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Published on: April 19, 2024
Perioperative outcomes and surgeon-specific temporal trends in subxiphoid robot-assisted anterior mediastinal
Satoshi Fumimoto1, Kiyoshi Sato1, Shohei Okai1
1Department of Thoracic and Cardiovascular Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan.
Background:
Subxiphoid robot-assisted anterior mediastinal surgery provides a midline operative view of the bilateral phrenic nerves, upper thymic poles, and left brachiocephalic vein, but requires vascular dissection within a narrow retrosternal space. Previous learning-curve studies have mainly evaluated a single surgeon or an institution as a whole. This study descriptively evaluated perioperative outcomes and surgeon-specific temporal trends among three primary console surgeons within a single institutional program using cumulative sum (CUSUM) analysis.
Methods:
We retrospectively reviewed 76 patients who underwent subxiphoid robot-assisted thymectomy or anterior mediastinal tumor resection performed by three board-certified thoracic surgeons as primary console surgeons between April 2019 and June 2026. The institutional indications remained unchanged throughout the study period and excluded tumors with radiological evidence of definite aortic or pulmonary arterial invasion. Operator-specific CUSUM analysis of operative time and console time was performed in 74 patients who completed the procedure robotically.
Results:
Among 76 patients, open conversion occurred in 2 (2.6%): one for extensive intrathoracic adhesions and one after an intraoperative frozen-section diagnosis of thymic carcinoma. Neither was due to uncontrolled bleeding or an intraoperative complication, and no intraoperative complications occurred. Postoperative complications occurred in 7 patients (9.2%), including 5 major complications (6.6%). The 74 robotically completed procedures comprised 22, 27, and 25 cases for Surgeons A, B, and C, respectively. Mean operative and console times were 146.9±51.4 and 85.6±40.4 minutes, respectively. Surgeons A and B had no sustained upward CUSUM trend. Surgeon C reached positive peaks around cases 17 and 20 for operative and console times, respectively, followed by downward trends.
Conclusions:
In this single-center cohort, subxiphoid robot-assisted anterior mediastinal surgery was performed by three thoracic surgeons, including one who entered the program later, without intraoperative complications or temporary console handovers. These findings support the feasibility of transferring the procedure to a later-entering surgeon within an established institutional program.
