Skip to main content
SpringerLink
Log in

Robot-assisted surgery outperforms video-assisted thoracoscopic surgery for anterior mediastinal disease: a multi-institutional study

  • Research
  • Published:
Journal of Robotic Surgery Aims and scope Submit manuscript

Abstract

Anterior mediastinal procedures are increasingly being performed using robot-assisted thoracic surgery (RATS) or video-assisted thoracoscopic surgery (VATS). While both approaches have shown superior outcomes compared to open surgery, their comparative benefits are not as distinct. The aim of this retrospective study was to bridge this knowledge gap using a multicenter dataset. Patients who underwent elective minimally invasive surgery for anterior mediastinal disease between 2015 and 2022 were deemed eligible. The study participants were grouped based on whether a robot was used or not, and perioperative outcomes were compared. To mitigate selection bias, inverse probability of treatment weighting (ITPW) was applied using the propensity score. The final analysis included 312 patients (RATS = 120; VATS = 192). Following the application of IPTW, RATS was found to be associated with a longer operating time (215.3 versus 139.31 min, P < 0.001), fewer days with a chest tube (1.96 versus 2.61 days, P = 0.047), and a shorter hospital stay (3.03 versus 3.91 days, P = 0.041) compared to VATS. Subgroup analyses indicated that the benefit of RATS in reducing the length of hospital stay was particularly pronounced in patients with tumors larger than 6 cm (mean difference [MD] =  – 2.28 days, P = 0.033), those diagnosed with myasthenia gravis (MD =  – 3.84 days, P = 0.002), and those who underwent a trans-subxiphoid surgical approach (MD =  – 0.81 days, P = 0.04). Both VATS and RATS are safe and effective approaches for treating anterior mediastinal disease. However, RATS holds distinct advantages over VATS including shorter hospital stays and reduced chest tube drainage periods.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

References

  1. Seo Y-J, Christian-Miller N, Aguayo E, Sanaiha Y, Benharash P, Yanagawa J (2022) National use and short-term outcomes of video and robot-assisted thoracoscopic thymectomies. Annals Thorac Surg 113:230–236. https://doi.org/10.1016/j.athoracsur.2021.02.003

    Article  Google Scholar 

  2. Kamel MK, Villena-Vargas J, Rahouma M, Lee B, Harrison S, Stiles BM, Abdelrahman AM, Altorki NK, Port JL (2019) National trends and perioperative outcomes of robotic resection of thymic tumours in the United States: a propensity matching comparison with open and video-assisted thoracoscopic approaches. Eur J Cardio-Thorac Surg 56:762–769. https://doi.org/10.1093/ejcts/ezz111

    Article  Google Scholar 

  3. Yang C-FJ, Hurd J, Shah SA, Liou D, Wang H, Backhus LM, Lui NS, D’Amico TA, Shrager JB, Berry MF (2020) A national analysis of open versus minimally invasive thymectomy for stage I to III thymoma. J Thorac Cardiovasc Surg 160:555-567.e15. https://doi.org/10.1016/j.jtcvs.2019.11.114

    Article  PubMed  Google Scholar 

  4. Seong YW, Kang CH, Choi J-W, Kim H-S, Jeon JH, Park IK, Kim YT (2014) Early clinical outcomes of robot-assisted surgery for anterior mediastinal mass: its superiority over a conventional sternotomy approach evaluated by propensity score matching. Eur J Cardio-Thorac Surg 45:e68–e73. https://doi.org/10.1093/ejcts/ezt557

    Article  Google Scholar 

  5. Ye B, Tantai J-C, Li W, Ge X-X, Feng J, Cheng M, Zhao H (2013) Video-assisted thoracoscopic surgery versus robotic-assisted thoracoscopic surgery in the surgical treatment of Masaoka stage I thymoma. World J Surg Oncol 11:1–5. https://doi.org/10.1186/1477-7819-11-157

    Article  Google Scholar 

  6. Rückert JC, Swierzy M, Ismail M (2011) Comparison of robotic and nonrobotic thoracoscopic thymectomy: a cohort study. J Thorac Cardiovasc Surg 141:673–677. https://doi.org/10.1016/j.jtcvs.2010.11.042

    Article  PubMed  Google Scholar 

  7. Ochi T, Suzuki H, Hirai Y, Yamanaka T, Matsumoto H, Kaiho T, Inage T, Ito T, Tanaka K, Sakairi Y (2023) Robot-assisted thoracic surgery versus video-assisted thoracic surgery for mediastinal lesions. J Thorac Dis 15:384

    Article  Google Scholar 

  8. Li R, Ma Z, Qu C, Qiu J, Wang K, Yue W, Tian H (2022) Comparison of perioperative outcomes between robotic-assisted and video-assisted thoracoscopic surgery for mediastinal masses in patients with different body mass index ranges: a population-based study. Front Surg 9:963335. https://doi.org/10.3389/fsurg.2022.963335

