Zeng Liping, Wang Weidong, Han Jia, Zhu Linhai, Zhao Jiangang, Tu Zhengliang
Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Gland Surg. 2021 Jan;10(1):101-111. doi: 10.21037/gs-20-536.
This study aims to identify the feasibility of uniportal video-assisted thoracoscopic surgery (VATS) and robot-assisted thoracoscopic surgery (RATS) compared with multiportal VATS in the resection of mediastinal lesions.
Patients who underwent mediastinal lesion resection were enrolled and allocated to the uni-VATS, tri-VATS, and RATS groups according to the surgical approach. Propensity score-matched (PSM) analysis was performed between the VATS and RATS groups as well as the uni-VATS and tri-VATS groups. The operative and recovery parameters were compared.
Totally, 274 patients were enrolled. There was no difference in the operative parameters among the groups. Compared with multiportal VATS, uniportal VATS and RATS had a significantly shorter chest tube placement time (2.43±0.88 1.78±1.22 2.21±1.11 days, P<0.001) and hospital length of stay (LOS) (4.07±1.75 3.27±1.05 3.62±1.21 days, P=0.001) without increasing the incidence rate of complications (5.6% 7.2% 5.7%, P=0.864). After PSM, the RATS group showed a significantly lower unplanned conversion rate than the VATS group (0.0% 8.2%, P=0.041), while the uni-VATS group had a shorter chest tube placement time (1.83±1.20 2.35±0.86 days, P=0.013) and hospital LOS (3.23±1.03 3.95±2.00 days) than the tri-VATS group.
Compared with multiportal VATS, uniportal VATS and RATS are technically safe and feasible with potential advantages for mediastinal lesion resection.
本研究旨在确定单孔电视辅助胸腔镜手术（VATS）和机器人辅助胸腔镜手术（RATS）相较于多孔VATS切除纵隔病变的可行性。
纳入接受纵隔病变切除术的患者，并根据手术方式将其分为单孔VATS组、三孔VATS组和RATS组。对VATS组和RATS组以及单孔VATS组和三孔VATS组进行倾向评分匹配（PSM）分析。比较手术和恢复参数。
共纳入274例患者。各组手术参数无差异。与多孔VATS相比，单孔VATS和RATS的胸管留置时间显著缩短（2.43±0.88、1.78±1.22、2.21±1.11天，P<0.001），住院时间（LOS）也显著缩短（4.07±1.75、3.27±1.05、3.62±1.21天，P=0.001），且未增加并发症发生率（5.6%、7.2%、5.7%，P=0.864）。PSM分析后，RATS组的非计划中转率显著低于VATS组（0.0%、8.2%，P=0.041），而单孔VATS组的胸管留置时间（1.83±1.20、2.35±0.86天，P=0.013）和住院LOS（3.23±1.03、3.95±2.00天）均短于三孔VATS组。
与多孔VATS相比，单孔VATS和RATS在技术上安全可行，在纵隔病变切除方面具有潜在优势。
