Clinical efficacy and learning curve of robot-assisted thymectomy via subxiphoid approach_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Tao , E Haoran , WU Jun , YANG Chenlu , JIANG Gening , ZHU Yuming , CHEN Chang ,  ZHAO Deping

Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, 200082, P. R. China;

Corresponding author：

ZHAO Deping, Email: dpzhao@tongji.edu.cn

Keywords：

Subxiphoid approach; robot-assisted surgery; thymectomy; cumulative sum analysis; learning curve

DOI：

10.7507/1007-4848.202212059

Video：

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Objective To explore the clinical efficacy and learning curve of robot-assisted thymectomy via subxiphoid approach. Methods The clinical data of patients with robot-assisted thymectomy surgery via subxiphoid approach performed by the same surgical team in the Department of Thoracic Surgery of Shanghai Pulmonary Hospital from February 2021 to August 2022 were retrospectively analyzed. The cumulative sum (CUSUM) analysis and best fit curve were used to analyze the learning curve of this surgery. The general information and perioperative indicators of patients at different learning stages were compared to explore the impact of different learning stages on clinical efficacy of patients. Results A total of 67 patients were enrolled, including 31 males and 36 females, aged 57.10 (54.60, 59.60) years. The operation time was 117.00 (87.00, 150.00) min. The best fitting equation of CUSUM learning curve was y=0.021 2x³–3.192 5x² +120.17x–84.444 (x was the number of surgical cases), which had a high R² value of 0.977 8, and the fitting curve reached the top at the 25th case. Based on this, the learning curve was divided into a learning period and a proficiency period. The operation time and intraoperative blood loss in the proficiency stage were significantly shorter or less than those in the learning stage (P＜0.001), and there was no statistical difference in thoracic drainage time and volume between the two stages (P＞0.05). Conclusion The learning process of robot-assisted thymectomy via subxiphoid approach is safe, and this technique can be skillfully mastered after 25 cases.

Citation： WANG Tao, E Haoran, WU Jun, YANG Chenlu, JIANG Gening, ZHU Yuming, CHEN Chang, ZHAO Deping. Clinical efficacy and learning curve of robot-assisted thymectomy via subxiphoid approach. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(6): 830-834. doi: 10.7507/1007-4848.202212059 Copy

1.	Friedant AJ, Handorf EA, Su S, et al. Minimally invasive versus open thymectomy for thymic malignancies: Systematic review and meta-analysis. J Thorac Oncol, 2016, 11(1): 30-38.
2.	Brown LM, Louie BE. Robot-assisted total thymectomy: How I teach it. Ann Thorac Surg, 2017, 103(2): 369-372.
3.	Park S. Robot-assisted thoracic surgery thymectomy. J Chest Surg, 2021, 54(4): 319-324.
4.	Xu JX, Qian K, Deng Y, et al. Complications of robot-assisted thymectomy: A single-arm meta-analysis and systematic review. Int J Med Robot, 2021, 17(6): e2333.
5.	Argueta AJO, Cañas SRR, Abu Akar F, et al. Subxiphoid approach for a combined right upper lobectomy and thymectomy through a single incision. J Vis Surg, 2017, 3: 101.
6.	Suda T, Hachimaru A, Tochii D, et al. Video-assisted thoracoscopic thymectomy versus subxiphoid single-port thymectomy: Initial results. Eur J Cardiothorac Surg, 2016, 49 Suppl 1: i54-i58.
7.	Buitrago MR, Restrepo J. Robot-assisted thoracic surgery in Colombia: A multi-institutional initial experience. Ann Cardiothorac Surg, 2019, 8(2): 233-240.
8.	Shen C, Li J, Li J, et al. Robot-assisted thoracic surgery versus video-assisted thoracic surgery for treatment of patients with thymoma: A systematic review and meta-analysis. Thorac Cancer, 2022, 13(2): 151-161.
9.	Kang DK, Kang MK, Heo W, et al. Subxiphoid single-port thymectomy: Six-year experience of a single center. ANZ J Surg, 2021, 91(10): 2188-2191.
10.	Rao M, Salami A, Robbins A, et al. Subxiphoid-subcostal versus transthoracic thoracoscopic thymectomy: A safe and feasible approach. JTCVS Tech, 2022, 16: 172-181.
11.	Zhang H, Chen L, Zheng Y, et al. Robot-assisted thymectomy via subxiphoid approach: Technical details and early outcomes. J Thorac Dis, 2018, 10(3): 1677-1682.
12.	Zhang H, Wang F, Qiu G, et al. Safety and feasibility of a modularized procedure for trans-subxiphoid robotic extended thymectomy. Surg Endosc, 2023, 37(1): 90-100.
13.	Park JH, Na KJ, Kang CH, et al. Robotic subxiphoid thymectomy versus lateral thymectomy: A propensity score-matched comparison. Eur J Cardiothorac Surg, 2022, 62(1): ezac288.
14.	Park SY, Han KN, Hong JI, et al. Subxiphoid approach for robotic single-site-assisted thymectomy. Eur J Cardiothorac Surg, 2020, 58(Suppl_1): i34-i38.
15.	Meacci E, Nachira D, Congedo MT, et al. Learning curve of robot-assisted thymectomy: Single surgeon's 7-year experience. Front Surg, 2022, 9: 860899.
16.	刘博, 汪明敏, 许世广, 等. 达芬奇机器人纵隔肿瘤切除术的学习曲线. 中国胸心血管外科临床杂志, 2017, 24(2): 127-131.
17.	Kang CH, Na KJ, Song JW, et al. The robotic thymectomy via the subxiphoid approach: Technique and early outcomes. Eur J Cardiothorac Surg, 2020, 58(Suppl_1): i39-i43.
18.	Suda T, Ishizawa H, Nagano H, et al. Early outcomes in 147 consecutive cases of subxiphoid single-port thymectomy and evaluation of learning curves. Eur J Cardiothorac Surg, 2020, 58(Suppl_1): i44-i49.
19.	朱炬, 陈焕文, 刘蔡杨, 等. 经剑突下路径胸腔镜下全胸腺切除术学习曲线分析. 重庆医科大学学报, 2018, 43(9): 1257-1261.

