Chen Kai, Zhang Xianfei, Jin Runsen, Xiang Jie, Han Dingpei, Zhang Yajie, Li Hecheng
Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
J Thorac Dis. 2020 Feb;12(2):105-113. doi: 10.21037/jtd.2019.08.105.
The objectives of this study were to evaluate the feasibility and safety of robot-assisted thoracic surgery (RATS) using the da Vinci robotic system for mediastinal mass resection and to describe the surgical approach for masses in different mediastinal regions.
We retrospectively reviewed data from 84 patients who underwent RATS for resection of a mediastinal mass from June 2015 to April 2019. The results were analyzed with descriptive statistics.
The mediastinal mass was resected successfully in all patients, with one patient requiring conversion to conventional open surgery. There were no intraoperative complications. The most common diagnoses were thymoma (n=17), bronchogenic cyst (n=16), and schwannoma (n=12). The surgical approach was determined by the location of the lesion and the planned extent of surgical resection. Resection was performed in the lateral decubitus position in 29 patients with posterior mediastinal tumor, semi-lateral decubitus position in 42 patients who only need resection of anterior mediastinal mass, and reverse Trendelenburg position in 13 patients undergoing thymectomy. The mean (± standard deviation) operation time was 91.86±56.42 min, duration of chest tube use was 1.83±0.93 days, and postoperative hospital stay was 3.62±7.52 days. Three patients (3.5%) developed postoperative complications: one chylous fistula, which required reoperation, and one case each of atrial fibrillation and pulmonary infection, which were treated conservatively.
Our experience demonstrated that different surgical approaches of RATS are safe and feasible for mediastinal mass resection. An appropriate approach can be selected based on the mediastinal region in which the tumor is located.
本研究的目的是评估使用达芬奇机器人系统进行机器人辅助胸外科手术（RATS）切除纵隔肿物的可行性和安全性，并描述不同纵隔区域肿物的手术方法。
我们回顾性分析了2015年6月至2019年4月期间84例行RATS切除纵隔肿物患者的数据。结果采用描述性统计分析。
所有患者均成功切除纵隔肿物，1例患者转为传统开放手术。术中无并发症。最常见的诊断为胸腺瘤（n = 17）、支气管囊肿（n = 16）和神经鞘瘤（n = 12）。手术方法根据病变部位和计划的手术切除范围确定。29例后纵隔肿瘤患者采用侧卧位手术，42例仅需切除前纵隔肿物的患者采用半侧卧位，13例胸腺切除术患者采用头高脚低位。平均（±标准差）手术时间为91.86±56.42分钟，胸腔引流管使用时间为1.83±0.93天，术后住院时间为3.62±7.52天。3例患者（3.5%）发生术后并发症：1例乳糜胸，需再次手术；1例房颤和1例肺部感染，采用保守治疗。
我们的经验表明，RATS的不同手术方法用于纵隔肿物切除是安全可行的。可根据肿瘤所在的纵隔区域选择合适的手术方法。
