Robotic approach to a subcarinal functional paraganglioma

Rare and complicated functional posterior mediastinal paraganglioma

“…This required partial left atrial resection and CPB, and so we converted to an open surgery. Marthy et al reported converting from RAT to open surgery with CPB for similar reasons as well 2. In 22%–30% of patients with posterior mediastinal tumours, conversion to open surgery has been reported as a necessary technical step to overcome challenges such as difficult anatomical locations 8.…”

“…However, the involvement of major blood vessels and invasion into surrounding structures can complicate resection. Varying approaches for safe resection such as MRI for assessment of cardiac involvement,7 preoperative embolisation for minimising intro-operative bleeding,4 5 robotic resection for minimal tumour manipulation2 8 and median sternotomy for complicated/cardiac-origin tumours have been proposed 3 7. Based on these reports, preoperative imaging and complexity of our patient’s tumour, a multidisciplinary approach involving alpha/beta blockade and preoperative embolisation followed by minimally invasive robotic-assisted resection was planned.…”

“…While most prior case reports have used an open resection, RAT provides flexible endo-wrist instruments, allowing for intuitive movements with minimal tumour/nerve manipulation 8. Additionally, a thoracoscopy provides ideal access to the subcarinal area,2 and open surgery is associated with longer hospital stays and higher morbidity and mortality 8…”

“…Moreover, only a few cases to date have used robotic-assisted thoracoscopy (RAT) for the resection of posterior mediastinal masses. These cases, however, were non-functional PGs6 or did not report major blood vessel involvement 2. We report a unique case of a patient with a functional, subcarinal PG with arterial supply from large branches of the right coronary artery (RCA) and bronchial arteries, and mass effect on the left atrium.…”

“…PGs account for 0.3% of mediastinal tumours 1. Functional PGs, that is, catecholamine-secreting PGs, are even more rare with only approximately 50 reported cases in literature 2. Patients with functional PGs present with hypertension, diaphoresis, palpitations and/or headaches with elevated levels of norepinephrine and normetanephrine 3.…”