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
目的:探讨经剑突下路径胸腔镜下全胸腺切除术的学习曲线,总结开展该手术的技术要点。方法:回顾性分析我院胸外科于2015年10月至2017年10月最开始行全胸腺切除术的患者临床资料,其中男21例,女16例,采用累积和分析法(cumulative sum analy...目的:探讨经剑突下路径胸腔镜下全胸腺切除术的学习曲线,总结开展该手术的技术要点。方法:回顾性分析我院胸外科于2015年10月至2017年10月最开始行全胸腺切除术的患者临床资料,其中男21例,女16例,采用累积和分析法(cumulative sum analysis,CUSUM)对经剑突下路径胸腔镜下全胸腺切除术的学习曲线进行分析。结果:平均手术时间为123.7 min,最佳拟合曲线为三次方曲线,拟合方程为CUSUN(min)=89.703 7X-4.594 8X2+0.059 9X3(X为手术例数)。学习曲线跨越顶点为13例,以13例为界限,将病例分为A、B 2组。A组和B组在手术时间、术后住院天数、术后胸腔引流管放置时间、术后并发症比较,差异有统计学意义,而术中出血量比较差异无统计学意义。结论:本研究中,13例是跨越经剑突下路径胸腔镜下全胸腺切除术学习曲线所需要累积的最低手术例数。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.
