Video-assisted thoracoscopic surgery is safe and reliable for large and invasive primary mediastinal tumors

Outcomes of robot-assisted versus video-assisted mediastinal mass resection during the initial learning curve

To compare the learning curve of mediastinal mass resection between robot-assisted surgery and thoracoscopic surgery. Retrospective perioperative data were collected from 160 mediastinal mass resection cases. Data included 80 initial consecutive video-assisted thoracoscopic surgery (VATS) resection cases performed from February 2018 to February 2020 and 80 initial consecutive robotic-assisted thoracic surgery (RATS) resection cases performed from March 2020 to March 2023. All cases were operated on by a thoracic surgeon. The clinical characteristics and perioperative outcomes of the two groups were compared. The operation time in both the RATS group and VATS group was analyzed using the cumulative sum (CUSUM) method. Based on this method, the learning curves of both groups were divided into a learning period and mastery period. The VATS group and the RATS group crossed the inflection point in the 27th and 21st case, respectively. Subsequently, we found that the learning period was longer than the mastery period with statistically significant differences in terms of the operating time, and postoperative hospital stay in the VATS group and the RATS group. A certain amount of VATS experience can shorten the learning curve for RATS.

Simultaneous uniportal video-assisted thoracic surgery for pulmonary nodules and synchronous mediastinal lesions

Introduction

Video-assisted thoracic surgery (VATS) has been widely accepted in the diagnosis and treatment of thoracic diseases for the past three decades due to its small incision, minimal trauma, and rapid recovery after surgery. A growing number of patients with concurrent pulmonary nodules and mediastinal lesions have been detected. Simultaneous ipsilateral resection of coexisting lesions is a preferred procedure.

Aim

To introduce our technique and preliminary experience in performing uniportal video-assisted thoracic surgery (VATS) for the simultaneous resection of pulmonary and mediastinal lesions.

Material and methods

We retrospectively analysed 8 consecutive patients who underwent simultaneous uniportal VATS resection of coexisting lesions of the lung and mediastinum in our centre. The clinical data were recorded and analysed.

Results

A total of 8 patients were enrolled, and all patients successfully underwent surgery through a single incision; no perioperative deaths occurred. The average single incision length was 3.9 ±0.3 cm, the operative time was 102.3 ±54.4 min, and the bleeding volume was 27.5 ±17.9 ml. The thoracic drainage time was 3.0 ±2.3 days, with a mean volume of 390.6 ±361.3 ml. The length of postoperative hospital stay was 4.0 ±1.9 (range: 3–9) days. No serious complications were observed in the hospital or during postoperative follow-up.

Conclusions

Uniportal VATS is feasible and safe for the simultaneous resection of pulmonary and mediastinal lesions in selected patients and offers cosmetically pleasing incisions and promising clinical application prospects.

Safety of subxiphoid uniportal video-assisted thoracoscopic surgery for anterior mediastinal tumour in obese patients

Introduction

Subxiphoid uniportal video-assisted thoracoscopic surgery (VATS) has been gradually applied for the treatment of anterior mediastinal tumour (AMT). However, whether obesity is a risk factor for subxiphoid uniportal VATS for AMT is still unknown.

Aim

To explore the safety and short-term outcome of subxiphoid uniportal VATS for AMT in obese patients.

Material and methods

The clinical data of 142 patients who received VATS via subxiphoid approach for AMT were analysed. According to body mass index (BMI), the patients were divided into an obese group (BMI ≥ 28 kg/m²) and a non-obese group (BMI < 28 kg/m²). Then, the clinical and surgical characteristics between the obese group and the non-obese group were analysed to explore the effect of obesity on VATS for AMT. The pain scores were evaluated by the Numeric Rating Scale.

Results

The operative time and tracheal intubation time using subxiphoid uniportal VATS for AMT in the obese group were longer than that in the non-obese group (p < 0.05). However, there was no obvious difference in intraoperative blood loss, chest tube drainage time, chest tube drainage volume, and length of hospital stay between the obese group and the non-obese group (p > 0.05). Moreover, there was also no significant difference in postoperative complications, including pulmonary complications, wound infection, arrhythmia, and pulmonary leak, between the obese group and the non-obese group. In addition, the pain scores in the obese group were similar to those in the non-obese group.

Conclusions

Although obesity might prolong operative time of subxiphoid uniportal VAST for AMT, it does not increase the rate of postoperative complications. An experienced centre can properly conduct VAST via subxiphoid approach when treating AMT in obese patients.