Abstract: Objective To discuss the security, effectiveness and risk factors of videoassisted thoracoscopic surgery for posterior mediastinal tumors. Methods We retrospectively analyzed the data of 59 patients including 36 men and 23 women who underwent thoracoscopic resection of posterior mediastinal tumors in People’s Hospital of Peking University from May 2001 to July 2009. Their age ranged from 6 to 73 years old with an average age of 40.6 years old. The average maximum diameter of the tumors was 4.86 cm. All procedures were performed under general anesthesia and tumors were cut out with three ports. The anterior port was extended to 6 to 10 cm when conversion to thoracotomy was needed. After mediastinal pleura were opened, the tumor was stripped out along the outside of peplos and the vascular pedicle nerves were managed respectively. Results All surgeries were carried out successfully. The surgical duration, perioperative blood loss, postoperative chest tube duration and postoperative stay in hospital were respectively 45-300 min(125.80±57.40 min), 10-1 000 ml(168.10±157.70 ml), 1-10 d(2.50±1.74 d), and 2-14 d(5.24±2.24 d). There were 6 cases of conversion to open thoracotomy with a conversion rate of 10.2%. Postoperative pathology showed that there were 46 cases of neurogenic tumors, 10 cases of cyst, 2 cases of teratoma, and 1 case of lipoma. Follow-up was done on 51 cases for a period of 7-108 months(55.0±24.0 months) and 8(13.6%) cases were missed out during the period. No recurrence or death occurred during the followup. Logistic multivariable analysis showed that maximum diameter of the tumor ≥6 cm was the independent risk factor for extending operative time (OR=1.932，P=0.004), increasing perioperative blood loss (OR=2.267，P=0.002), increasing conversion rate to thoracotomy (OR=3.123，P=0.004) and increasing postoperative complication rate (OR=1.778，P=0.013). Conclusion Videoassisted thoracoscopic surgery for posterior mediastinal tumor is safe and effective. Maximum diameter of the tumor ≥6 cm is an independent risk factor for increasing operation difficulty and risk.
Objective To investigate the learning curve for da Vinci robot-assisted mediastinal tumor resection (DRMTR). Methods A total of 50 consecutive patients received DRMTR between March 2011 and September 2012 in our hospital. Clinical data of the 50 patients were collected and analyzed. There were 23 males, 27 females aged 46.9(17–80) years. The learning curve was evaluated by using the cumulative sum (CUSUM) analysis. Results The mean operation time was 124.6 min. The CUSUM learning curve was best modeled as a third-order polynomial curve with the equation: CUSUM=0.046×case-number3–4.681×case-number2+127.508×case-number–237.940, which had a highR2 value of 0.868. The fitting curve reached the top after the 19th case, which suggested that the surgeons master the technique after they finished 19 cases. As a cut-off point, the 19th case divided the learning curve into two phases, in which there was statistical diffference in operation time (P<0.01), intraoperative blood loss (P<0.01), the postoperative duration of chest tube drainage (P<0.01 ) and the rate of postoperative complications (P<0.05 ). Conclusion The DRMTR identified by CUSUM analysis represents two characteristic stages of DRMTR: the learning stage and the mastery stage. It is suggested from our data that the surgeons need finish about 19 cases to master DRMTR.
Objective To compare the differences in the application of ultrasound scalpel and coagulation hook in thoracoscopic anterior mediastinal tumor surgery and to analyze the respective advantages and indications of the two commonly used energy instruments. Methods The clinical data of 85 patients undergoing thoracoscopic anterior mediastinal tumor surgery in West China Hospital of Sichuan University between June and November in 2017 were prospectively analyzed. There were 45 males and 40 females at age of 50.45 (18–75) years. The patients were divided into three groups including a ultrasound scalpel group (59 patients), a coagulation hook group (17 patients) and a mixed group (9 patients) according to the using time of energy devices. The clinical effect among the three groups were compared. Results No significant difference was found among the three groups in operation time, blood loss, average duration of chest tube drainage or volume of drainage (P>0.05). No significant complications occurred in all groups during operation or after operation. The proportion of subxiphoid approach in the ultrasound scalpel group was higher than that in the other two groups (49/59vs. 7/17 vs. 5/9, P<0.01). The maximum diameter of the tumor (4.58±2.19 cmvs. 4.05±1.07 cm vs. 3.00±1.45 cm, P<0.05) and the resected tissue weight (103.67±74.78 gvs. 61.17±31.97 g vs. 61.86±34.13 g, P<0.05) were also significantly greater than that in the coagulation hook group or the mixed group. Conclusion Ultrasound scalpel has good safety and reliability in the thoracoscopic anterior mediastinal tumor surgery, and is more suitable for operation in a narrow space.