1. Friedant AJ, Handorf EA, Su S, et al. Minimally invasive versus open thymectomy for thymic malignancies: Systematic review and meta-analysis. J Thorac Oncol, 2016, 11(1): 30-38.
2. Brown LM, Louie BE. Robot-assisted total thymectomy: How I teach it. Ann Thorac Surg, 2017, 103(2): 369-372.
3. Park S. Robot-assisted thoracic surgery thymectomy. J Chest Surg, 2021, 54(4): 319-324.
4. Xu JX, Qian K, Deng Y, et al. Complications of robot-assisted thymectomy: A single-arm meta-analysis and systematic review. Int J Med Robot, 2021, 17(6): e2333.
5. Argueta AJO, Cañas SRR, Abu Akar F, et al. Subxiphoid approach for a combined right upper lobectomy and thymectomy through a single incision. J Vis Surg, 2017, 3: 101.
6. Suda T, Hachimaru A, Tochii D, et al. Video-assisted thoracoscopic thymectomy versus subxiphoid single-port thymectomy: Initial results. Eur J Cardiothorac Surg, 2016, 49 Suppl 1: i54-i58.
7. Buitrago MR, Restrepo J. Robot-assisted thoracic surgery in Colombia: A multi-institutional initial experience. Ann Cardiothorac Surg, 2019, 8(2): 233-240.
8. Shen C, Li J, Li J, et al. Robot-assisted thoracic surgery versus video-assisted thoracic surgery for treatment of patients with thymoma: A systematic review and meta-analysis. Thorac Cancer, 2022, 13(2): 151-161.
9. Kang DK, Kang MK, Heo W, et al. Subxiphoid single-port thymectomy: Six-year experience of a single center. ANZ J Surg, 2021, 91(10): 2188-2191.
10. Rao M, Salami A, Robbins A, et al. Subxiphoid-subcostal versus transthoracic thoracoscopic thymectomy: A safe and feasible approach. JTCVS Tech, 2022, 16: 172-181.
11. Zhang H, Chen L, Zheng Y, et al. Robot-assisted thymectomy via subxiphoid approach: Technical details and early outcomes. J Thorac Dis, 2018, 10(3): 1677-1682.
12. Zhang H, Wang F, Qiu G, et al. Safety and feasibility of a modularized procedure for trans-subxiphoid robotic extended thymectomy. Surg Endosc, 2023, 37(1): 90-100.
13. Park JH, Na KJ, Kang CH, et al. Robotic subxiphoid thymectomy versus lateral thymectomy: A propensity score-matched comparison. Eur J Cardiothorac Surg, 2022, 62(1): ezac288.
14. Park SY, Han KN, Hong JI, et al. Subxiphoid approach for robotic single-site-assisted thymectomy. Eur J Cardiothorac Surg, 2020, 58(Suppl_1): i34-i38.
15. Meacci E, Nachira D, Congedo MT, et al. Learning curve of robot-assisted thymectomy: Single surgeon's 7-year experience. Front Surg, 2022, 9: 860899.
16. 刘博, 汪明敏, 许世广, 等. 达芬奇机器人纵隔肿瘤切除术的学习曲线. 中国胸心血管外科临床杂志, 2017, 24(2): 127-131.
17. Kang CH, Na KJ, Song JW, et al. The robotic thymectomy via the subxiphoid approach: Technique and early outcomes. Eur J Cardiothorac Surg, 2020, 58(Suppl_1): i39-i43.
18. Suda T, Ishizawa H, Nagano H, et al. Early outcomes in 147 consecutive cases of subxiphoid single-port thymectomy and evaluation of learning curves. Eur J Cardiothorac Surg, 2020, 58(Suppl_1): i44-i49.
19. 朱炬, 陈焕文, 刘蔡杨, 等. 经剑突下路径胸腔镜下全胸腺切除术学习曲线分析. 重庆医科大学学报, 2018, 43(9): 1257-1261.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical efficacy and learning curve of robot-assisted thymectomy via subxiphoid approach

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