Application Of Totally No Tube Uniportal Video-assisted Thoracoscopic Technology In Mediastinal Tumor Resection

Background: Totally no tube(TNT)surgery is a novel type of minimally invasive thoracic surgery.However,there has never been a randomized controlled trial(RCT)verifying the performance of TNT surgery in mediastinal tumor resection.The aim of our RCT was to evaluate the feasibility and advantages of TNT surgery in uniportal video-assisted thoracoscopic surgery(VATS)for non-invasive mediastinal tumors.Methods: This single-center randomized trial included patients 18 to 75 years of age with mediastinal tumors.Through random assignment,patients were placed in two groups: the TNT group underwent TNT uniportal VATS mediastinal tumor resection(general anesthesia,laryngeal mask ventilation,no indwelling urinary catheter and thoracic drainage tube)and control group underwent traditional uniportal VATS(general anesthesia,tracheal intubation ventilation,indwelling urinary catheter and thoracic drainage tube).Perioperative details and outcome variables during hospitalization were evaluated for both groups.Results: From April 2018 to August 2019,131 of 165 consecutive patients were eligible for inclusion in the study.There was no perioperative mortality.Postoperative complications,postoperative hospital stay,postoperative VAS(visual analogue scale)pain score and hospitalization expense were less or lower in the TNT group than in the control group(P<0.05).Operative time,blood loss,oxygen saturation,heart rate,and mean arterial pressure during the operation did not differ between groups.Conclusions: These findings demonstrates that TNT uniportal VATS is a feasible surgical procedure to treat non-invasive mediastinal tumors.It has the advantages of less postoperative complications,faster recover and less hospitalization expenses(dollar)compared to traditional uniportal VATS.Trial registry number:Clinical Trials.gov NCT03537430.