomy: The current evidence. Int J Med Robot, 2017, 13(4). doi: 10.1002/rcs.1847. Epub ahead of print.
13.	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.
14.	O'Sullivan KE, Kreaden US, Hebert AE, et al. A systematic review of robotic versus open and video assisted thoracoscopic surgery (VATS) approaches for thymectomy. Ann Cardiothorac Surg, 2019, 8(2): 174-193.
15.	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.
16.	Suda T, Tochii D, Tochii S, et al. Trans-subxiphoid robotic thymectomy. Interact Cardiovasc Thorac Surg, 2015, 20(5): 669-671.
17.	Abdellateef A, Ali JM, Jiang G, et al. Tips and tricks for success in subxiphoid video-assisted thoracic surgery. J Thorac Dis, 2019, 11(1): 292-301.
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.

1. Pugin F, Bucher P, Morel P. History of robotic surgery: from AESOP? and ZEUS? to da Vinci?. J Visc Surg, 2011, 148(5 Suppl): e3-e8.
2. Park BJ, Melfi F, Mussi A, et al. Robotic lobectomy for non-small cell lung cancer (NSCLC): long-term oncologic results. J Thorac Cardiovasc Surg, 2012, 143(2): 383-389.
3. Ruffini E, Filosso PL, Guerrera F, et al. Optimal surgical approach to thymic malignancies: New trends challenging old dogmas. Lung Cancer, 2018, 118: 161-170.
4. Zirafa CC, Romano G, Key TH, et al. The evolution of robotic thoracic surgery. Ann Cardiothorac Surg, 2019, 8(2): 210-217.
5. Ashrafian H, Clancy O, Grover V, et al. The evolution of robotic surgery: surgical and anaesthetic aspects. Br J Anaesth, 2017, 119(suppl_1): i72-i84.
6. Melfi FM, Menconi GF, Mariani AM, et al. Early experience with robotic technology for thoracoscopic surgery. Eur J Cardiothorac Surg, 2002, 21(5): 864-868.
7. Yoshino I, Hashizume M, Shimada M, et al. Video-assisted thoracoscopic extirpation of a posterior mediastinal mass using the da Vinci computer enhanced surgical system. Ann Thorac Surg, 2002, 74(4): 1235-1237.
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. 黃佳, 羅清泉, 趙曉菁, 等. 胸腺瘤切除術中機器人輔助胸腔鏡技術的應用. 腫瘤, 2009, 29(8): 796-798.
10. Kajiwara N, Kakihana M, Usuda J, et al. Extended indications for robotic surgery for posterior mediastinal tumors. Asian Cardiovasc Thorac Ann, 2012, 20(3): 308-313.
11. 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.
12. Buentzel J, Heinz J, Hinterthaner M, et al. Robotic versus thoracoscopic thymectomy: The current evidence. Int J Med Robot, 2017, 13(4). doi: 10.1002/rcs.1847. Epub ahead of print.
13. 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.
14. O'Sullivan KE, Kreaden US, Hebert AE, et al. A systematic review of robotic versus open and video assisted thoracoscopic surgery (VATS) approaches for thymectomy. Ann Cardiothorac Surg, 2019, 8(2): 174-193.
15. 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.
16. Suda T, Tochii D, Tochii S, et al. Trans-subxiphoid robotic thymectomy. Interact Cardiovasc Thorac Surg, 2015, 20(5): 669-671.
17. Abdellateef A, Ali JM, Jiang G, et al. Tips and tricks for success in subxiphoid video-assisted thoracic surgery. J Thorac Dis, 2019, 11(1): 292-301.
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.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Da Vinci robot-assisted surgery versus video-assisted thoracoscopic surgery for resection of mediastinal tumors: A retrospective cohort study

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