Short-term efficacy of robot-assisted surgery versus video-assisted thoracoscopic surgery for anterior mediastinal mass

Bin JIANG; Poming KANG; Shaolin TAO; Cheng SHEN; Bo DENG; Ruwen WANG; Qunyou TAN

doi:10.16016/j.1000-5404.201904181

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Short-term efficacy of robot-assisted surgery versus video-assisted thoracoscopic surgery for anterior mediastinal mass

Clinical Medicine | 更新时间：2026-01-09

- Short-term efficacy of robot-assisted surgery versus video-assisted thoracoscopic surgery for anterior mediastinal mass
- Journal of Third Military Medical University Vol. 41, Issue 16, Pages: 1578-1582(2019)
- 作者机构：
  
  400042 重庆，陆军军医大学(第三军医大学)大坪医院全军胸外科研究所
- 作者简介：
- 基金信息：
- DOI：10.16016/j.1000-5404.201904181
  CLC： R181.32; R616; R655.5
- Received：11 April 2019，
  
  Revised：2019-05-20，
  
  Published：30 August 2019
- 稿件说明：
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Bin JIANG, Poming KANG, Shaolin TAO, et al. Short-term efficacy of robot-assisted surgery versus video-assisted thoracoscopic surgery for anterior mediastinal mass[J]. Journal of Third Military Medical University, 2019, 41(16): 1578-1582.
DOI：

Bin JIANG, Poming KANG, Shaolin TAO, et al. Short-term efficacy of robot-assisted surgery versus video-assisted thoracoscopic surgery for anterior mediastinal mass[J]. Journal of Third Military Medical University, 2019, 41(16): 1578-1582. DOI： 10.16016/j.1000-5404.201904181.

摘要

目的

比较机器人与胸腔镜手术治疗前纵隔肿物的近期临床疗效，探讨机器人辅助前纵隔肿物切除的优势。

方法

采用回顾性队列研究的方法，收集2016年10月至2018年9月陆军军医大学(第三军医大学)大坪医院收治的111例行微创前纵隔肿物切除手术患者的临床病理资料。111例患者中，56例行达芬奇机器人手术，设为机器人组；55例行电视胸腔镜手术，设为胸腔镜组。对两组患者的病变直径、直径≥5 cm例数、手术时间、术中失血量、中转开胸率、术后引流量、术后胸引天数、联合扩大切除例数、术后住院日、并发症发生率和住院费用进行比较分析。

结果

全组患者均顺利完成手术，无

围术期死亡。机器人组对比胸腔镜组，在病变直径、直径≥5 cm比例(22/56

11/55

=0.026)、术中失血量、联合扩大切除率(8/56

1/55

=0.04)、住院费用方面差异有统计学意义；两组在手术时间、中转开胸率、术后引流量、术后胸引天数、术后住院日、并发症发生率上差异均无统计学意义(

0.05)。

结论

机器人辅助前纵隔肿物切除术安全可行，但费用较高；与胸腔镜手术比较出血更少，在大血管周围和深部狭小空间内操作有一定优势，对直径较大或有明显外侵需联合大血管切除的前纵隔肿瘤更为适用。

Abstract

Objective

To compare the short-term clinical efficacy of robot-assisted thoracic surgery (RATS) and video-assisted thoracoscopic surgery (VATS) for anterior mediastinal mass and investigate the advantages of robot-assisted surgery.

Methods

This retrospective cohort study was conducted in 111 patients undergoing minimally invasive surgery for anterior mediastinal mass in Daping Hospital of Army Medical University between October

2016 and September

2017. Of the 111 patients

56 underwent Da Vinci robotic surgery (RATS group) and 55 underwent VATS. The clinicopathological data were collected from the two groups for comparison of the tumor diameter

number of cases with tumor diameter ≥5 cm

operation time

intraoperative blood loss

conversion to open surgery rate

postoperative pleural drainage volume

days of pleural drainage

extended resection rate

postoperative hospital stay

complications and hospitalization costs.

Results

The operations were completed successfully in all the patients without perioperative mortality. Compared with those in VATS group

the patients with RATS had significantly larger tumor diameter (4.6±2.2

3.3±1.6 cm

=0.002)

more cases with a tumor diameter ≥5 cm (22/56

11/55

=0.026)

a less intraoperative blood loss volume (54.1±51.6

89.9±91.0 mL

=0.013)

and a higher rate of extended resection (8/56

1/54

=0.040). The hospitalization costs in RATS group was much higher than that in VATS group (

0.001). No significant differences were found between the two groups in the operation time

conversion to open surgery rate

postoperative pleural drainage volume

days of pleural drainage

postoperative hospital stay or incidence of complications.

Conclusion

RATS is safe and feasible for treatment of anterior mediastinal mass

but its hospitalization costs are much higher. Compared with VATS

RATS is associated with less intraoperative blood loss and allows more convenient operations around large vessels and in deep and narrow space. RATS is more suitable for anterior mediastinal tumors with a larger diameter or with external invasion

which requires extended resection along with the large vessels.

关键词

Keywords

references

王如文, 蒋耀光, 谭群友, 等.电视胸腔镜经右胸前侧径路胸腺切除治疗重症肌无力[J].中国胸心血管外科临床杂志, 2002, 9(4): 254-256. DOI: 10.3969/j.issn.1007-4848.2002.04.006.

