Perioperative effects of da Vinci robot with totally no tube versus subxiphoid video-assisted thymectomy surgery for thymic tumors: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

DING Renquan ¹ , CHENG Ming ^1,3 , XU Shiguang ¹ , ZHANG Yinan ² , XU Wei ¹ , LIU Bo ¹ , HU Yuhang ¹ , JIN Xidong ¹ , WANG Xilong ¹ ,  WANG Shumin ¹

1. Department of Thoracic Surgery, General Hospital of Northern Theater Command, Shenyang, 110016, P. R. China;
2. Department of Anesthesiology, General Hospital of Northern Theater Command, Shenyang, 110016, P. R. China;
3. Graduate Training Base of General Hospital of Northern Theater Command, Dalian Medical University, Shenyang, 110016, P. R. China;

Corresponding author：

WANG Shumin, Email: sureman2003congo@163.com

Keywords：

Da Vinci robot; totally no tube; thoracoscopy; thymoma; surgery; retrospective cohort study

DOI：

10.7507/1007-4848.202202029

Video：

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Objective To compare the clinical efficacy and safety of da Vinci robot with totally no tube (TNT) versus subxiphoid video-assisted thymectomy surgery (SVATS) in the treatment of thymic tumors. Methods From 2019 to 2021, a retrospective analysis was conducted on patients with thymic tumor resection in the Department of Thoracic Surgery, General Hospital of Northern Theater Command. All patients underwent total thymectomy and mediastinal fat removal, and they were divided into a TNT group and a SVATS group according to the operation method. The intraoperative blood loss, conversion rate, postoperative visual analogue score (VAS), postoperative hospital stay time and postoperative complications were compared between the two groups. Results We finally included 435 patiets. There were 168 patients with 83 males and 85 females at an average age of 61.920±9.210 years in the TNT group and 267 patients with 147 males and 120 females at an average age of 61.460±8.119 years in the SVATS group. There was no death or postoperative myasthenic crisis in both groups. There was no statistical difference in postoperative hospital stay (1.540±0.500 d vs. 3.400±0.561 d, P=0.000), intraoperative blood loss (13.450±5.498 mL vs. 108.610±54.462 mL, P=0.000), postoperative 24 h VAS score (4.960±1.757 points vs. 3.600±1.708 points, P=0.000), or postoperative complication rate (3.0% vs. 11.6%, P=0.001).Conclusion TNT is a more efficient, safe, and effective surgical approach for treating thymic tumors, which can shorten hospital stay time and reduce postoperative complications. However, SVATS can minimize postoperative pain.

Citation： DING Renquan, CHENG Ming, XU Shiguang, ZHANG Yinan, XU Wei, LIU Bo, HU Yuhang, JIN Xidong, WANG Xilong, WANG Shumin. Perioperative effects of da Vinci robot with totally no tube versus subxiphoid video-assisted thymectomy surgery for thymic tumors: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(6): 818-823. doi: 10.7507/1007-4848.202202029 Copy

