Objective To analyze the risk factors for postoperative length of stay (PLOS) after mediastinal tumor resection by robot-assisted non-endotracheal intubation and to optimize the perioperative process. MethodsThe clinical data of patients who underwent Da Vinci robot-assisted mediastinal tumor resection with non-endotracheal intubation at the Department of Thoracic Surgery, General Hospital of Northern Theater Command from 2016 to 2019 were retrospectively analyzed. According to the median PLOS, the patients were divided into two groups. The univariate analysis and multivariate logistic regression were used to analyze risk factors for prolonged PLOS (longer than median PLOS). ResultsA total of 190 patients were enrolled, including 92 males and 98 females with a median age of 51.5 (41.0, 59.0) years. The median PLOS of all patients was 3.0 (2.0, 4.0) d. There were 71 patients in the PLOS>3 d group and 119 patients in the PLOS≤3 d group. Multivariate logistic regression showed that indwelled thoracic catheter [OR=11.852, 95%CI (2.384, 58.912), P=0.003], preoperative symptoms of muscle weakness [OR=4.814, 95%CI (1.337, 17.337), P=0.016] and postoperative visual analogue scale>5 points [OR=6.696, 95%CI (3.033, 14.783), P<0.001] were independent factors for prolonged PLOS. Totally no tube (TNT) allowed patients to be discharged on the first day after surgery. ConclusionRobot-assisted mediastinal tumor resection with non-endotracheal intubation can promote rapid recovery. The methods of optimizing perioperative process are TNT, controlling muscle weakness symptoms and postoperative pain relief.
Objective To evaluate the safety and feasibility of remote robot-assisted thoracoscopic surgery utilizing 5G technology. Methods Clinical data from five patients who underwent 5G remote robot-assisted thoracoscopic surgery at the Thoracic Surgery Center of Gansu Provincial People's Hospital from May to October 2024 were retrospectively analyzed. Results Finally, five patients were included. There were 2 males and 3 females at median age of 50 (42-63) years. All five surgeries (including 1 patient of lobectomy, 3 patients of partial lung resection and 1 patient of mediastinal lesion resection) were successfully completed without conversion to thoracotomy, complications, or mortality. The median intraoperative signal delay across the patients was 39 (37-42) ms. The median psychological load score for the surgeons was 9 (3-13). The median operation time was 100 (80-122) minutes with a median intraoperative blood loss of 100 (30-200) mL. Catheter drainage lasted a median of 4 (3-5) days, and the median drainage volumes on the first, second, and third postoperative day were 200 (100-300) mL, 150 (60-220) mL, and 80 (30-180) mL, respectively. The median postoperative hospital stay was 4 (3-7) days, and the median pain scores on the third postoperative day were 3 (1-4), 3 (0-3), and 1 (0-3), respectively. Conclusion 5G remote robot-assisted thoracoscopic surgery is safe and effective, with good surgical experience, smooth operation and small intraoperative delay.
ObjectiveTo explore the clinical efficacy of two procedures in thoracoscopic anterior mediastinal tumor resection. MethodsA retrospective study was conducted on patients who underwent thoracoscopic anterior mediastinal tumor resection at the Department of Thoracic Surgery, the 910th Hospital of Joint Logistics Support Force from October 2016 to January 2024. Patients were divided into two groups according to the surgical approach: a modified approach group (bilateral intercostal ports+two subcostal ports) and a classic subxiphoid approach group (one subxiphoid port+two subcostal ports). Perioperative data and postoperative improvement of myasthenia gravis (MG) subgroup were compared between the two groups. ResultsA total of 55 patients were included, including 27 males and 28 females with a mean age of (49.4±15.1) years. There were 23 patients in the modified approach group and 32 patients in the classic subxiphoid approach group. The modified approach group had shorter operation time [(129.0±20.5) min vs. (148.9±16.7) min, P<0.001], less intraoperative blood loss [(63.0±16.6) mL vs. (75.0±10.8) mL, P<0.001], shorter postoperative drainage tube removal time [(3.1±0.4) d vs. (3.9±0.6) d, P<0.001] and shorter postoperative hospital stay [(4.2±0.4) d vs. (5.0±0.6) d, P<0.001), and lower proportion of intraoperative cardiac dysfunction [4 (17.4%) vs. 14 (43.8%), P=0.040]. There was no statistical difference in maximum diameter of tumor resected [(4.5±1.7) cm vs. (4.0±0.9) cm, P=0.193] and postoperative drainage volume [(396.4±121.5) mL vs. (399.9±161.3) mL, P=0.932]. There was 1 patient of perioperative collateral injury in the modified approach group (pericardial injury), and 6 patients in the classic subxiphoid approach group (1 patient of diaphragm injury, 1 patient of liver contusion, 4 patients of pericardial injury). There was no statistical difference in pain scores at 24 h, 48 h and 72 h after surgery (P>0.05). The postoperative improvement of MG symptoms in the modified approach group was better than that in the classic subxiphoid approach group at 1 year after surgery (complete stable remission rate: 77.8% vs. 50.0%; effective rate: 100.0% vs. 91.6%). No conversion to open chest surgery occurred in either group, and there were no postoperative rehospitalizations or deaths related to surgery within 30 days after surgery in both groups. ConclusionThe modified approach is safe and controllable with more open surgical field and more reliable complete resection range than the classic subxiphoid approach group.
