| BackgroundIn recent years,thymectomy has developed rapidly with the progress of surgical technology.In the current clinical practice,thymectomy has been widely used in the treatment of anterior mediastinal tumor and myasthenia gravis.Until now,median sternotomy is still the most widely used surgical method in thymectomy.However,in the past 10 years,with the development of minimally invasive technology promoted by technological innovation,thymoma surgery has also made great progress.The application and effect of video assisted thoracoscopic surgery(VATS)assisted thymectomy have been reported by medical centers all over the world.Taking the treatment of myasthenia gravis as an example,compared with traditional open surgery,VATS assisted thymectomy has obvious advantages,including shorter hospital stay,less postoperative pleural drainage and less pain,Reduce the infection rate and blood loss.At the same time,with the rapid development of minimally invasive technology,surgical operation system represented by Da Vinci robotic surgery system has been gradually applied to clinical practice.In the field of thoracic surgery,especially in thymectomy,the first reports about robotic assisted thoracic surgery(rats)appeared in the early 2000s.Yoshino et al.Reported for the first time robotic surgery on the mediastinum,in which thymectomy was performed on a small thymoma.Since then,the application scope of surgical operation system represented by Da Vinci robotic operation system has been expanding,which is first reflected in benign thymic diseases.Due to the worry about tumor capsule destruction and incomplete resection and other reasons,the application of robotic operation system in thymic malignant tumors develops slowly.However,with its wide application,more and more reports have proved that robotic surgery is safe and effective.ObjectiveThis study conducted a systematic review and meta-analysis to compare robotic assisted thymectomy(rats)and video-assisted thymectomy(VATS).In order to provide reference for the selection of thymectomy and the application of new technology。MethodsWe searched Cochrane Library,PubMed,Scopus,Wanfang Data knowledge service platform,China biomedical literature service system,CNKI database and other databases to collect the relevant clinical studies on the treatment of thymoma with rats and vats.The retrieval time was from the establishment of the database to January 2021.In order to ensure the comprehensiveness of the research data,we searched for the relevant publications about the clinical evaluation manually.The required outcome data were extracted,such as intraoperative blood loss,operation time,postoperative thoracic drainage time,hospital stay,conversion to thoracotomy rate,postoperative infection rate,incidence of myasthenia gravis crisis,positive rate of surgical margin,and overall postoperative complications.After risk assessment,the meta-analysis was conducted by Revman 5.3.ResultsThis study analyzed 10 retrospective cohort studies published from 2011 to 2020.The total number of patients included was 863.The total number of patients included in VATS group was 451,and the total number of patients included in rats group was 412.The results of meta-analysis showed that the intraoperative blood loss in VATS group was more than that in rats Group[SMD=-1.23,9.5%CI(-2.22-The results of meta-analysis showed that there was no significant difference in the operation time between the two groups[MD=7.24,9.5%CI(-0.46;P<0.05);The results of meta-analysis showed that the results of the rats group were better than those of the VATS group[MD=-0.78,95%CI(-1.19;P<0.05);0.38),P=0.0002]。Eight studies reported the postoperative drainage days,and the postoperative drainage days of VATS group were more than those of rats Group[MD=-1.33,95%CI(-2.09-At the same time,the results of meta-analysis showed that there was significant heterogeneity between the two groups[or=0.47,95%CI(0.12;0.57),P=0.0006];92),P=0.29],postoperative infection rate[or=0.59,95%CI(0;64),P=0.29],myasthenia gravis crisis[or=0.69,95%CI(0;99),P=0.68],overall postoperative complications[or=0.72,95%CI(0;41),P=0.34],positive rate of margin[or=0.71,95%CI(0;10),P=0.65].ConclusionThis paper systematically reviewed and analyzed 10 literatures,including VATS assisted thymectomy and robot assisted thymectomy.It was found that robot assisted thymectomy can significantly reduce blood loss,postoperative thoracic drainage time and hospital stay.Compared with VATS assisted thymectomy,there were no significant differences in conversion rate to thoracotomy,postoperative infection rate,incidence of myasthenia gravis crisis,positive rate of surgical margin and overall postoperative complications. |
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