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Perioperative outcomes comparison of robotic and video-assisted thoracoscopic thymectomy for thymic epithelial tumor: a single-center experience

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Abstract

Background

The advent of robot-assisted thoracoscopic surgery (RATS) has completely revolutionized the modality of thymectomy, which could reportedly achieve equivalent efficacy compared with a minimally invasive approach. This study was conducted to further compare the perioperative outcomes between these two modalities.

Methods

A retrospective single-center study that included patients receiving either a robotic or video-assisted thoracoscopic (VAT) thymectomy between February 2021 and January 2023 was conducted. All the patients were pathologically confirmed with thymic epithelial tumors. Clinical and pathological characteristics and perioperative outcomes were collected and compared between these two cohorts.

Results

A total of 190 patients were included in this study, with 61 (32.1%) and 129 (67.9%) receiving robotic and video-assisted thymectomy, respectively. The clinicopathological characteristics were not significantly different between these 2 groups. The size of the resected specimens in the RATS cohort was larger than the VATS cohort [median (IQR), 13.0 (8.0–16.0) vs. 9.0 (6.7–12.0) cm, p < 0.001], while the procedural duration was longer for the RATS group than its counterpart [median (IQR), 105 (85–143) vs. 85 (69–115) min, p = 0.001]. Moreover, no other significant difference was observed between these two groups. Since more than half of the robotic thymectomy was performed using a subxiphoid approach, a subgroup analysis was further conducted. Similarly, the robotic group through a subxiphoid approach harbored a longer procedural duration, and the size of the specimens obtained was larger than the VATS group [median (IQR), 14.0 (11.0–16.5) vs. 12.5 (8.5–15.0) cm, p = 0.061].

Conclusions

The early clinical efficacy of robotic thymectomy was proven comparable to the established VATS approach, and such a modality might have strength when obtaining larger specimens, which could contribute to improving long-term efficacy. Despite the longer procedural duration recorded in the early stage of conducting robotic thymectomy, further accumulation would help decrease the time.

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Data availability

The data underlying this article will be shared on reasonable request to the corresponding author.

Abbreviations

ASA:

American society of anaesthesiologists

BMI:

Body mass index

CCI:

Charlson comorbidity index

CT:

Computed-tomography

IQR:

Interquartile range

LOS:

Length of stay

MG:

Myasthenia gravis

MNT:

Micronodular thymoma with lymphoid stroma

RATS:

Robot-assisted thoracoscopic surgery

TC:

Thymic carcinoma

TET:

Thymic epithelial tumours

VATS:

Video-assisted thoracoscopic surgery

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Acknowledgements

Dr Haoran E would particularly like to thank Tianrui Zhang for her consistent encouragements and supports during the past years.

Funding

This study was supported by Shanghai Hospital Development Center (SHDC22021310-A and SHDC22021217), the Science and Technology Commission of Shanghai Municipality (21S31905200) and Shanghai Municipal Health Commission (202040322).

Author information

Author notes

  1. Haoran E, Chenlu Yang, Lei Zhang, and Lang Xia have contributed equally to this work.

Authors and Affiliations

  1. Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, No. 507 Zhengmin Road, Shanghai, 200443, China

    Haoran E, Chenlu Yang, Lei Zhang, Lang Xia, Long Xu, Nan Song, Xuefei Hu, Yuming Zhu, Chang Chen & Deping Zhao

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  1. Haoran E
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  2. Chenlu Yang
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Correspondence to Deping Zhao.

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The authors have no conflicts of interest to disclose.

Ethical approval

The study including human participants has been performed in accordance with the ethical standards of the Declaration of Helsinki and its later amendments.

Informed consent

This study was approved by the Institutional Review Board of Shanghai Pulmonary Hospital (IRB ID: K20-262) and informed consent was waived due to its retrospective nature.

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E, H., Yang, C., Zhang, L. et al. Perioperative outcomes comparison of robotic and video-assisted thoracoscopic thymectomy for thymic epithelial tumor: a single-center experience. Updates Surg (2023). https://doi.org/10.1007/s13304-023-01702-5

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