ObjectiveTo evaluate the safety and the clinical curative effect of mediastinal tumor resection by video-assisted thoracoscopic surgery(VATS） with spontaneous breathing under intravenous anesthesia, comparing with endotracheal tube anesthesia.MethodsThe data of 43 patients, aged 28–58 years, with mediastinal benign tumors which had been cofirmed by chest CT in our hospital were retrospectively analyzed. Among them, 18 patients underwent mediastinal tumor resection by VATS with spontaneous breathing under intravenous anesthesia, 25 patients by endotracheal tube anesthesia.The differences, including the time of anesthesia intubation and extubation, operation time and intraoperative blood loss, muscle strength at 4 hours and at 24 hours after operation, pain score at 24 hours after operation, hospitalization time, were be compared between the two groups.ResultsThe duration of intubation (17.8±4.8 min) in spontaneous breathing under intravenous anesthesia group was shorter than another group (28.6±8.17 min), the difference was statistically significant (P<0.05). Muscle strength at 4 hours after operation in spontaneous breathing under intravenous anesthesia group was significantly higher than another group (38.5±6.5 kg vs. 28.3±5.2 kg, P<0.05) as well. However, there was no significant difference between the two groups in extubation time, operation time and intraoperative blood loss, muscle strength and pain score at 24 hours after operation, hospitalization time.
Objective To analyze the feasibility of totally no tube (TNT) in da Vinci robotic mediastinal mass surgery and its significance for fast track surgery. Methods A total of 79 patients receiving robotic mediastinal TNT surgery in the General Hospital of Shenyang Military Command from January 2016 to December 2017 were enrolled as a TNT group; 35 patients receiving robotic mediastinal surgery in General Hospital of Shenyang Military Command from January 2014 to December 2017 and 54 patients receiving thoracoscopic mediastinal surgery during the same period were enrolled as a non-TNT group and a video-assisted thoracoscopic surgery (VATS) group. The muscle relaxation and tracheal intubation/laryngeal masking time, operation time, intraoperative blood loss, postoperative ICU stay, postoperative hospital stay, postoperative visual analogue scale (VAS), hospitalization costs and postoperative complications and other related indicators were retrospectively analyzed among the three groups. Results Surgeries were successfully completed in 168 patients with no transfer to thoracotomy, serious complications (postoperative complications in 9 patients) or death during the perioperative period. All patients were discharged. Compared with the non-TNT group, the TNT group had significantly less muscle relaxation-tracheal intubation/laryngeal masking time, operation time, intraoperative blood loss, VAS pain score, ICU stay, postoperative hospital stay (P<0.01); there was no significant difference in the total cost of hospitalization between the two groups (P>0.05). Between the non-TNT group and the VATS group, there was no significant difference in time of muscle relaxation and tracheal intubation, operation time and ICU stay (P>0.05). The non-TNT group was superior to the VATS group in terms of intraoperative blood loss, VAS pain scores on the following day after operation, chest drainage volume 1-3 days postoperatively, postoperative catheterization time and postoperative hospital stay (P<0.05); but the cost of hospitalization in the non-TNT group was significantly higher (P=0.000). Conclusion The da Vinci robot is safe and feasible for the treatment of mediastinal masses. At the same time, TNT is also safe and reliable on the basis of robotic surgery which has many advantages such as better comfort, less pain, ICU stay and hospital stay as well as faster recovery.
