Bronchogenic cysts are congenital malformations resulting from abnormal budding of the tracheal diverticulum. They are lined with respiratory epithelium and often contain fluid or mucus. Patients present with compression symptoms, chronic infection, or malignant degeneration and resection is recommended.
We present a 50-year-old male with chest pain and prolonged upper respiratory tract infections. Contrasted computed tomography of the chest demonstrated a subcarinal cystic structure in the mediastinum. Endobronchial ultrasound with aspiration was consistent with cystic contents. The patient was scheduled for robotic-assisted resection of mediastinal cyst. He was placed in right lateral position with a double lumen endotracheal tube. The right lung was isolated and four robotic ports and one assistant port were placed in the right chest. The robot was docked. The right lung was retracted anteriorly. The posterior mediastinum was opened and station seven lymph nodes were removed. Dissection continued in the subcarinal space and the bronchogenic cyst was identified. It was densely adherent to adjacent mediastinal structures. During dissection, the cyst was entered and copious amounts of mucus was suctioned. The cyst cavity was dissected from the underlying pulmonary artery bifurcation. It was amputated and removed from the chest in a bag. A drain was placed in the posterior mediastinum and removed postoperative day 1 and the patient was discharged on day 2. Final pathology showed benign subcarinal lymph nodes and a 4.5 cm bronchogenic cyst.
The robot is an excellent platform for resection of a posterior mediastinal bronchogenic cyst owing to excellent visualization and surgical access.