Subxiphoid two-port robotic vs video-assisted thymic surgery: a single-center propensity-matched analysis of perioperative outcomes.

Robot-assisted thoracoscopic surgery (RATS) has emerged as a new option for treating mediastinal tumors, offering advantages of high precision and minimal invasiveness. This study uses a subxyphoid approach to compare the short-term outcomes of RATS versus video-assisted thoracoscopic surgery (VATS) for anterior mediastinal lesions; additionally, it assesses the short-term outcomes ofsubxyphoid bilateral port placement for these lesions and provides a preliminary evaluation of dual-port robotic assistance in terms of safety and feasibility. A retrospective analysis of patients treated at the Third Affiliated Tumor Hospital of Xinjiang Medical University from May 2020 to May 2025, who had preoperative CT evidence of anterior mediastinal lesions and underwent RATS or VATS. Propensity score matching (PSM) was used, and Love plots were generated to evaluate balance post-matching; perioperative outcomes between groups were compared with Holm correction for multiple testing. Finally, CUSUM/sequential analysis was used to assess the dynamic changes in operative time and intraoperative blood loss. A total of 88 patients were included (VATS 58, RATS 30). After PSM, the RATS group showed advantages in several perioperative outcomes: median operative time significantly shorter (80.0 [60.0, 100.0] minutes vs. 110.0 [90.0, 120.0] minutes, P < 0.001); intraoperative blood loss significantly reduced to 50.0 [20.0, 100.0] mL, compared with 100.0 [100.0, 200.0] mL in the VATS group, P = 0.001; postoperative white blood cell count lower (7.18 ± 1.92 × 10^9/L vs. 13.13 ± 2.69 × 10^9/L, P < 0.001); total drainage decreased to 150.0 [0.0, 200.0] mL, vs. 385.0 [20.5, 500.0] mL in the VATS group, P = 0.001; postoperative length of stay shorter (3.0 [1.0, 4.0] days vs. 5.0 [4.0, 6.0] days, P < 0.001). These results suggest that RATS may be associated with less trauma. For anterior mediastinal tumor resections, the perioperative outcomes of subxiphoid two-port robot-assisted surgery were comparable to VATS in terms of efficacy, with good safety and feasibility.