Robotic resection of anterior mediastinal masses >10 cm: a case series

Abstract

Background: Robot-assisted thoracic surgery (RATS) for intrathoracic pathology and especially for mediastinal mass resection has been increasingly accepted as an alternative method to open sternotomy and video-assisted thoracic surgery (VATS). However, the utilization of this approach for complex and advanced in size cases needs more clinical evidence. We are presenting a series of 4 patients who had resection of >10 cm mediastinal masses via RATS.

Cases description: The mean age was 76.25±10.3 years and 3 were males (75%). All masses were positron emission tomography (PET) positive, and 1 patient had positive Acetyl-cholinesterase antibodies and myasthenia gravis (MG). All patients underwent RATS resection via DaVinci^® X system. The dissections were conducted with spatula and/or Maryland bipolar forceps. In 2 cases, the resection was done with bilateral docking, and in 1 case, a drain was not inserted at the end. In 1 patient, pericardial resection was necessitated. All masses were thymomas with 1 dimension measured >10 cm on pathology. All patients were discharged on day 1 or 2 postoperatively with uneventful recoveries. There was no in-hospital, 30- or 90-day mortality. All patients were found to be without issues on follow-up.

Conclusions: This report shows that RATS is safe and can be offered in the management of >10 cm anterior mediastinal masses. The previous size limit of the tumor for minimally invasive and especially RATS approach of 5 cm should be challenged.

Keywords: Robotic; case series; thymectomy; thymoma.

Figure 1

PET imaging of patients undergoing surgery. (A) PET scan from patient with a mass measuring 102×63×76 showing a partial cystic photopenic component and a solid lateral PET positive component. (B) PET scan from patient with a mass measuring 130×101×57 and which was homogenously PET positive. PET, positron emission tomography.

Figure 2

CT scans from the same patients showing the masses in the anterior mediastinum. (A) The mass is depicted to be cystic with a lateral solid part. (B) The mass is multilobulated and was considered to be involving the pericardium. CT, computed tomography.

Figure 3

Pictures taken during surgery. (A) 15 cm anterior mediastinal mass. (B) Mass is pushed superiorly, the pericardium has been opened and lesions are found to be infiltrating through the pericardium.

Figure 4

Pictures taken from the resection of 15 cm anterior mediastinal mass. (A) The 12 mm port was elongated up to 4 cm in order to facilitate the removal of the mass and this was used in all cases up to an extend. (B) One of the masses measured bigger than anticipated from imaging i.e., 15 cm in this case.