Hybrid robotic thoracic surgery for excision of large mediastinal masses

Abstract

Between April 2016 and October 2017, we retrospectively reviewed all patients undergoing excision of large mediastinal masses using a hybrid robotic thoracic approach at the Unit of Thoracic Surgery of Monaldi Hospital in Naples. The inclusion criteria for this approach were: evident unilateral predominance of the mass; absence of invasion to surrounding structures. Planned conversion to sternotomy was necessary in one patient for tenacious adhesions between the mediastinal goiter and the left innominate vein. In all cases the postoperative course was uneventful. The hybrid robotic approach, adopted in our Unit, consists of a thoracic procedure performed completely with articulated surgical instruments under three-dimensional vision and followed by final extension of a port-site incision to retrieve the voluminous specimen. This approach uses all the advantages of robotic technology that enables to perform a fine dissection in the small space of the anterior mediastinum and at the same time, through the simple extension of a minimally invasive access, avoids the painful sequelae of thoracotomy. In selected cases, with increased experience in robotic surgery, it can be proposed for excision of large mediastinal masses, although a longer follow-up period is necessary to validate our findings.

Presenting Symptomatology of Mediastinal Masses and Its Effect on Surgical Outcomes

“…Different surgical approaches can be utilized to manage mediastinal masses, including median sternotomy, thoracotomy, mediastinoscopy, video-assisted thoracoscopic surgery (VATS), and robotic-assisted thoracoscopic surgery (RATS). 10,11 To our knowledge, no previous study has shown a correlation between the presence of symptoms and a particular operative approach. The aim of this study is to further describe the prevalence and characteristics of symptoms from a mediastinal mass and to determine if the presence of symptoms has an effect on postoperative outcomes.…”

Application of Artificial Intelligence in the Diagnosis, Treatment, and Prognostic Evaluation of Mediastinal Malignant Tumors

“…A combination of robotic systems and AI is the future tool in the medical field. The complex structure of the mediastinum makes it easy to injure the spinal cord, cervical nerve roots, hilum of the lung, and unnamed vessels and nerve branches during the surgical approach, and renders fat removal during the surgical procedure difficult [61][62][63]. Completely depending on humans is not reliable enough.…”

Roboterassistierte Thoraxchirurgie bei Mediastinaltumoren

“…Ausgehend von den guten Ergebnissen der roboterassistierten Thymuschirurgie vor allem bei Myasthenia gravis [6,7] wurden zunehmend auch Mediastinaltumoren im vorderen und hinteren Mediastinum roboterassistiert minimalinvasiv entfernt [8,9]. Mit steigender operativer Expertise können heute erweiterte Resektionen bei größeren Tumoren mit hoher Sicherheit und geringem perioperativem Trauma durchgeführt werden, wobei Langzeitergebnisse noch abgewartet werden müssen [10].…”