1.	Travis WD, Brambilla E, Burke AP, et al. Introduction to the 2015 World Health Organization classification of tumors of the lung, pleura, thymus, and heart. J Thorac Oncol, 2015, 10(9): 1240-1242.
2.	Rea F, Marulli G, Girardi R, Bortolotti L, et al. Long-term survival and prognostic factors in thymic epithelial tumours. Eur J Cardiothorac Surg, 2004, 26(2): 412-418.
3.	Raza A, Woo E. Video-assisted thoracoscopic surgery versus sternotomy in thymectomy for thymoma and myasthenia gravis. Ann Cardiothorac Surg, 2016, 5(1): 33-37.
4.	Jurado J, Javidfar J, Newmark A, et al. Minimally invasive thymectomy and open thymectomy: Outcome analysis of 263 patients. Ann Thorac Surg, 2012, 94(3): 974-981.
5.	程少先, 徐文礼, 艾瑞华, 等. 胸腔镜剑突下小切口治疗双侧胸腺瘤的临床效果. 中国当代医药, 2018, 25(13): 8-12.
6.	钟斌, 童继春, 张明, 等. 经剑突下与经侧胸入路胸腔镜手术在胸腺瘤切除中的应用比较. 广东医学, 2019, 40(3): 383-386.
7.	Romano G, Zirafa CC, Ceccarelli I, et al. Robotic thymectomy for thymoma in patients with myasthenia gravis: Neurological and oncological outcomes. Eur J Cardiothorac Surg, 2021, 60(4): 890-895.
8.	刘星池, 李博, 徐惟, 等. 达芬奇机器人手术系统行纵隔肿瘤切除术后不放置引流管的病例对照研究. 中国胸心血管外科临床杂志, 2015, 22(10): 940-943.
9.	Kondo K, Monden Y. Therapy for thymic epithelial tumors: A clinical study of 1, 320 patients from Japan. Ann Thorac Surg, 2003, 76(3): 878-885.
10.	Schnabel PA, Junker K. Pulmonary neuroendocrine tumors in the new WHO 2015 classification: Start of breaking new grounds?. Pathologe. 2015, 36(3): 283-92.
11.	张云峰, 于磊, 景筠, 等. 合并重症肌无力的胸腺瘤治疗与预后特点分析. 中华外科杂志, 2015, 53(8): 612-616.
12.	方文涛, 谷志涛, 陈克能. 胸腺肿瘤微创手术研究进展. 中国肺癌杂志, 2018, 21(4): 269-272.
13.	叶敏华, 陈保富, 叶中瑞, 等. 电视胸腔镜手术治疗前纵隔小结节32例. 中国微创外科杂志, 2009, 9(7): 638-639.
14.	王贵刚, 陈椿, 郑炜, 等. 电视胸腔镜手术治疗胸腺瘤75例. 中国微创外科杂志, 2013, 13(7): 581-583.
15.	李晓, 惠本刚, 肖蓉心, 等. 胸腔镜治疗胸腺瘤的安全性及中长期疗效分析. 中国微创外科杂志, 2017, 17(3): 193-196.
16.	Zieliński M, Kuzdzał J, Szlubowski A, et al. Transcervical-subxiphoid-videothoracoscopic "maximal" thymectomy-operative technique and early results. Ann Thorac Surg, 2004, 78(2): 404-410.
17.	Lu Q, Zhao J, Wang J, et al. Subxiphoid and subcostal arch "Three ports" thoracoscopic extended thymectomy for myasthenia gravis. J Thorac Dis, 2018, 10(3): 1711-1720.
18.	Zhao J, Wang J, Zhao Z, et al. Subxiphoid and subcostal arch thoracoscopic extended thymectomy: A safe and feasible minimally invasive procedure for selective stage Ⅲ thymomas. J Thorac Dis, 2016, 8(Suppl 3): S258- S264.
19.	Kawaguchi K, Fukui T, Nakamura S, et al. A bilateral approach to extended thymectomy using the da Vinci Surgical System for patients with myasthenia gravis. Surg Today, 2018, 48(2): 195-199.
20.	Yoshino I, Hashizume M, Shimada M, et al. Thoracoscopic thymomectomy with the da Vinci computer-enhanced surgical system. J Thorac Cardiovasc Surg, 2001, 122(4): 783-785.
21.	中国医师协会医学机器人医师分会胸外科专业委员会筹备组. 机器人辅助纵隔肿瘤手术中国专家共识(2019版). 中国胸心血管外科临床杂志, 2020, 27(2): 117-125.
22.	丁仁泉, 童向东, 许世广, 等. 达芬奇机器人手术系统与电视胸腔镜在胸内纵隔疾病手术治疗中的对比研究. 中国肺癌杂志, 2014, 17(7): 557-562.
23.	沈诚, 李珏, 李鹏飞, 等. 加速康复外科评价指标: 病人报告结局在胸外科的临床应用现状与进展. 中国肺癌杂志, 2019, 22(3): 161-166.
24.	Murgu S, Laxmanan B, Stoy S, et al. Evaluation of safety and short-term outcomes of therapeutic rigid bronchoscopy using total intravenous anesthesia and spontaneous assisted ventilation. Respiration, 2020, 99(3): 239-247.
25.	Ozdamar D, Turna C, Kimar A, et al. Tracheal injury: Late symptom after double-lumen tube intubation-A case report. J Pak Med Assoc, 2018, 68(11): 1711-1713.
26.	叶雄, 陈刚, 唐继鸣, 等. 胸腔镜微创术后不留置胸腔引流管在快速康复外科中的应用. 中国胸心血管外科临床杂志, 2014, 21(1): 112-114.
27.	唐善卫, 武强, 束余声. 肺癌术后胸腔闭式引流管理的现状与进展. 中华胸部外科电子杂志, 2019, 6(3): 182-186.
28.	王维, 李川, 林琳, 等. 经剑突下达芬奇机器人手术与传统胸腔镜手术治疗重症肌无力合并胸腺瘤的对比研究. 中国胸心血管外科临床杂志, 2020, 27(11): 1287-1291.
29.	Kamel MK, Rahouma M, Stiles BM, et al. Robotic thymectomy: learning curve and associated perioperative outcomes. J Laparoendosc Adv Surg Tech A, 2017, 27(7): 685-690.

