Robotic Video Assisted Thoracoscopy – Minimally Invasive Approach for Management of Mediastinal Tumors

Pejman Radkani, MD, Devendra Joshi, MD, Tushar Barot, MD, MPH, Roy Williams, MD. Mount Sinai Medical Center

INTRODUCTION: Tumors of the mediastinum represent a wide range of pathologic processes. Inspite of difficult anatomic access, surgical resection remains the best diagnostic and therapeutic approach in the management of these rare tumors. Video assisted thoracoscopy (VATS) has been developed as an alternative to open procedures but its widespread acceptance is restricted by the limiting nature of instruments and suboptimal visualization. Robotic assisted minimally invasive surgery seems to hold most promise in remote, narrow anatomical regions such as the mediastinum. We present a single surgeon’s experience with robotic assisted video-thoracoscopy (RVATS) for the resection of mediastinal tumor over a period of 4 years.

METHODS: A prospective database of patients undergoing RVATS between years 2009 – 2013 for the management of mediastinal tumors was maintained. After obtaining approval from Institutional Review Board (IRB) at Mount Sinai Medical center, a retrospective review of the data was conducted. Age, gender, co-morbidities, length of surgery, estimated blood loss (EBL), length of ICU and hospital stay, early and late post-operative complications, conversion to open technique, tumor recurrence rate, and follow up were reviewed. SPSS software was used for statistical analysis.

RESULTS: Forty-eight patients underwent robotic assisted thoracosopic resection of mediastinal tumor which included 22 females (45.8%) and 26 males (54.2%). The mean age of patients was 54.19 years. One procedure (2.1%) was converted to open secondary to locally invasive nature of tumor, the rest of the procedures were completed using robotic assisted thoracoscopy as planned. The most common location of the tumor was anterior mediastinum (69.4%).The most common pathologic diagnosis was thymoma (16.7%). The size of the mass ranged from 0.6 cm to 12.5 cm in greatest dimension (mean – 5.16 cm). The mean duration of procedure was 127.96 minutes (60 – 240 minutes). Average blood loss was 45.94ml (5 – 500 ml). The mean hospital stay was 3.73 days. Five patients (10.4%) had early postoperative complications including chylothorax (1 patient), new onset atrial fibrillation (1 patient), pleural effusion (1 patient) empyema (1 patient) and bleeding (1 patient). Mean follow up time was 186 days (10 – 1300 days). Two patients (4%) with invasive thymoma developed local recurrence.

CONCLUSION: The present study documents the feasibility of RVATS in the management of mediastinal tumors irrespective of the location in various mediastinal compartments. The role for careful and complete excision of the tumor, and surveillance afterward on invasive thymoma was noted in our study, as in literature.

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