Robotic resection of mediastinal tumors: surgical approach and procedure.

Background: Mediastinal tumors (MTs) develop in various sites within the thoracic cavity, and the robotic surgical approach for MTs varies depending on the tumor location. This study aimed to assess the optimal approach for robotic surgery for MTs.

Methods: From April 2012 to May 2023, 141 cases of MTs removed by robotic surgery were noted. Of these, 130 cases, excluding those with combined lung resection, combined chest wall resection, and biopsy, were investigated for the MT location, surgical approach, operative time, and console time.

Results: Of the participants, 61 were male and 69 were female, with a median age of 60 (16-85) years and a median tumor diameter of 23 (2.5-150) mm. Additionally, 5 upper MTs, 99 anterior MTs, 22 middle MTs, and 4 posterior MTs were observed. The median operative and console time was 146 (38-371) and 76 (14-239) min, respectively. All cases, except for one case of the upper and middle MTs, were operated in the lateral position via a lateral approach. Of the 99 anterior MTs, 87, 9, and 3 were operated via lateral approach, subxiphoid approach, and single incision, respectively. Of the 87 patients who underwent the lateral approach, 78 and 12 underwent surgery in the 30° lateral decubitus position and lateral positions, respectively.

Conclusions: Standardizing the robotic surgery approach for MTs on the basis of tumor location enhances procedural safety and feasibility.