Objective To discuss the safety, feasibility and advantages of tubeless trans-subxiphoid thoracoscopic surgery in anterior mediastinal tumor resection. Methods A total of 32 patients suffering anterior mediastinal tumor were enrolled, including 17 patients (8 males and 9 females) with average age of 31.8±8.4 years who had been performed tubeless trans-subxipohoid tharcoscopic surgery and 15 patients (8 males and 7 females) with average age of 31.1±9.2 years who had been performed traditional trans-subxipohoid tharcoscopic surgery. The differences of surgical duration, the lowest intraoperative arterial oxygen saturation (SaO2), postoperative awaking time, postoperative pain visual analogue score (VAS), postoperative pulmonary recruitment time, duration of postoperative hospital stay and hospitalization cost were analyzed. Results Postoperative awaking time (18.5±1.8 min vs. 28.9±4.2 min, P=0.000), postoperative VAS (1.6±0.6 vs. 3.5±7.4, P=0.000), duration of postoperative hospital stay (2.5±7.2 d vs. 4.3±1.1 d, P=0.000) and hospitalization cost (3.2±1.1 ten thousand RMB vs. 4.9±1.1 10 ten thousand RMB, P=0.000) in the tubeless group were better than those in the control group. There was no significant difference in surgical duration (51.7±6.5 min vs. 55.1±8.5 min), the lowest intraoperative SaO2 (98.5%±0.9% vs. 98.1%±0.8%), postoperative pulmonary recruitment time (33.9±12.2 d vs. 38.4±15.2 d, P>0.05) between the two groups.Conclusion Tubeless trans-subxiphoid thoracoscopic surgery is safe, feasible and advanced in anterior mediastinal tumor resection.
ObjectiveTo summarize the experience of minimally invasive anterior mediastinal tumor resection in our center, and compare the Da Vinci robotic and video-assisted thoracoscopic approaches in the treatment of mediastinal tumor.MethodsA retrospective cohort study was conducted to continuously enroll 102 patients who underwent minimally invasive mediastinal tumor resection between September 2014 and November 2019 by the single medical group in our department. They were divided into two groups: a robotic group (n=47, 23 males and 24 females, average age of 52 years) and a thoracoscopic group (n=55, 29 males and 26 females, average age of 53 years). The operation time, intraoperative blood loss, postoperative thoracic drainage volume, postoperative thoracic drainage time, postoperative hospital stay, hospitalization expense and other clinical data of two groups were compared and analyzed.ResultsAll the patients successfully completed the surgery and recovered from hospital, with no perioperative death. Myasthenia gravis occurred in 4 patients of the robotic group and 5 of the thoracoscopic group. The tumor size was 2.5 (0.8-8.7) cm in the robotic group and 3.0 (0.8-7.7) cm in the thoracoscopic group. Operation time was 62 (30-132) min in the robotic group and 60 (29-118) min in the thoracoscopic group. Intraoperative bleeding volume was 20 (2-50) mL in the robotic group and 20 (5-100) mL in the thoracoscopic group. The postoperative drainage volume was 240 (20-14 130) mL in the robotic group and 295 (20-1 070) mL in the thoracoscopic group. The postoperative drainage time was 2 (1-15) days in the robotic group and 2 (1-5) days in the thoracoscopic group. There was no significant difference between the two groups in the above parameters and postoperative complications (P>0.05). The postoperative hospital stay were 3 (2-18) days in the robotic group and 4 (2-14) in the thoracoscopic group (P=0.014). The hospitalization cost was 67 489(26 486-89 570) yuan in the robotic group and 27 917 (16 817-67 603) yuan in the thoracoscopic group (P=0.000).ConclusionCompared with the video-assisted thoracoscopic surgery, Da Vinci robot-assisted surgery owns the same efficacy and safety in the treatment of mediastinal tumor, with shorter postoperative hospital stay, but higher cost.
ObjectiveTo investigate the safety and feasibility of thoracoscopic surgery of anterior mediastinal tumors via subxiphoid approach under scissors position (SASP) and lateral thoracic approach under lateral position (LALP).MethodsClinical data of 69 patients who received anterior mediastinal tumor excision surgery in our hospital from June 2016 to November 2019 were retrospectively analyzed, including 32 males and 37 females with an average age of 46.38±11.52 years. The clinical effects of the two groups were compared.ResultsThere was no perioperative death or conversion to thoracotomy. There was no statistically significant difference between the two groups in the operative time (123.34±12.64 min vs. 125.05±17.02 min, P=0.642), intraoperative blood loss [50.00 (73.75) mL vs. 50.00 (80.00) mL, P=0.643], tumor diameter (2.75±0.57 cm vs. 2.89±0.45 cm, P=0.787) and total hospital expenses [32.70 (5.30) thousand yuan vs. 32.90 (4.80) thousand yuan, P=0.923]. However, the postoperative catheterization time [2.00 (1.00) d vs. 4.00 (1.50) d, P=0.000], postoperative drainage [260.00 (200.00) mL vs. 400.00 (225.00) mL, P=0.031], postoperative pain index [2.00 (1.00) points vs. 4.00 (2.00) points, P=0.000], postoperative analgesic time [1.50 (1.00) d vs. 3.00 (2.00) d, P=0.000], postoperative fever time [1.50 (1.00) d vs. 2.00 (1.00) d, P=0.000] in the SASP group were better than those in the LALP group.ConclusionThoracoscopic surgery via SASP is more suitable for the treatment of anterior mediastinal tumor with rapid postoperative recovery and reduced pain, and the postoperative curative effect is definite. However, there is a high requirement for the surgical experience and techniques. It can be promoted in the clinic.
