Robotic assisted resection of a complex thymoma
Epublication WebSurg.com, Mar 2015;15(03). URL: http://websurg.com/doi/vd01en4466
Our objective is to demonstrate the management of a very complex mediastinal tumor. To do so, a minimally invasive resection is used, highlighting the benefit of a robotic approach. The present case is that of a 64-year-old patient diagnosed with an anterior mediastinal mass discovered during myasthenia assessment with positive antibodies. The tumor was in contact with the aorta, pulmonary artery, and the innominate vein with probable pericardial invasion. Given such a complex localization, the challenge was to propose a radical resection using minimally invasive surgery with robotic assistance. As compared to a VATS approach, a robotic approach provides a better view and instruments to achieve complete resection in complex mediastinal tumor. What is important to first control on the CT-scan is the size of the tumor as compared to the thoracic cavity’s size which will allow robotic surgery with a good operative field. Pericardial resection associated with a lateral plasty of the innominate vein were required to achieved complete R0 resection. The entire resection was performed using a bipolar forceps. The postoperative course was uneventful. The patient is discharged on postopeartive day 3. The phrenic nerve was preserved. Pathological analysis of the operative specimen is evocative of a B1 thymoma classified IIb on the Masaoka staging system with complete R0 resection (margins were clear). The entire file was discussed at the Rhythmic meeting, which is the national meeting for thymoma tumor management held every two weeks. A simple survey was put forward without any adjuvant radiotherapy.