A Retrospective Study On The Clinical Efficacy Of Da Vinci Robotic And Thoracoscopic Transxiphoid Approach In The Treatment Of Anterior Mediastinal Tumors

Objective:This study compared the effectiveness,safety,and clinical efficacy of two surgical approaches—namely da Vinci robot–assisted thoracoscopic surgery(RATS)and video-assisted thoracoscopic surgery(VATS)—via subxiphoid approach for the treatment of anterior mediastinal tumors.Methods:Between June 2020 and December 2022,a total of 135 patients underwent thoracoscopic anterior mediastinal tumor resection with trans-subsagittal incision at the Department of Thoracic Surgery of the First Hospital of Lanzhou University.Patients for whom the surgical approach was intraoperatively converted to median sternotomy(n=4),those who were lost to follow-up(n=14),and those who had a history of previous thoracic surgery(n=1)were excluded.Accordingly,116patients were included in the study sample.The patients were divided into two groups according to surgical approach:the RATS group(n=60;mean age=45.28±13.39years;28 men and 32 women)and VATS group(n=56;mean age=47.04±13.52years;25 men and 31 women).Information on age,height,weight,tumor characteristics(e.g.,size and postoperative pathological type),and perioperative data(e.g.,hospitalization cost;operative time;intraoperative bleeding;and postoperative complications such as cardiac arrhythmia,incisional infection,and pulmonary infection)was collected and compared between the groups.Results:All 116 patients underwent surgery successfully.Hospitalization cost(Z=6.972,P<0.001)and operative time(t=3.341,P=0.001)were significantly higher in the RATS group than in the VATS group.The RATS group exhibited more favorable outcomes than did the VATS group in terms of intraoperative bleeding(Z=2.393,P=0.017),postoperative hospitalization time(Z=2.134,P=0.033),postoperative water or food intake time(Z=2.541,P=0.011),postoperative downtime(Z=2.377,P=0.017),postoperative day 1 white blood cell count(t=2.369,P=0.020),postoperative day 1 neutrophil percentage(t=3.067,P=0.003),postoperative day 1 visual analogue scale score(Z=2.473,P=0.013),patient-controlled intravenous analgesia pump use time(Z=2.208,P=0.027),number of voluntary compressions of the analgesia pump(Z=2.472,P=0.013),and mediastinal drainage(Z=2.245,P=0.025).Moreover,both groups did not differ significantly in terms of postoperative day 3 white blood cell count(t=0.338,P=0.736),postoperative day 3 neutrophil percentage(t=1.068,P=0.288),and visual analogue scale score(Z=1.592,P=0.111)on postoperative day 3,duration of drainage tube retention(Z=1.173,P=0.241),as well as total postoperative complication rate(x~2<0.001,P=0.999)and the incidence of each complication.During the follow-up period,no tumor recurrence or metastasis occurred in either group.Conclusion:da Vinci robot–assisted subxiphoid anterior mediastinal tumor resection was determined to be a safe and effective surgical approach with good clinical efficacy.The method can help reduce surgical trauma and postoperative pain,thereby achieving the purpose of expediting recovery,and has potential for extensive clinical application.