Robotic Resection of Superior Mediastinal Mass

Alison F. Ward, MD; Keiji Drysdale; Michael Zervos, MD

Product Details
Product ID: ACS-5815
Year Produced: 2019
Length: 5 min.


In this case we describe resection of a superior mediastinal mass using a robotic technique. Traditionally this mass would be approached via a sternotomy or "trap door" incision. Our approach allows for excellent visualization while remaining safe and effective. The patient is a 41-year-old male with a history of papillary thyroid cancer status post total thyroidectomy with central neck dissection, bilateral selective neck dissection, and tracheostomy. He underwent a CT chest 2 months postoperatively demonstrating a residual 3.6 x 2.1cm mass between the left subclavian and left common carotid arteries. Because of his radioactive iodine treatment he was unable to undergo CT angiography of the chest; an immersive virtual reality model was used to delineate the anatomy. Using this preoperative imaging as a guide, the patient underwent robotic resection of this superior mediastinal mass. Four robotic ports were placed in the 7th intercostal space and an additional assistant port in the 10th intercostal space. The left lung was retracted inferiorly and mass was visualized between the left subclavian and left common carotid arteries. Using blunt and bipolar dissection the mass was carefully dissected off of these vessels and removed. A chest tube was placed through the assistant port and the left lung was re-expanded. The patient was extubated in the operating room and his tracheostomy was replaced. On postoperative day 1 his chest tube was removed; post-operative day 2 he was discharged home. Final pathology revealed metastatic papillary thyroid carcinoma to a lymph node with extranodal extension.