ObjectiveTo analyze and compare the perioperative efficacy difference between full-port Da Vinci robotic surgery and thoracoscopic surgery in patients with mediastinal tumor resection. MethodsThe data of 232 patients with mediastinal tumors treated by the same operator in the Department of Thoracic Surgery of the Second Affiliated Hospital of Harbin Medical University were included. There were 103 (44.4%) males and 129 (55.6%) females, with an average age of 49.7 years. According to the surgical methods, they were divided into a robot-assisted thoracic surgery (RATS) group (n=113) and a video-assisted thoracoscopic surgery (VATS) group (n=119). After 1 : 1 propensity score matching, 57 patients in the RATS group and 57 patients in the VATS group were obtained. ResultsThe RATS group was better than the VATS group in the visual analogue scale pain score on the first day after the surgery [3.0 (2.0, 4.0) points vs. 4.0 (3.0, 5.0) points], postoperative hospital stay time [4.0 (3.0, 5.5) d vs. 6.0 (5.0, 7.0) d] and postoperative catheterization time [2.0 (2.0, 3.0) d vs. 3.0 (3.0, 4.0) d] (all P<0.05). There was no statistical difference between the two groups in terms of intraoperative blood loss, postoperative complications, postoperative thoracic closed drainage catheter placement rate or postoperative total drainage volume (all P>0.05). The total hospitalization costs [51 271.0 (44 166.0, 57 152.0) yuan vs. 35 814.0 (33 418.0, 39 312.0) yuan], operation costs [37 659.0 (32 217.0, 41 511.0) yuan vs. 19 640.0 (17 008.0, 21 421.0) yuan], anesthesia costs [3 307.0 (2 530.0, 3 823.0) yuan vs. 2 059.0 (1 577.0, 2 887.0) yuan] and drug and examination costs [9 241.0 (7 987.0, 12 332.0) yuan vs. 14 143.0 (11 620.0, 16 750.0) yuan] in the RATS group was higher than those in the VATS group (all P<0.05). ConclusionRobotic surgery and thoracoscopic surgery can be done safely and effectively. Compared with thoracoscopic surgery, robotic surgery has less postoperative pain, shorter tube-carrying time, and less postoperative hospital stay, which can significantly speed up the postoperative recovery of patients. However, the cost of robotic surgery is higher than that of thoracoscopic surgery, which increases the economic burden of patients and is also one of the main reasons for preventing the popularization of robotic surgery.
ObjectiveTo explore the application of Toumai® minimally invasive endoscopic robot in thoracic surgery, and to observe its safety and short-term surgical efficacy. MethodsThree patients were enrolled from October to December 2021, including 1 male (69 years) and 2 females (47 years and 22 years). All 3 patients received surgery with Toumai® endoscopic surgical robot, including radical lung cancer surgery in 2 patients and mediastinal tumor resection in 1 patient. ResultsAll 3 patients were successfully operated without conversion to thoracotomy, complication or death. For the male lobectomy patient, the total operation time was 120 min, the intraoperative blood loss was 100 mL, the catheter drainage time was 4 days and the hospital stay time was 5 days. For the female lobectomy patient, the total operation time was 103 min, the intraoperative blood loss was 100 mL, the catheter drainage time was 4 days and the hospital stay time was 5 days. For the female mediastinal tumor patient, the total operation time was 81 min, the intraoperative blood loss was 50 mL, the catheter drainage time was 3 days and the hospital stay time was 3 days. ConclusionThe Toumai® minimally invasive endoscopic surgical robot is safe and effective in thoracic surgery. Compared with Da Vinci surgical robot, Toumai® has the same 3D visual field experience and smooth operation.