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.
ObjectiveTo compare the differences in clinical outcomes of artificial pneumothorax-assisted three-port, two-port, and uniportal thoracoscopic surgeries for the treatment of mediastinal tumors. Methods A retrospective analysis was conducted on clinical data of patients who underwent mediastinal tumor surgery in the Department of Thoracic Surgery at the General Hospital of Northern Theater Command from September 2020 to November 2024. Patients were divided into three groups based on the surgical approach: an artificial pneumothorax-assisted three-port thoracoscopy group, a two-port thoracoscopy group, and a uniportal thoracoscopy group. Perioperative data including operation time, intraoperative blood loss, postoperative hospital stay, chest tube indwelling rate, postoperative drainage volume, chest tube duration, and postoperative pain visual analogue scale (VAS) scores were compared among the three groups. Results A total of 308 patients were included. The artificial pneumothorax-assisted three-port thoracoscopy group comprised 75 patients [29 males, 46 females; median age: 57 (IQR: 47, 62) years]. The two-port thoracoscopy group included 127 patients [49 males, 78 females; median age: 52 (IQR: 43, 60) years], and the uniportal thoracoscopy group included 106 patients [48 males, 58 females; median age: 52.5 (IQR: 42, 62) years]. The operation time in the artificial pneumothorax-assisted three-port thoracoscopy group [74 (62, 99) min] was significantly shorter than that in the two-port thoracoscopy group [91 (71, 118) min] and the uniportal thoracoscopy group [90 (68, 110) min] (P<0.05). Intraoperative blood loss [30 (20, 75) mL] was also significantly less than that in the two-port thoracoscopy group [55 (30, 105) mL] and the uniportal thoracoscopy group [55 (30, 100) mL] (P<0.05). Regarding postoperative recovery, the length of hospital stay in the artificial pneumothorax-assisted three-port thoracoscopy group [2 (2, 4) days] was shorter than that in the two-port thoracoscopy group [3 (2, 5) days] and the uniportal thoracoscopy group [3 (3, 6) days] (P<0.05). On postoperative day 1 (POD1), the VAS score in the artificial pneumothorax-assisted three-port thoracoscopy group [4 (3, 4) points] was lower than that in the two-port thoracoscopy group [4 (3, 5) points] and the uniportal thoracoscopy group [4 (3, 5) points] (P<0.05). The chest tube indwelling rate (52.0%) was significantly lower than that in the two-port thoracoscopy group (92.9%) and the uniportal thoracoscopy group (84.9%) (P<0.05). POD1 chest tube drainage volume [80 (0, 105) mL] and chest tube duration [1 (0, 2) days] were also significantly less or shorter than those in the two-port thoracoscopy group [110 (80, 150) mL, 2 (1, 2) days] and the uniportal thoracoscopy group [100 (50, 150) mL, 1 (1, 2) days], respectively (P<0.05). Conclusion All three different surgical approaches for mediastinal tumors are safe and effective. Artificial pneumothorax-assisted three-port thoracoscopic surgery demonstrates comprehensive advantages in terms of operation time, intraoperative blood loss, and postoperative recovery.