A 9 cm robotic thymectomy and pericardial repair case report

Abstract

In the modern surgical era, improved technology has allowed for the increasing use of the robotic platform for thymoma resection. Historically, tumors >5 cm were deemed inappropriate for minimally invasive approaches; thoracic surgeons, however, have become adept with performing increasingly complex thymectomies using minimally invasive techniques. Excision of large thymomas using the robotic platform is no longer considered a rare event, however few publications have described the use of minimally invasive surgery for en bloc excision of the pericardium with mesh reconstruction. We present a case of an asymptomatic, incidentally discovered 9 cm thymoma involving the pericardium and right lung upper lobe that was resected via bilateral robotic-assisted thymectomy en bloc with wedge resection and pericardial resection with mesh reconstruction. The case highlights the use of the robotic platform to avoid a conversion to open thymectomy. The patient was discharged home on postoperative day 3 with minimal pain and narcotic requirement. We aim to contribute to the existing literature supporting the use of the robotic platform during complex thymectomy. The associated video presentation serves as a visual instructional guide for the thymoma resection, en bloc with the right upper lobe and pericardium and the pericardial reconstruction. This minimally invasive technique has been associated with shorter hospital stay, reduced pain and faster recovery.

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

“…Literature is scanty with regards to this and very few cases of big masses have been reported to have been resected via minimally invasive approaches and RATS more specifically. To our knowledge, 9 cm is the biggest mass resected via RATS that has been reported ( 19 ).…”

Robotic resection of large anterior mediastinal masses

“…Our case highlights the feasibility of minimally invasive techniques even with large thymomas invading adjacent structures. Our patient was subsequently discharged home on postoperative day 3 with minimal pain and narcotic requirement due to our enhanced recovery protocol ( 6 ).…”