Comparison of efficacy and safety between da Vinci robot-assisted surgery and thoracoscopic surgery in the treatment of mediastinal tumors: A systematic review and meta-analysis

Abstract

Objective Systematic evaluation of the efficacy and safety of da Vinci robot-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS) in the treatment of mediastinal tumors. Methods Computer retrieval of PubMed, Embase, The Cochrane Library, and Web of Science databases for literature comparing the clinical effects of RATS and VATS in treating mediastinal tumors, with the retrieval time limit from the establishment of the database to September 2023. Two researchers independently screened the literature and extracted data. The Newcastle-Ottawa Scale was used to assess the quality of the literature, and RevMan 5.4 was used for Meta-analysis. Results A total of 19 articles were included, with a total of 3517 patients. The results of the Meta-analysis showed that the RATS group had less intraoperative bleeding [MD=-5.20, 95%CI (-9.28, -1.12), P = 0.01], lower rate of conversion to thoracotomy [OR = 0.41, 95%CI (0.23, 0.72), P = 0.002], lower rate of total postoperative complications [OR = 0.57, 95%CI (0.34, 0.95), P = 0.03], shorter postoperative drainage time [MD=-0.72, 95%CI (-1.13, -0.32), P = 0.0004], and shorter postoperative hospital stay [MD=-0.90, 95%CI (-1.16, -0.65), P < 0.001], in comparison with the VATS group. There was insignificant difference between the two groups in terms of tumor size [MD=-0.02, 95%CI (-0.33, 0.30), P = 0.91] and operation time [MD = 0.17, 95%CI (-7.61, 7.94), P = 0.97]. However, in regards of hospitalization costs [MD = 2634.75, 95%CI (991.62, 4277.88), P = 0.002], the RATS group was more expensive than the VATS group. Conclusion Robot-assisted mediastinal tumor resection surgery has more advantages in terms of intraoperative bleeding, conversion to thoracotomy rate, total postoperative complication rate, postoperative drainage time, and postoperative hospital stay, in comparison with thoracoscopic-assisted mediastinal tumor resection surgery. There is insignificant difference in tumor size and operation time between the two surgeries. However, robot-assisted mediastinal tumor resection surgery increases hospitalization costs.