Comparison of Open Thoracotomy, Video-Assisted Thoracoscopic Surgery, and Robot-Assisted Thoracoscopic Surgery for Resection of Mediastinal Tumors in Pediatric Patients

This study aims to compare the clinical outcomes of robot-assisted thoracoscopic surgery (RATS), traditional video-assisted thoracoscopic surgery (VATS), and open thoracotomy (OT) in children with mediastinal tumors, while also evaluating the technical advantages associated with RATS. This study conducted a retrospective analysis of clinical data from 184 pediatric patients who underwent surgery for mediastinal tumors at our center between December 2014 and January 2025. Baseline characteristics, surgical technical parameters and perioperative outcomes were compared among the three groups.184 patients were identified, all surgeries were completed successfully, with no recorded perioperative deaths. There were no significant differences in baseline characteristics. The length of hospital stay for minimally invasive group was significantly shorter than for OT group. The intraoperative blood loss in minimally invasive group was significantly less than in OT group. Total hospital charges for RATS were significantly higher than for VATS and OT groups. Mean usage of diclofenac sodium suppositories for postoperative analgesia was lowest in RATS group, significantly lower than that in other groups. Multivariate analysis indicated significant influences on hospital stay, including operative time, blood transfusion, chest tube duration, age, and surgical approach. RATS demonstrates superior perioperative outcomes compared to VATS and OT in the management of mediastinal tumors in pediatric patients. Key advantages include shorter chest drainage time and length of hospital stay, lower rates of postoperative complications and postoperative pain. However, RATS is associated with higher treatment costs.