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.
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 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 explore the clinical application effects of using no drainage tube in mediastinal tumor resection via thoracoscopic subxiphoid approach. MethodsA retrospective analysis was conducted on the clinical data of patients who underwent mediastinal tumor resection via thoracoscopic subxiphoid approach at the Fourth People's Hospital of Zigong City from January 2020 to February 2024. Patients were divided into a non-drainage tube group and a drainage tube group, and their perioperative data were compared. ResultsA total of 149 patients were included, and there were 111 patients of thymoma, 5 patients of teratoma, and 33 patients of cyst. There were 77 patients in the non-drainage tube group, including 40 males and 37 females, aged 28-79 (53.72±13.34) years; there were 72 patients in the drainage tube group, including 33 males and 39 females, aged 26-80 (55.60±11.06) years. The differences in postoperative pain score at 48 hours, maximum postoperative pain score, postoperative hospital stay, postoperative drainage tube-related complications, and the number of temporary analgesics used after surgery between the two groups were statistically significant (P<0.05). ConclusionThe use of non-drainage tube technology in mediastinal tumor resection through thoracoscopic subxiphoid approach can reduce postoperative pain and the number of temporary analgesics used, as well as decrease the incidence of drainage tube-related complications.
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.
Mediastinal and chest wall tumors contain various benign and malignant tumors. In order to further standardize the whole-course diagnosis and treatment of mediastinal and chest wall tumors, the consensus was formulated through discussion by the expert group. Based on the clinical diagnosis and treatment experience and various prospective and retrospective studies, the consensus was formed.
ObjectiveTo evaluate the short-term outcome of robot-assisted thoracoscopic surgery (RATS) for the treatment of posterior mediastinal neurogenic tumour. MethodsThe clinical data of consecutive patients with mediastinal neurogenic tumors who received RATS treatment completed by the same operator in the Department of Thoracic Surgery, Gansu Provincial People's Hospital from June 2016 to June 2022 were retrospectively analyzed. The tumors were preoperatively localized and evaluated using magnetic resonance imaging or enhanced CT. Results A total of 35 patients were enrolled, including 19 males and 16 females with a mean age of 34.9±7.1 years. All patients successfully completed the resection of posterior mediastinal neurogenic tumors under RATS, and no conversion to thoracotomy occurred during the operation. The average operative time was 62.3±18.0 min, docking time was 10.3±2.6 min, intraoperative bleeding was 33.9±21.6 mL, postoperative 24-hour chest drainage was 69.0±28.9 mL, postoperative chest drainage time was 2.0 (1.0, 3.0) d and the postoperative hospital stay was 3.0 (2.0, 4.0) d. Postoperative complications occurred in 3 patients, including 2 patients with transient Honor syndrome and 1 patient with transient anhidrosis of the affected upper limb. ConclusionRATS for posterior mediastinal neurogenic tumours is safe, effective and feasible, and allows the full benefit of the robotic surgical system to be exploited.