Robot-assisted thoracic surgery versus video-assisted thoracic surgery for mediastinal lesions

Abstract

Background Robot-assisted thoracic surgery (RATS) has become widely used for mediastinal procedures since 2018 when it was included in insurance coverage in Japan. Few studies have compared the surgical outcomes of RATS with the more established video-assisted thoracic surgery (VATS) approach to mediastinal surgery. We aimed to compare the perioperative outcomes of VATS and RATS to examine the advantages of the RATS approach in a single institutional cohort. Methods A total of 144 patients who underwent VATS and 46 who underwent RATS mediastinal surgery between 2014 and 2022 were enrolled. We compared clinicopathological features such as age, sex, smoking history, respiratory function, surgical field, laterality, surgical procedure, board certification of the surgeon, and histology between the two groups. Perioperative outcomes including operation time, volume of blood lost, number of conversion cases to open surgery, duration of chest drainage, postoperative hospital stay, and postoperative complications were also reviewed. Results The comparison of patient characteristics between the groups showed significant differences in median age (VATS, 52.5 years; RATS, 67.0 years; P=0.001), combined resection of surrounding tissues of the tumor (VATS, 2.1%; RATS, 10.9%; P=0.02), board certification of the surgeon (VATS, 53.5%; RATS, 100.0%; P<0.001), and histology (RATS group had a higher percentage of thymic epithelial tumors, P=0.01). Regarding perioperative outcomes, the median operation time was 120 min in the VATS group and 88 min in the RATS group, showing a significant difference (P=0.03). There were no significant differences in the volume of blood lost, incidence of conversion to open chest surgery, duration of chest drainage, postoperative length of stay in hospital, and incidence of perioperative complications. In the perioperative outcomes of cases operated on by board-certified surgeons, the median operation time (VATS, 117 min; RATS, 88 min; P=0.02) and median postoperative length of stay in hospital (VATS, 7 days; RATS, 6 days; P=0.001) showed significant differences, while other postoperative outcomes were not significantly different. Conclusions RATS for mediastinal surgery is as safe as the VATS approach and may result in a shorter operative time and postoperative hospital stay. Further analysis of RATS for mediastinal surgery in a larger cohort is warranted.

Meta-analysis of clinical efficacy of thoracoscopy and robotic surgery in the treatment of mediastinal tumors

“…1 . After careful reading, a total of 19 articles [ 9 – 27 ] were finally included. The detailed information and quality evaluation of the characteristics of all included studies are summarized in Table 1 .…”

“…A total of 9 articles [ 10 , 11 , 14 , 16 , 18 , 19 , 23 , 26 , 27 ] reported the postoperative drainage time of the two groups of patients, involving a total of 781 patients. There was statistical heterogeneity between the studies ( P < 0.00001, I 2 = 92%, so a random-effects model was used for data analysis.…”

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

“…A total of 10 studies were included [9,10,13,15,18,[20][21][22][23][24], with a total of 1023 patients. There was no statistical heterogeneity between the studies (P = 0.88 > 0.1, I 2 = 0%, so a xed-effects model was used for data analysis.…”