    Article  PubMed  PubMed Central  Google Scholar 

  9. Chendaer N, Jiang N, Hao Y, Zhao Y, Li G, Zhang W, Peng C (2023) A propensity score-matching analysis: robotic thymectomy through the subxiphoid has advantages over video-assisted thymectomy surgery. J Laparoendosc Adv Surg Tech 33:859–865

    Article  Google Scholar 

  10. Li X-K, Xu Y, Cong Z-Z, Zhou H, Wu W-J, Shen Y (2020) Comparison of the progression-free survival between robot-assisted thymectomy and video-assisted thymectomy for thymic epithelial tumors: a propensity score matching study. J Thorac Dis 12:4033

    Article  PubMed  PubMed Central  Google Scholar 

  11. Qian L, Chen X, Huang J, Lin H, Mao F, Zhao X, Luo Q, Ding Z (2017) A comparison of three approaches for the treatment of early-stage thymomas: robot-assisted thoracic surgery, video-assisted thoracic surgery, and median sternotomy. J Thorac Dis 9:1997

    Article  PubMed  PubMed Central  Google Scholar 

  12. Şehitogullari A, Nasır A, Anbar R, Erdem K, Bilgin C (2020) Comparison of perioperative outcomes of videothoracoscopy and robotic surgical techniques in thymoma. Asian J Surg 43:244–250

    Article  PubMed  Google Scholar 

  13. Suda T, Sugimura H, Tochii D, Kihara M, Hattori Y (2012) Single-port thymectomy through an infrasternal approach. Annals Thorac Surg 93:334–336. https://doi.org/10.1016/j.athoracsur.2011.08.047

    Article  Google Scholar 

  14. Chiu C-H, Chao Y-K, Liu Y-H (2018) Subxiphoid approach for video-assisted thoracoscopic surgery: an update. J Thorac Dis 10: S1662 https://doi.org/10.21037/jtd.2018.04.01

  15. Li M, Xu L, Li L, Dai Q, Xu D (2022) The early perioperative outcomes of subxiphoid approach versus lateral intercostal approach thoracoscopic thymectomy for thymic tumors: a meta-analysis. J Laparoendoscop Adv Surg Techn 32:256–264. https://doi.org/10.1089/lap.2021.0036

    Article  Google Scholar 

  16. Kido T, Hazama K, Inoue Y, Tanaka Y, Takao T (1999) Resection of anterior mediastinal masses through an infrasternal approach. Annals Thorac Surg 67:263265. https://doi.org/10.1016/s0003-4975(98)01210-7

    Article  Google Scholar 

Download references

Acknowledgements

The authors express their gratitude to Intuitive Surgical Sarl (Taiwan branch) for their support and collaborative assistance in project administration

Funding

This work was supported by the National Science and Technology Council of Taiwan (grant number NSTC 112-2314-B-182A-116-MY3) and the Chang Gung Memorial Hospital-Linkou (grant number NMRPG3N6201).

Author information

Authors and Affiliations

  1. Department of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital-Linkou, Chang Gung University, 5 Fuxing Street, Taoyuan, 333, Taiwan

    Yin-Kai Chao

  2. Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan

    Jui-Ying Lee

  3. Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan

    Jui-Ying Lee

  4. Department of Cardiovascular and Thoracic Surgery, Chang Gung Memorial Hospital-Kaohsiung, Chang Gung University, Kaohsiung, Taiwan

    Hung-I. Lu

  5. Division of Thoracic Surgery, Department of Surgery, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan

    Yau-Lin Tseng

  6. Department of Surgery, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan

    Jang-Ming Lee

  7. Department of Thoracic Surgery, Mackay Memorial Hospital, Taipei, Taiwan

    Wen-Chien Huang

Authors
  1. Yin-Kai Chao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jui-Ying Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hung-I. Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yau-Lin Tseng
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jang-Ming Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wen-Chien Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors provided conceptualization and provided the data for analysis. YKC wrote the main manuscript and prepared figures and tables. All authors reviewed the manuscript.

Corresponding author

Correspondence to Yin-Kai Chao.

Ethics declarations

Conflicts of interest

Yin-Kai Chao has received honoraria from Intuitive Surgical Sarl (Taiwan Branch) for his speaking engagements and educational contributions. The remaining authors have no conflicts of interest to declare.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chao, YK., Lee, JY., Lu, HI. et al. Robot-assisted surgery outperforms video-assisted thoracoscopic surgery for anterior mediastinal disease: a multi-institutional study. J Robotic Surg 18, 21 (2024). https://doi.org/10.1007/s11701-023-01745-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11701-023-01745-1

Keywords

Search

Navigation