Ten-year experience of mediastinal robotic surgery in a single referral centre.
OBJECTIVE
The aim of this study was to report a single referral centre experience in the exeresis of mediastinal lesions with robotic surgical system. The outcomes of all patients were retrospectively investigated with special regard to myasthenic and thymomatous patients.


METHODS
From February 2001 to December 2010, 69 patients (30 males, 39 females), with a mean age of 55.4 years (range 20-81), underwent robotic surgery for treatment of mediastinal lesions. There were 39 thymectomies, 13 paravertebral neurogenic tumour removals, 9 pleuropericardial cyst removals, 3 teratoma excisions, 4 lymphonodal removals and 1 enterogenous cyst excision. Operative time, conversion rate, morbidity and mortality were analysed.


RESULTS
There were no intra-operative complications, and no mortality. The mean operative time was 124.3 min (range 45-240). Conversion to open surgery occurred in three cases (4.3%). All post-operative complications (7.2%) were conservatively treated. The mean post-operative stay was 4.3 days (range 3-10). For the myasthenic patients (mean follow-up of 18 months), the Myasthenia Gravis Foundation of America change in status resulted improved in 18 (90%) patients and unchanged in 2 (10%) patients. In cases of thymoma, the pathological analysis revealed Masaoka stage I (seven cases), IIA (three cases), IIB (two cases) and III (one case). No disease recurrence occurred at a mean follow-up of 16 months.


CONCLUSIONS
Our experience suggests that the surgical system was safe in performing mediastinal mass resection, with low morbidity and conversion rate. The robotic system proved useful, especially in a tiny space such as the mediastinum, and appeared to be an effective treatment for myasthenia gravis and for early-stage thymoma.
Division of Thoracic Surgery, Department of Cardiac Thoracic and Vascular Surgery,  University of Pisa, Pisa,  Italy.
Franca
F
Melfi
Olivia
O
Fanucchi
Federico
F
Davini
Andrea
A
Viti
Marco
M
Lucchi
Marcello Carlo
MC
Ambrogi
Alfredo
A
Mussi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008477:Mediastinal Diseases / Q000601:surgery*; D008479:Mediastinal Neoplasms / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009157:Myasthenia Gravis / Q000601:surgery; D009367:Neoplasm Staging; D057234:Preoperative Period; D012371:Robotics / Q000379:methods*; D013934:Thymectomy / Q000379:methods; D013945:Thymoma / Q000601:surgery; D013953:Thymus Neoplasms / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult