Clinical efficacy of robot-assisted subxiphoid versus lateral thoracic approach in the treatment of anterior mediastinal tumors

Abstract

Abstract Background: The purpose of this study was to compare the perioperative efficacy and safety of da Vinci robot assisted thoracoscopic surgery (RATS) for the treatment of anterior mediastinal tumors through the subxiphoid and lateral thoracic approaches under the anesthesia of non tracheal intubation (i.e. laryngeal mask airway). Methods: We retrospectively analyzed the clinical data of 116 patients with anterior mediastinal tumors treated by RATS under laryngeal mask anesthesia completed by the same operator in the Department of Thoracic Surgery, Gansu Provincial People's Hospital from October 2016 to October 2022. There were 52 patients, 24 males and 28 females, with a mean age of (45.40±4.94) years, in the subxiphoid approach (subxiphoid group) and 64 patients, 34 males and 30 females, with a mean age of (46.86±5.46) years, in the lateral thoracic approach (lateral thoracic group). The operating time, intraoperative bleeding and total postoperative drainage in the two groups were compared and analyzed. Results: All patients in both groups successfully completed resection of the anterior mediastinal tumor without the occurrence of perioperative death. In terms of total postoperative drainage flow [(229.90±25.00) ml vs. (242.03±35.99) ml], postoperative drainage time [(2.56±0.78) days vs. (2.97±0.94) days], postoperative hospital stay [(3.69±0.92) days vs. (4.14±1.13) days], and VAS pain on postoperative day 2 and 3, the subxiphoid group had more advantages and the difference was statistically significant (P<0.05). In terms of docking time [(10.23±1.29) min vs. (12.40±2.13) min], the lateral chest group was more advantageous and the difference was statistically significant (P<0.05). There was no statistically significant difference between the two groups in terms of operative time, total operative time, total postoperative drainage, postoperative day 1 VAS pain score and postoperative complications (P>0.05). Conclusion: The subxiphoid approach of RATS under laryngeal mask anesthesia is safe and feasible for resection of anterior mediastinal tumors. Compared with the lateral thoracic approach, the subxiphoid approach has advantages in terms of rapid postoperative recovery and postoperative patient pain, and patient acceptance is also higher, which is worth promoting in hospitals where it is available.