Comparison of therapeutic effects between Da Vinci robot surgery by subxiphoid approach and video-assisted thoracoscopic surgery by subxiphoid approach for anterior mediastinal tumors

SUN Zhendong; ZHOU Yifan; XU Ruihong; SHEN Bin; LUO Jinlong; LI Xiangwei; LIU Songtao; SUN Siyuan

doi:10.3969/j.issn.1674-3806.2024.04.17

Abstract：Objective To compare the therapeutic effects between Da Vinci robot surgery by subxiphoid approach and video-assisted thoracoscopic surgery(VATS)by subxiphoid approach for anterior mediastinal tumors.Methods A total of 56 patients with anterior mediastinal tumors who were admitted to the People's Hospital of Guangxi Zhuang Autonomous Region from January 2020 to January 2023 were recruited and divided into robot-assisted thoracoscopic surgery(RATS)group(n=20)and VATS group(n=36)according to different surgical methods.All the patients were operated using subxiphoid approach.The operation time,intraoperative blood loss,48-hour drainage volume,catheter retention time,total hospitalization cost,postoperative hospital stay,Visual Analogue Scale(VAS)score and complications were compared between the two groups.Results In the VATS group,1 patient underwent a conversion to thoracotomy due to the close adhesion of the innominate vein to the thymus,and 1 patient underwent a conversion to thoracotomy due to the close adhesion of the thymus to the pericardium pleura and the left upper lung.In the RATS group,no patients underwent a conversion to thoracotomy or extended incision length.The operations were successful in the patients in both groups.The operation time of the RATS group was significantly shorter than that of the VATS group(P＜0.05),but there were no significant differences in the intraoperative blood loss,48-hour drainage volume and catheter retention time between the two groups(P＞0.05).The postoperative VAS scores in both groups showed a downward trend.The VAS scores of the RATS group on day 1,day 2 and day 3 after surgery were lower than those of the VATS group,and the differences were statistically significant(P＜0.05).There was no significant difference in the incidence of complications between the two groups(5.88％vs 0.00％;P=0.525).The hospitalization cost of the RATS group was higher than that of the VATS group,and the difference was statistically significant(P＜0.05).There was no significant difference in postoperative hospital stay between the two groups(P＞0.05).Conclusion RATS is a safe and feasible method for the treatment of anterior mediastinal lesions.Compared with VATS,RATS has positive significance in reducing the patients'postoperative pain and is conducive to their rapid recovery.