BACKGROUND Median sternotomy has been considered the gold standard approach for anterior mediastinal tumor resection.However,recent advances in video-assisted thoracoscopic surgery and robotic-assisted thoracoscopic s...BACKGROUND Median sternotomy has been considered the gold standard approach for anterior mediastinal tumor resection.However,recent advances in video-assisted thoracoscopic surgery and robotic-assisted thoracoscopic surgery with carbon dioxide insufflation have allowed minimally invasive approaches even for large and locally invasive tumors of the upper-anterior mediastinum.The subxiphoid robotic optical approach is a recently developed technique for accessing the mediastinum.The trans-subxiphoid technique offers excellent exposure of the surgical field,reduces postoperative pain,facilitates specimen retrieval even for large tumors,and potentially improves early surgical outcomes.AIM To evaluate the safety,feasibility,and outcomes of a robotic subxiphoid approach for the resecting of large/invasive mediastinal tumors.METHODS Between July 2024 and September 2025,12 patients underwent subxiphoid robotic mediastinal resection.The diameter of the operated lesions ranged from 30 mm to 70 mm.A 3 cm subxiphoid incision was made at the subxiphoid level for GelPort placement,allowing for optical port access.Two operating ports were placed at the sixth intercostal space bilaterally.Carbon dioxide insufflations(8-10 mmHg)enlarged the surgical field,improving visualization of critical anatomical landmarks,such as the internal mammary arteries and phrenic nerves.This approach allowed complete resection of large or invasive tumors,preserving thoracic stability and reducing the risk of postoperative myasthenic crisis.RESULTS The mean operating time was 170.2 minutes,and the median hospital stay was 3.5 days.No major postoperative complications occurred.Two conversions were necessary:One with a lateral robotic approach due to previous abdominal surgery,and one with a sternotomy for tumor invasion of the aortic arch.Histopathological analysis identified nine thymomas and one solitary fibrous tumor.CONCLUSION Subxiphoid robotic approach is a safe,effective technique for extended thymectomy,fulfilling both oncological and myasthenia gravis surgical objectives.展开更多
BACKGROUND Internal mammary(IM)lymphadenopathies in breast cancer indicate a worse prognosis than axillary metastases,yet they are rarely assessed.Accurate staging is essential for treatment planning.Robotic biopsy of...BACKGROUND Internal mammary(IM)lymphadenopathies in breast cancer indicate a worse prognosis than axillary metastases,yet they are rarely assessed.Accurate staging is essential for treatment planning.Robotic biopsy offers a promising alternative to video-assisted thoracic surgery for precise histological sampling.This article outlines a systematic robot-assisted dissection approach to enhance staging accuracy and optimize breast cancer management.CASE SUMMARY At our institution,robotic lymphadenectomy of the IM chain was performed in 5 patients between July 2020 and December 2024.Patients were positioned in a 30°semi-supine position with a roll under the shoulder to elevate the chest.The camera port was inserted in the fifth intercostal space along the mid-axillary line,allowing a 0°,12 mm robotic camera to inspect the chest cavity;CO_(2) insufflation(8 L/minute,8-10 mmHg)facilitated lung collapse and pneumo-mediastinum formation for improved dissection.Under direct vision,two additional operative ports were placed:One in the third intercostal space(anterior axillary line)and another in the fifth intercostal space(3-4 cm lateral to the parasternal line).The mean operative time was 118 minutes,with a median hospital stay of two days.No major complications occurred.Histology confirmed breast carcinoma metas tases in three patients,while two had benign disease.CONCLUSION Robotic biopsy of IM lymph nodes is safe,feasible,and provides key information on breast cancer management,with very rare contraindications.展开更多
文摘BACKGROUND Median sternotomy has been considered the gold standard approach for anterior mediastinal tumor resection.However,recent advances in video-assisted thoracoscopic surgery and robotic-assisted thoracoscopic surgery with carbon dioxide insufflation have allowed minimally invasive approaches even for large and locally invasive tumors of the upper-anterior mediastinum.The subxiphoid robotic optical approach is a recently developed technique for accessing the mediastinum.The trans-subxiphoid technique offers excellent exposure of the surgical field,reduces postoperative pain,facilitates specimen retrieval even for large tumors,and potentially improves early surgical outcomes.AIM To evaluate the safety,feasibility,and outcomes of a robotic subxiphoid approach for the resecting of large/invasive mediastinal tumors.METHODS Between July 2024 and September 2025,12 patients underwent subxiphoid robotic mediastinal resection.The diameter of the operated lesions ranged from 30 mm to 70 mm.A 3 cm subxiphoid incision was made at the subxiphoid level for GelPort placement,allowing for optical port access.Two operating ports were placed at the sixth intercostal space bilaterally.Carbon dioxide insufflations(8-10 mmHg)enlarged the surgical field,improving visualization of critical anatomical landmarks,such as the internal mammary arteries and phrenic nerves.This approach allowed complete resection of large or invasive tumors,preserving thoracic stability and reducing the risk of postoperative myasthenic crisis.RESULTS The mean operating time was 170.2 minutes,and the median hospital stay was 3.5 days.No major postoperative complications occurred.Two conversions were necessary:One with a lateral robotic approach due to previous abdominal surgery,and one with a sternotomy for tumor invasion of the aortic arch.Histopathological analysis identified nine thymomas and one solitary fibrous tumor.CONCLUSION Subxiphoid robotic approach is a safe,effective technique for extended thymectomy,fulfilling both oncological and myasthenia gravis surgical objectives.
文摘BACKGROUND Internal mammary(IM)lymphadenopathies in breast cancer indicate a worse prognosis than axillary metastases,yet they are rarely assessed.Accurate staging is essential for treatment planning.Robotic biopsy offers a promising alternative to video-assisted thoracic surgery for precise histological sampling.This article outlines a systematic robot-assisted dissection approach to enhance staging accuracy and optimize breast cancer management.CASE SUMMARY At our institution,robotic lymphadenectomy of the IM chain was performed in 5 patients between July 2020 and December 2024.Patients were positioned in a 30°semi-supine position with a roll under the shoulder to elevate the chest.The camera port was inserted in the fifth intercostal space along the mid-axillary line,allowing a 0°,12 mm robotic camera to inspect the chest cavity;CO_(2) insufflation(8 L/minute,8-10 mmHg)facilitated lung collapse and pneumo-mediastinum formation for improved dissection.Under direct vision,two additional operative ports were placed:One in the third intercostal space(anterior axillary line)and another in the fifth intercostal space(3-4 cm lateral to the parasternal line).The mean operative time was 118 minutes,with a median hospital stay of two days.No major complications occurred.Histology confirmed breast carcinoma metas tases in three patients,while two had benign disease.CONCLUSION Robotic biopsy of IM lymph nodes is safe,feasible,and provides key information on breast cancer management,with very rare contraindications.