1. Travis WD, Brambilla E, Burke AP, et al. Introduction to the 2015 World Health Organization classification of tumors of the lung, pleura, thymus, and heart. J Thorac Oncol, 2015, 10(9): 1240-1242.
2. Rea F, Marulli G, Girardi R, Bortolotti L, et al. Long-term survival and prognostic factors in thymic epithelial tumours. Eur J Cardiothorac Surg, 2004, 26(2): 412-418.
3. Raza A, Woo E. Video-assisted thoracoscopic surgery versus sternotomy in thymectomy for thymoma and myasthenia gravis. Ann Cardiothorac Surg, 2016, 5(1): 33-37.
4. Jurado J, Javidfar J, Newmark A, et al. Minimally invasive thymectomy and open thymectomy: Outcome analysis of 263 patients. Ann Thorac Surg, 2012, 94(3): 974-981.
5. 程少先, 徐文礼, 艾瑞华, 等. 胸腔镜剑突下小切口治疗双侧胸腺瘤的临床效果. 中国当代医药, 2018, 25(13): 8-12.
6. 钟斌, 童继春, 张明, 等. 经剑突下与经侧胸入路胸腔镜手术在胸腺瘤切除中的应用比较. 广东医学, 2019, 40(3): 383-386.
7. Romano G, Zirafa CC, Ceccarelli I, et al. Robotic thymectomy for thymoma in patients with myasthenia gravis: Neurological and oncological outcomes. Eur J Cardiothorac Surg, 2021, 60(4): 890-895.
8. 刘星池, 李博, 徐惟, 等. 达芬奇机器人手术系统行纵隔肿瘤切除术后不放置引流管的病例对照研究. 中国胸心血管外科临床杂志, 2015, 22(10): 940-943.
9. Kondo K, Monden Y. Therapy for thymic epithelial tumors: A clinical study of 1, 320 patients from Japan. Ann Thorac Surg, 2003, 76(3): 878-885.
10. Schnabel PA, Junker K. Pulmonary neuroendocrine tumors in the new WHO 2015 classification: Start of breaking new grounds?. Pathologe. 2015, 36(3): 283-92.
11. 张云峰, 于磊, 景筠, 等. 合并重症肌无力的胸腺瘤治疗与预后特点分析. 中华外科杂志, 2015, 53(8): 612-616.
12. 方文涛, 谷志涛, 陈克能. 胸腺肿瘤微创手术研究进展. 中国肺癌杂志, 2018, 21(4): 269-272.
13. 叶敏华, 陈保富, 叶中瑞, 等. 电视胸腔镜手术治疗前纵隔小结节32例. 中国微创外科杂志, 2009, 9(7): 638-639.
14. 王贵刚, 陈椿, 郑炜, 等. 电视胸腔镜手术治疗胸腺瘤75例. 中国微创外科杂志, 2013, 13(7): 581-583.
15. 李晓, 惠本刚, 肖蓉心, 等. 胸腔镜治疗胸腺瘤的安全性及中长期疗效分析. 中国微创外科杂志, 2017, 17(3): 193-196.
16. Zieliński M, Kuzdzał J, Szlubowski A, et al. Transcervical-subxiphoid-videothoracoscopic "maximal" thymectomy-operative technique and early results. Ann Thorac Surg, 2004, 78(2): 404-410.
