Biportal robotic surgery for anterior mediastinal mass

Jeong In Hong, Jun Hee Lee, Hyun Koo Kim

Research output: Contribution to journalArticlepeer-review


Background: Robotic-assisted surgery for mediastinal disease has been shown to be beneficial in facilitating easier mediastinal dissection with its three-dimensional views and multi-articulated moving instruments. Herein, we report our experience with the biportal approach of robot-assisted anterior mediastinal mass surgery, including both lateral transthoracic and subxiphoid approaches. Methods: We retrospectively analyzed 21 patients who underwent biportal robotic-assisted anterior mediastinal mass resection, without considering the tumor size between May 2018 and September 2022. We reviewed the technical advantages and limitations of the biportal approach and the perioperative outcomes, including operative time, conversion to multiport or open surgery, duration of chest drainage, and postoperative complications, to define the role of robot-assisted surgery using the biportal approach. Results: We approached the thoracic cavity from the right side in five patients, from the left side in three patients, and from the subxiphoid in 13 patients. Thymomas (n=13) and thymic cysts (n=3) were the most common diagnoses. The median operative time was 165 min [interquartile range (IQR), 140–196 min]. There were no conversions to multiport or open surgery. The chest drain was removed at a median of two days (IQR, 1–3 days), and the patients were discharged at a median of four days (IQR, 3–5 days). Perioperative complications were reported in two patients (one with prolonged air leak and one with vocal cord palsy). There were no cases of readmission or delayed complication. Conclusions: The biportal approach for robot-assisted surgery in anterior mediastinal masses is a feasible and safe alternative for treating associated pathologies. The subxiphoid approach for mediastinal surgery provides a better surgical view than the transthoracic approach. The biportal approach also enables the use of robotic staplers and energy devices and minimizes instrumental interference compared to that in the single-port approach.

Original languageEnglish
Pages (from-to)110-116
Number of pages7
JournalAnnals of Cardiothoracic Surgery
Issue number2
Publication statusPublished - 2023
Externally publishedYes

Bibliographical note

Funding Information:
Funding: This research was supported by Nano·Material Technology Development Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science and ICT (No. 2021M3H4A4079630), the Korea Medical Device Development Fund grant funded by the Korean government (the Ministry of Science and ICT, Ministry of Trade, Industry and Energy, Ministry of Health & Welfare, Ministry of Food and Drug Safety) (project No. 1711138151, KMDF_PR_20200901_0094_02), and the National Research Foundation of Korea funded by the Ministry of Education, Science, and Technology (No. NRF-2018R1D1A1B07048721).

Publisher Copyright:
© Annals of Cardiothoracic Surgery. All rights reserved.


  • Mediastinal disease
  • minimally invasive surgery
  • robot-assisted surgery

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine


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