Department of Cardio-Thoracic surgery, Institute of Yan'an Hospital Affiliated to Kunming Medical University, Kunming, China.
Faculty of Life and Biotechnology, Institute of Kunming University of Science and Technology, Kunming, China.
Int J Med Robot. 2021 Dec;17(6):e2333. doi: 10.1002/rcs.2333. Epub 2021 Sep 24.
Recently, thymectomy using minimally invasive approaches has been increasing with the development of robotic video-assisted thoracoscopic surgery (R-VATS). Although multimodal approach is effective for robot assisted thymectomy, it is necessary to determine the approach (left, right or subxiphoid) associated with the least complications.
An electronic retrieval from PubMed, Embase, Web of Science, GreyNet International and The Cochrane Library. The single-arm meta-analysis was performed to compare the rate of complications of right- and left-side approaches by R-VATS.
A total of 21 studies including 930 patients were identified. The pooled incidence of total complications was 12.2% (confidence interval: 10.0%-14.8%) for all studies. The overall complication rate was 17.3% for the right-side compared with 7.4% for the left side (P < 0.001, odds ratio = 2.484, 1.601-3.852). The pooled incidence of air leak was significantly higher for the right versus left side (5.1% vs. 1.2%, respectively; p = 0.004). The incidence of atrial fibrillation was higher for the right-side compared with the left-side approach (4% vs. 1.2%, respectively; p = 0.004). The open conversion rate was significantly higher for the right versus the left-side (6.5% vs. 2.9%, respectively; p = 0.004). However, there was no significant difference in the pooled incidence of pleural effusion and thoracic duct fistula when comparing the right- and left-side approaches. In subgroup analysis, in the left approach, the incidence of overall complications (28.6% vs. 5.5%, respectively; p = 0.002) and pleural effusion (14.3% vs. 1%, respectively; p = 0.002) was higher for the 'Old Age' group compared with the 'Youth' group; However, In the subgroup analysis of gender, there was no significant difference in the incidence of complications after thymectomy.
Robotic video-assisted thoracoscopic surgery can be performed on the left- and right-sides; however, complications are minimal with the left-side approach. These data demonstrate that the incidence of overall complications, atrial fibrillation, open conversion ratios, and air leak rate of left-side R-VATS thymectomy are lower than those of right-side. Further subgroup analysis showed that the incidence of postoperative complications was higher in the older group.
随着机器人辅助电视胸腔镜手术（R-VATS）的发展，微创胸腺切除术的应用越来越多。尽管多模式方法对机器人辅助胸腺切除术有效，但有必要确定与并发症最少相关的方法（左侧、右侧或剑突下）。
从 PubMed、Embase、Web of Science、GreyNet International 和 The Cochrane Library 进行电子检索。通过单臂荟萃分析比较了右侧和左侧 R-VATS 治疗的并发症发生率。
共纳入 21 项研究，包括 930 例患者。所有研究的总并发症发生率为 12.2%（置信区间：10.0%-14.8%）。右侧总体并发症发生率为 17.3%，左侧为 7.4%（P<0.001，比值比=2.484，1.601-3.852）。右侧气胸的发生率明显高于左侧（分别为 5.1%和 1.2%；p=0.004）。右侧心房颤动的发生率高于左侧（分别为 4%和 1.2%；p=0.004）。右侧中转开胸率明显高于左侧（分别为 6.5%和 2.9%；p=0.004）。然而，右侧和左侧的胸腔积液和胸导管瘘的发生率没有显著差异。在亚组分析中，在左侧入路中，与“青年”组相比，“老年”组的总并发症发生率（分别为 28.6%和 5.5%；p=0.002）和胸腔积液发生率（分别为 14.3%和 1%；p=0.002）更高；然而，在性别亚组分析中，胸腺切除术后并发症的发生率没有显著差异。
机器人辅助电视胸腔镜手术可在左侧和右侧进行；然而，左侧入路的并发症最小。这些数据表明，左侧 R-VATS 胸腺切除术的总并发症发生率、心房颤动、中转开胸率和气胸发生率均低于右侧。进一步的亚组分析显示，老年组术后并发症发生率较高。
