TITLE:
Robotic Surgery of the Mediastinum: A Review
AUTHORS:
Farid Gharagozloo
KEYWORDS:
Mediastinum, Robotic Surgery, Anterior Mediastinal Mass, Posterior Mediastinal Mass
JOURNAL NAME:
World Journal of Cardiovascular Surgery,
Vol.12 No.3,
March
18,
2022
ABSTRACT: Background: The mediastinum is a complex anatomical region which
contains many vital structures. Many aspects of
mediastinal surgery, like that for other anatomic regions, have evolved from a maximally invasive approach involving a median
sternotomy, anterior mediastinotomy, mediastinoscopy or thoracotomy, to a minimally invasive video-assisted approach. Robotic surgery is presently the most advanced form of minimally invasive surgery. Methods: We reviewed our experience with a robotic approach to mediastinal pathology. In
addition, an extensive search was conducted using PubMed, in order to extract
references for the application of robotics to surgical conditions of the mediastinum. Results: The first
robotic procedure by our group was a mediastinal procedure in 2003. In
the past eighteen years, 203 patients have undergone robotic surgery for
mediastinal pathology. There
were 119 procedures for the Anterior
Mediastinum, 33 procedures for the Middle Mediastinum, and 51 procedures for the Posterior Mediastinum.
78 patients underwent robotic thymectomy using a left-sided approach. 43/78 (55%) patients underwent
radical thymectomy for Myasthenia Gravis. Thymoma was
histologically identified in 32% of
patients with Myasthenia Gravis. In patients
with thymoma, there was no tumor recurrence. In patients with Myasthenia Gravis, the overall
improvement rate after robotic radical
complete thymectomy was 91% (39/43). Following robotic surgery for the mediastinal disease, the median hospitalization was 3 days, major complications
occurred in 0.9% of patients and there was no mortality. Conclusion: With the advent of robotic surgery, many of the current surgical approaches to diseases of
the mediastinum will likely be replaced over time by robotic surgery. When
applied to the mediastinum, robotics has a
number of benefits when compared to conventional Video-Assisted Thoracic Surgery (VATS) including three-dimensional visualization,
magnification of the operative field,
precise instrument movement, and improved dexterity. Much of the mediastinal disease encountered in an adult is
benign, making it especially suited to a minimally invasive approach. With the use of the robot, a complete
anatomical and oncological procedure can be performed through a number of small incisions or ports, while at the
same time providing the patient with
minimally invasive benefits including shorter hospitalizations, quicker returns
to preoperative activity, less pain, less inflammatory response and better cosmesis. The excellent range of motion of the
robotic instruments makes them particularly
suitable to maneuver around the vital structures and the rigid axial skeleton encountered in various
compartments of the mediastinum,
and for reaching those “distant” areas of the mediastinum that are difficult to explore and dissect with conventional Video-Assisted
Thoracic Surgery (VATS).