WANG R W, JIANG Y G, TAN Q Y, et al . Video-assisted thoracoscopic thymectomy through right anterior lateral approach to treat myasthenia gravis[J ] . Chin J Clin Thorac Cardiovasc Surg, 2002, 9(4): 254-256. DOI: 10.3969/j.issn.1007-4848.2002.04.006.

AGATSUMA H, YOSHIDA K, YOSHINO I, et al . Video-assisted thoracic surgery thymectomy versus sternotomy thymectomy in patients with thymoma[J ] . Ann Thorac Surg, 2017, 104(3): 1047-1053. DOI: 10.1016/j.athoracsur.2017.03.054.

FREEMAN R K, ASCIOTI A J, VAN WOERKOM J M, et al . Long-term follow-up after robotic thymectomy for nonthymomatous myasthenia gravis[J ] . Ann Thorac Surg, 2011, 92(3): 1018-1022; discussion 1022-1023. DOI: 10.1016/j.athoracsur.2011.04.054.

SAVITT M A, GAO G, FURNARY A P, et al . Application of robotic-assisted techniques to the surgical evaluation and treatment of the anterior mediastinum[J ] . Ann Thorac Surg, 2005, 79(2): 450-455; discussion 455. DOI: 10.1016/j.athoracsur.2004.07.022.

滕洪, 王述民, 曲家骐, 等.电视胸腔镜手术治疗前纵隔肿瘤和囊肿103例[J].临床军医杂志, 2011, 39(5): 827-829.

TENG H, WANG S M, QU J Q, et al . Video-assistedthoracoscopic resections in the treatment of anterior mediastinal tumors and cysts: report of 103 cases[J ] . Clin J Med Officers, 2011, 39(5): 827-829.

GUO K, TONG L P, LI X F, et al . Video-assistedthoracoscopic completion thymectomy based on mediastinal pleura guidance[J ] . J Thorac Dis, 2017, 9(5): 1382-1385. DOI: 10.21037/jtd.2017.04.53.

ISHIKAWA N, WATANABE G. Robot-assisted cardiacsurgery[J]. Nippon Rinsho, 2011, 69(Suppl 9): 607-611.

BUCHS N C. Robotic technology: Optimizing the outcomes in rectal cancer?[J]. World J Clin Oncol, 2015, 6(3): 22-24. DOI: 10.5306/wjco.v6.i3.22.

HAGEN M E, ROHNER P, JUNG M K, et al . Robotic gastric bypass surgery in the swiss health care system: anal ysis of hospital costs and reimbursement[J ] . Obes Surg, 2017, 27(8): 2099-2105. DOI: 10.1007/s11695-017-2613-x.

BACCHETTA M D, KORST R J, ALTORKI N K, et al . Resection of a symptomatic pericardial cyst using the computer-enhanced Da Vinci Surgical System[J ] . Ann Thorac Surg, 2003, 75(6): 1953-1955.

SEONG Y W, KANG C H, CHOI J W, et al . Early clinical outcomes of robot-assisted surgery for anterior mediastinal mass: its superiority over a conventional sternotomy approach evaluated by propensity score matching[J ] . Eur J Cardiothorac Surg, 2014, 45(3): e68-e73; discussion e73. DOI:10.1093/ejcts/ezt557.

QIAN L Q, CHEN X K, HUANG J, et al . A comparison of three approaches for the treatment of early-stagethymomas: robot-assisted thoracic surgery, video-assisted thoracic surgery, and median sternotomy[J ] . J Thorac Dis, 2017, 9(7): 1997-2005. DOI:10.21037/jtd.2017.06.09.

赵鑫, 张镱镭, 姜天烁, 等.电视胸腔镜手术治疗前纵隔肿物35例[J].中华腔镜外科杂志(电子版), 2013, 6(3): 226-227.

ZHAO X, ZHANG Y L, JIANG T S, et al . Video-assisted thoracoscopic resection in the treatment of anterior mediastinal masses:report of 35 cases[J ] . Clin J Lapar Surg, 2013, 6(3): 226-227.

陈舒晨, 余绍斌, 林济红, 等.经剑突下入路胸腔镜下前纵隔肿瘤切除术学习曲线分析[J].福建医科大学学报, 2017, 51(5): 311-315.

CHEN S C, YU S B, LIN J H, et al . Learning curve of subxiphoid approach in video-assisted thoracoscopic for the treatment of anterior mediastinal tumor[J ] . J Fujian Med Univ, 2017, 51(5): 311-315.

MAAT A P, VAN DOORN P A, BOGERS A J. Inclusion of the transcervical approach in the video-assisted thoracoscopic extended thymectomy (BATET) for myasthenia gravis: A prospective trial[J]. Surg Endosc, 2008, 22(1): 265. DOI: 10.1007/s00464-007-9581-5.

CERFOLIO R J, BESS K M, WEI B, et al . Incidence, results, and our current intraoperative technique to control major vascular injuries during minimally invasive robotic thoracic surgery[J ] . Ann Thorac Surg, 2016, 102(2): 394-399. DOI: 10.1016/j.athoracsur.2016.02.004.

林皓, 黄佳, 罗清泉, 等.机器人辅助纵隔肿瘤切除术47例分析[J].中国胸心血管外科临床杂志, 2015, 22(10): 914-918. DOI: 10.7507/1007-4848.20150229.

LIN H, HUANG J, LUO Q Q, et al . Initial experience of robot-assisted surgery for 47 patients with mediastinal tumor[J ] . Chin J Clin Thorac Cardiovasc Surg, 2015, 22(10): 914-918. DOI: 10.7507/1007-4848.20150229.

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