Comparison between robot- and video-assisted thoracoscopic surgeries for anterior mediastinal lesions

Abstract OBJECTIVES Video-assisted thoracic surgery (VATS) and robot-assisted thoracic surgery (RATS) are widely used in the treatment of anterior mediastinal lesions. However, recent reports comparing the efficacy of VATS and RATS remain unclear, owing to limitations, including territorial constraints, small sample sizes or lack of subgroup analysis. Thus, we conducted a multi-centre retrospective study to compare perioperative outcomes of VATS and RATS via lateral thoracic or subxiphoid approach for anterior mediastinal lesions. METHODS Patients with anterior mediastinal lesions from 3 high-volume Chinese centres were included. VATS and RATS via lateral thoracic or subxiphoid approaches were performed. A propensity score-matching analysis was conducted with covariates including sex, smoking, alcohol, hypertension, diabetes, myasthenia gravis symptoms, lesion diameter, pathology and blood test results. RESULTS A total of 1076 patients (954 VATS, 122 RATS) were included. For the lateral thoracic approach, 122 VATS and 62 RATS patients were matched. RATS resulted in shorter catheter retention (P < 0.001), shorter postoperative stays (P = 0.002) and lower complication rates (P < 0.001), with no conversions or re-surgeries. For the subxiphoid approach, 98 VATS and 52 RATS patients were matched. RATS demonstrated higher drainage volume (P < 0.001), longer catheter retention (P = 0.03) and greater albumin reduction (P < 0.001), with no conversions or re-surgeries. CONCLUSION Using the lateral thoracic approach, RATS offered shorter catheter retention, shorter postoperative stays and fewer complications. However, with the subxiphoid approach, RATS led to higher drainage volume and longer catheter retention. Our study indicates that surgical approach impacts outcomes, with RATS being more beneficial for lateral thoracic cases and VATS for subxiphoid cases.