Comparison of open, thoracoscopic, and robotic approaches for pediatric mediastinal tumor resection

This study compared perioperative outcomes among robot-assisted thoracoscopic surgery (RATS), video-assisted thoracoscopic surgery (VATS), and open thoracotomy (OT) in pediatric patients with mediastinal tumors, and evaluated the technical advantages and economic implications of RATS. Clinical data of 184 children who underwent mediastinal tumor resection at our institution between December 2014 and January 2025 were retrospectively analyzed. Baseline characteristics, operative parameters, and perioperative outcomes were compared across the three surgical approaches. Multivariate regression was performed to identify independent predictors of postoperative hospital stay. All procedures were completed successfully, with no perioperative mortality. Baseline demographics were comparable among the groups. Both RATS and VATS resulted in significantly shorter chest drainage duration and hospital stay than OT. Intraoperative blood loss was lower in minimally invasive groups, with the least blood loss and postoperative analgesic requirement observed in the RATS. The RATS group, however, incurred the highest total hospitalization costs, reflecting robotic system and disposable instrument expenses. Multivariate analysis identified chest drainage duration and surgical approach as significant predictors of hospital stay. Longer operative duration was modestly associated with postoperative complications, while older age predicted ICU admission. RATS was associated with superior short‑term perioperative outcomes, including reduced blood loss, shorter drainage duration and hospitalization, and lower postoperative analgesic use, compared with VATS and OT in children with mediastinal tumors. Despite these advantages, the higher procedural costs remain a key limitation. RATS represents a promising minimally invasive alternative for appropriately selected pediatric patients, warranting further validation through multicenter prospective studies.