Thymectomy via open surgery or robotic video assisted thoracic surgery

Abstract

Background:Robot-assisted minimally invasive surgery (RVATS) is a relatively new technique applied for thymectomies. Only few studies directly compare RVATS to the mainstay therapy, open surgery (sternotomy).Methods:A systematic search of the literature was performed in October 2016. The meta-analysis includes studies comparing robotassisted and open thymectomy regarding operation time, length of hospitalization, intraoperative blood loss, and chest-in-tube days, postoperative complications, reoperation, arrhythmic events, pleural effusion, and postoperative bleeding.Results:Of 626 studies preliminary screened, 7 articles were included. There were no significant differences in comparison of operation time (−3.19 minutes [95% confidence interval, 95% CI −112.43 to 106.05]; P = .94), but patients undergoing RVATS spent significantly less time in hospital (−4.06 days [95% CI −7.98 to −0.13], P = .046). There were fewer chests-in-tube days (−2.50 days [95% CI −15.01 to 10.01]; P = .24) and less intraoperative blood loss (−256.84 mL [95% CI −627.47 to 113.80]; P = .10) observed in the RVATS group; due to a small number of studies, these results were not statistically significant. There were also less post-operative complications in the RVATS group (12 complications in 209 patients vs 51 complications in 259 patients); however, this difference was not statistical significant (odds ratio 0.27, 95% CI 0.07–1.12; P = .06).Conclusions:Patients undergoing RVATS spent less time in hospital than patients treated by open surgery (sternotomy). These patients tended to have less postoperative complications, less intraoperative blood loss, and fewer chest-in-tube days. We found evidence for the safety and feasibility of RVATS compared with open surgery, which has to be further confirmed in randomised controlled trials.

Robot-assisted thoracic surgery in Colombia: a multi-institutional initial experience

“…This series of RVATS for mediastinal surgeries has similar results compared with the literature. In the metaanalysis by Buentzel et al, the operation time ranged from 97 to 224.2 minutes and in our study the mean total operative time was in this range (37). As in this series, most of the studies had 0% conversion rate, and short length of chest tube duration (37).…”

“…The hospital LOS in the literature ranged from 3.7 to 9.6 days. In this series this time was shorter, with a mean LOS of 2.5 days (37). Meta-analysis showed blood loss was minimal with no postoperative complications (38).…”

“…RVATS for thymic epithelial tumors achieved comparable longterm oncologic outcomes (35). There are two metaanalysis (36,37) and one systematic review (38) comparing RVATS and VATS for thymectomy-these show no difference with respect to conversion rate, hospital LOS, or postoperative morbidity. One meta-analysis showed a tendency towards reduced hospital LOS and reduced chest tube drainage days with RVATS compared to VATS but the power of the study was low [only seven studies were included (37)].…”

A systematic review of robotic versus open and video assisted thoracoscopic surgery (VATS) approaches for thymectomy

“…To our knowledge, there have been five prior systematic reviews comparing robotic thymectomy with VATS (40)(41)(42) or open (7,42,43)…”

<p>Optimal management of thymic malignancies: current perspectives</p>

“…Finally, recent meta-analyses comparing open surgery -VATS -RATS were unable to find any differences between the 450 patients analyzed in outcomes, intra, and postoperative complications and conversion rate. [32][33][34][35] Medico-economics studies are needed to evaluate the costbenefit ratio of open surgery and MIS.…”