Objective To analyze the feasibility of totally no tube (TNT) in da Vinci robotic mediastinal mass surgery and its significance for fast track surgery. Methods A total of 79 patients receiving robotic mediastinal TNT surgery in the General Hospital of Shenyang Military Command from January 2016 to December 2017 were enrolled as a TNT group; 35 patients receiving robotic mediastinal surgery in General Hospital of Shenyang Military Command from January 2014 to December 2017 and 54 patients receiving thoracoscopic mediastinal surgery during the same period were enrolled as a non-TNT group and a video-assisted thoracoscopic surgery (VATS) group. The muscle relaxation and tracheal intubation/laryngeal masking time, operation time, intraoperative blood loss, postoperative ICU stay, postoperative hospital stay, postoperative visual analogue scale (VAS), hospitalization costs and postoperative complications and other related indicators were retrospectively analyzed among the three groups. Results Surgeries were successfully completed in 168 patients with no transfer to thoracotomy, serious complications (postoperative complications in 9 patients) or death during the perioperative period. All patients were discharged. Compared with the non-TNT group, the TNT group had significantly less muscle relaxation-tracheal intubation/laryngeal masking time, operation time, intraoperative blood loss, VAS pain score, ICU stay, postoperative hospital stay (P<0.01); there was no significant difference in the total cost of hospitalization between the two groups (P>0.05). Between the non-TNT group and the VATS group, there was no significant difference in time of muscle relaxation and tracheal intubation, operation time and ICU stay (P>0.05). The non-TNT group was superior to the VATS group in terms of intraoperative blood loss, VAS pain scores on the following day after operation, chest drainage volume 1-3 days postoperatively, postoperative catheterization time and postoperative hospital stay (P<0.05); but the cost of hospitalization in the non-TNT group was significantly higher (P=0.000). Conclusion The da Vinci robot is safe and feasible for the treatment of mediastinal masses. At the same time, TNT is also safe and reliable on the basis of robotic surgery which has many advantages such as better comfort, less pain, ICU stay and hospital stay as well as faster recovery.
Citation：
MENG Xiangrui, XU Wei, LIU Bo, WANG Xilong, DAI Feng, KANG Yunteng, LIN Jie, LIU Xingchi, XU Shiguang, WANG Shumin. Retrospective analysis of mediastinal mass resection with totally no tube during da Vinci robotic surgery for 79 patients. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(3): 211-216. doi: 10.7507/1007-4848.201805076
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Copyright © the editorial department of Chinese Journal of Clinical Thoracic and Cardiovascular Surgery of West China Medical Publisher. All rights reserved
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- 1. Kajiwara N, Taira M, Yoshida K, et al. Early experience using the da Vinci Surgical System for the treatment of mediastinal tumors. Gen Thorac Cardiovasc Surg, 2011, 59(10): 693-698.
- 2. Kawaguchi K, Fukui T, Nakamura S, et al. A bilateral approach to extended thymectomy using the da Vinci Surgical System for patients with myasthenia gravis. Surg Today, 2018, 48(2): 195-199.
- 3. 方文涛, 谷志涛, 陈克能, 等. 胸腺肿瘤微创手术研究进展. 中国肺癌杂志, 2018, 21(4): 269-272.
- 4. 王述民, 李博, 许世广, 等. 达芬奇机器人在胸腺扩大切除术治疗Ⅰ型重症肌无力的应用. 中国胸心血管外科临床杂志, 2013, 20(6): 679-682.
- 5. 代锋, 许世广, 徐惟, 等. 达芬奇机器人与电视胸腔镜辅助非小细胞肺癌根治术近期疗效配对的病例对照研究. 中国肺癌杂志, 2018, 21(3): 206-211.
- 6. Zhao Y, Jiao W, Ren X, et al. Left lower lobe sleeve lobectomy for lung cancer using the Da Vinci surgical system. J Cardiothorac Surg, 2016, 11(1): 59.
- 7. Kim ER, Lim C, Kim DJ, et al. Robot-assisted cardiac surgery using the da vinci surgical system: a single center experience. Korean J Thorac Cardiovasc Surg, 2015, 48(2): 99-104.
- 8. Miyazaki T, Sakai T, Yamasaki N, et al. Chest tube insertion is one important factor leading to intercostal nerve impairment in thoracic surgery. Gen Thorac Cardiovasc Surg, 2014, 62(1): 58-63.
- 9. Refai M, Brunelli A, Salati M, et al. The impact of chest tube removal on pain and pulmonary function after pulmonary resection. Eur J Cardiothorac Surg, 2012, 41(4): 820-822.
- 10. 刘星池, 许世广, 徐惟, 等. 完全无管化达芬奇机器人纵隔肿瘤切除手术在快速康复外科中应用. 临床军医杂志, 2016, 44(6): 569-570.
- 11. Tang C, Chai X, Kang F, et al. I-gel laryngeal mask airway combined with tracheal intubation attenuate systemic stress response in patients undergoing posterior fossa surgery. Mediators Inflamm, 2015, 2015: 965925.
- 12. Chauhan G, Nayar P, Seth A, et al. Comparison of clinical performance of the I-gel with LMA proseal. J Anaesthesiol Clin Pharmacol, 2013, 29(1): 56-60.
