A Comparative Study Of The Perioperative Therapeutic Effects Between Da Vinci Robot-assisted Extended Thymectomy And Traditional Thoracoscopic Extended Thymectomy Via The Three-port Subxiphoid Approach

Objective:To explore the feasibility and safety of the Da Vinci robot applyed to perform extended thymectomy through the three-port subxiphoid approach,to compare and analyze the differences of the perioperative therapeutic effects between the Da Vinci robotic and the traditional thoracoscopic three-port subxiphoid approach to perform extended thymectomy,and to preliminarily explore the application value of the Da Vinci robot in this operation.Methods:From June 2021 to February 2023,118 patients were included in our department who were performed the three-port subxiphoid approach for extended thymectomy via Da Vinci robot surgery system and traditional thoracoscope,including 44 patients in Da Vinci robot surgery group and 74 patients in traditional thoracoscopic surgery group.There was no statistical difference in preoperative general information between two groups.Within the group,patients were further divided into corresponding subgroups based on whether they had myasthenia gravis and whether they had thymic tumor according to postoperative pathological results.Whether there were significant differences in perioperative indicators and therapeutic effects one month after surgery were compared.Results:There was no statistically significant difference between Da Vinci robot operation group and traditional thoracoscopic operation group in intraoperative blood loss,chest tube drainage volume 24 hours after surgery,chest tube drainage volume 48 hours after surgery,time of postoperative chest tube drainage and the incidence of postoperative complications.There was no statistically significant difference between the subgroup of patients with thymic tumor in Da Vinci robot operation group and traditional thoracoscopic operation group in chest tube drainage24 hours after surgery,postoperative chest tube drainage 48 hours after surgery,and time of chest tube drainage after surgery.There was no significant difference between the subgroup of patients with myasthenia gravis in Da Vinci robot surgery group and traditional thoracoscopic surgery group in the time of staying in the thoracic surgery ICU after surgery,postoperative tracheal intubation ventilator assisted ventilation time,time of hospitalization after surgery,QMGS scale score and relative score one month after surgery.There was no significant difference between the subgroup of patients without myasthenia gravis in Da Vinci robot surgery group and traditional thoracoscopic surgery group in time of staying in the thoracic surgery ICU after surgery and time of hospitalization after surgery.The operative time of Da Vinci robotic surgery group was(188.18±65.88)min,and that of traditional thoracoscopic surgery group was(142.03±45.86)min.The operative time of Da Vinci robotic surgery group was significantly longer than that of traditional thoracoscopic surgery group(P<0.001);The volume of excised specimens was(283.15±220.37)cm~3in Da Vinci robotic surgery group and(190.37±132.1)cm~3in traditional thoracoscopic surgery group.The volume of excised specimens in Da Vinci robotic surgery group was significantly larger than that in traditional thoracoscopic surgery group(P<0.05);The number of lymph node dissection in patients pathologically confirmed thymus tumor in Da Vinci robotic surgery group was(4.94±7.12),while the number of lymph node dissection in patients pathologically confirmed thymus tumor in traditional thoracoscopic surgery group was(1.04±2.14).The number of lymph nodes dissection in Da Vinci robot thymic tumor group was significantly higher than that in traditional thoracoscopic thymic tumor group.In Da Vinci robotic surgery group,the total hospitalization cost was(86819.50±39075.85)yuan in myasthenia gravis subgroup and(58908.76±6679.00)yuan in non-myasthenia gravis subgroup.In traditional thoracoscopic surgery group,the total hospitalization cost was(54802.07±29048.57)yuan in myasthenia gravis subgroup and(39450.95±8415.19)yuan in non-myasthenia gravis subgroup.The total hospitalization cost in Da Vinci robotic surgery group was significantly higher than that in traditional thoracoscopic surgery group(P<0.05).Conclusion:The traditional thoracoscopic three-port subxiphoid approach has been modified and applied to Da Vinci robot for extended thymectomy,which can achieve complete thymectomy and clearance of mediastinal adipose tissue,and the operation is safe and reliable.Compared with traditional thoracoscopic surgery,Da Vinci robot surgery possesses advantages such as bigger volume of excised specimens,more thorough sweeping of mediastinal adipose tissue and wider dissection of lymph nodes.However,the cost of Da Vinci robot surgery is significantly increased compared with traditional thoracoscopic surgery,which restricts Da Vinci robot’s further use.