17. Lu Q, Zhao J, Wang J, et al. Subxiphoid and subcostal arch "Three ports" thoracoscopic extended thymectomy for myasthenia gravis. J Thorac Dis, 2018, 10(3): 1711-1720.
18. Zhao J, Wang J, Zhao Z, et al. Subxiphoid and subcostal arch thoracoscopic extended thymectomy: A safe and feasible minimally invasive procedure for selective stage Ⅲ thymomas. J Thorac Dis, 2016, 8(Suppl 3): S258- S264.
19. Kawaguchi K, Fukui T, Nakamura S, et al. A bilateral approach to extended thymectomy using the da Vinci Surgical System for patients with myasthenia gravis. Surg Today, 2018, 48(2): 195-199.
20. Yoshino I, Hashizume M, Shimada M, et al. Thoracoscopic thymomectomy with the da Vinci computer-enhanced surgical system. J Thorac Cardiovasc Surg, 2001, 122(4): 783-785.
21. 中国医师协会医学机器人医师分会胸外科专业委员会筹备组. 机器人辅助纵隔肿瘤手术中国专家共识(2019版). 中国胸心血管外科临床杂志, 2020, 27(2): 117-125.
22. 丁仁泉, 童向东, 许世广, 等. 达芬奇机器人手术系统与电视胸腔镜在胸内纵隔疾病手术治疗中的对比研究. 中国肺癌杂志, 2014, 17(7): 557-562.
23. 沈诚, 李珏, 李鹏飞, 等. 加速康复外科评价指标: 病人报告结局在胸外科的临床应用现状与进展. 中国肺癌杂志, 2019, 22(3): 161-166.
24. Murgu S, Laxmanan B, Stoy S, et al. Evaluation of safety and short-term outcomes of therapeutic rigid bronchoscopy using total intravenous anesthesia and spontaneous assisted ventilation. Respiration, 2020, 99(3): 239-247.
25. Ozdamar D, Turna C, Kimar A, et al. Tracheal injury: Late symptom after double-lumen tube intubation-A case report. J Pak Med Assoc, 2018, 68(11): 1711-1713.
26. 叶雄, 陈刚, 唐继鸣, 等. 胸腔镜微创术后不留置胸腔引流管在快速康复外科中的应用. 中国胸心血管外科临床杂志, 2014, 21(1): 112-114.
27. 唐善卫, 武强, 束余声. 肺癌术后胸腔闭式引流管理的现状与进展. 中华胸部外科电子杂志, 2019, 6(3): 182-186.
28. 王维, 李川, 林琳, 等. 经剑突下达芬奇机器人手术与传统胸腔镜手术治疗重症肌无力合并胸腺瘤的对比研究. 中国胸心血管外科临床杂志, 2020, 27(11): 1287-1291.
29. Kamel MK, Rahouma M, Stiles BM, et al. Robotic thymectomy: learning curve and associated perioperative outcomes. J Laparoendosc Adv Surg Tech A, 2017, 27(7): 685-690.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Perioperative effects of da Vinci robot with totally no tube versus subxiphoid video-assisted thymectomy surgery for thymic tumors: A retrospective cohort study

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