Hong Jeong In, Lee Jun Hee, Kim Hyun Koo
Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea.
Ann Cardiothorac Surg. 2023 Mar 31;12(2):110-116. doi: 10.21037/acs-2022-urats-24. Epub 2023 Mar 10.
Robotic-assisted surgery for mediastinal disease has been shown to be beneficial in facilitating easier mediastinal dissection with its three-dimensional views and multi-articulated moving instruments. Herein, we report our experience with the biportal approach of robot-assisted anterior mediastinal mass surgery, including both lateral transthoracic and subxiphoid approaches.
We retrospectively analyzed 21 patients who underwent biportal robotic-assisted anterior mediastinal mass resection, without considering the tumor size between May 2018 and September 2022. We reviewed the technical advantages and limitations of the biportal approach and the perioperative outcomes, including operative time, conversion to multiport or open surgery, duration of chest drainage, and postoperative complications, to define the role of robot-assisted surgery using the biportal approach.
We approached the thoracic cavity from the right side in five patients, from the left side in three patients, and from the subxiphoid in 13 patients. Thymomas (n=13) and thymic cysts (n=3) were the most common diagnoses. The median operative time was 165 min [interquartile range (IQR), 140-196 min]. There were no conversions to multiport or open surgery. The chest drain was removed at a median of two days (IQR, 1-3 days), and the patients were discharged at a median of four days (IQR, 3-5 days). Perioperative complications were reported in two patients (one with prolonged air leak and one with vocal cord palsy). There were no cases of readmission or delayed complication.
The biportal approach for robot-assisted surgery in anterior mediastinal masses is a feasible and safe alternative for treating associated pathologies. The subxiphoid approach for mediastinal surgery provides a better surgical view than the transthoracic approach. The biportal approach also enables the use of robotic staplers and energy devices and minimizes instrumental interference compared to that in the single-port approach.
机器人辅助纵隔疾病手术已被证明有益，其三维视野和多关节移动器械便于更轻松地进行纵隔解剖。在此，我们报告机器人辅助前纵隔肿物手术双孔入路的经验，包括经胸外侧入路和剑突下入路。
我们回顾性分析了2018年5月至2022年9月期间接受双孔机器人辅助前纵隔肿物切除术的21例患者，未考虑肿瘤大小。我们回顾了双孔入路的技术优势和局限性以及围手术期结果，包括手术时间、转为多孔或开放手术、胸腔引流持续时间和术后并发症，以确定双孔入路机器人辅助手术的作用。
5例患者经右侧进入胸腔，3例经左侧，13例经剑突下进入。最常见的诊断是胸腺瘤（n = 13）和胸腺囊肿（n = 3）。中位手术时间为165分钟[四分位间距（IQR），140 - 196分钟]。没有转为多孔或开放手术的情况。胸腔引流管中位拔除时间为2天（IQR，1 - 3天），患者中位出院时间为4天（IQR，3 - 5天）。2例患者报告了围手术期并发症（1例气胸持续时间延长，1例声带麻痹）。没有再次入院或延迟并发症的病例。
机器人辅助前纵隔肿物手术的双孔入路是治疗相关病变的一种可行且安全的替代方法。纵隔手术的剑突下入路比经胸入路提供更好的手术视野。与单孔入路相比，双孔入路还能够使用机器人吻合器和能量设备，并最大限度地减少器械干扰。
