Chest wall resection with robotic-assisted thoracoscopic surgery for a Pancoast tumour: a case report.

We describe a rare procedure involving near-total robotic-assisted thoracoscopic surgery resection of a right posterior Pancoast tumour. Four ports and an assistant port were used. The DaVinci X system was used. The lobectomy was performed first to allow for adequate exposure to the apex and spine. The lateral aspect of ribs 1 to 4 was resected next, and the extrathoracic space was entered. Dissection proceeded through this space superiorly up to the level of the scapula and then posteriorly towards the spine. The second to the fifth ribs were dissected off the chest wall and resected medially off the spine at the rib heads. Further postero-superior exploration revealed the tumour to be invading the transverse process of the second rib, with ill-defined margins. Because of this development, and with the support of the spinal surgeons, a small high posterior thoracotomy was performed to complete the procedure and remove the specimen en bloc. The postoperative recovery was uneventful, and the patient was discharged on post-operative day 5. The final histological report confirmed a squamous non-small-cell lung cancer (pT3N0M0) with negative margins (R0). Asymptomatic recurrence was noted near the margin of the second rib resection posteriorly 1 year postoperatively and was successfully treated with radiotherapy.

Robotic left intrapericardial upper lobectomy, pericardial reconstruction and diaphragmatic plication.

Primary mediastinal malignant germ cell tumours are rare, comprising only 1-4% of mediastinal tumours, of which 50-70% are non-seminomatous germ cell tumours. Non-seminomatous germ cell tumours typically demonstrate an excellent response to cisplatin-based chemotherapy. However, in some cases, tumours may persistently enlarge despite normal tumour markers following chemotherapy, leading to a rare condition known as growing teratoma syndrome. This poses a significant challenge for thoracic surgeons, especially when associated with infiltration of neighbouring pulmonary structures. Robot-assisted thoracoscopic surgery is not commonly employed in the resection of large mediastinal tumours. We present a case showcasing the robotic approach to complete resection of a sizeable mediastinal tumour originating from the left/main pulmonary artery, en bloc with a left upper lobectomy, pericardial resection, and reconstruction and diaphragmatic plication.

Robotic intrapericardial bilobectomy with stapler on the atrium and pericardial reconstruction.

Few intrapericardial robotic lung resection cases have been reported in the literature because of the perceived complexity of the procedure, with most surgeons embarking on an open resection via a thoracotomy. We present the case of a right middle and lower lobe tumour involving the pericardium and the origin of the right middle lobe vein. An intrapericardial lower bilobectomy was performed, with pericardial resection, pre-pericardial fat resection and mesh reconstruction. The vascular stapler for the right middle lobe vein was fired on the atrium. The resection was completed via a retrograde and fissureless approach, dividing the bronchus intermedius first, because it was impossible to open the fissure, leaving the division of the pulmonary artery until last. The case was performed solely robotically, with no complications and excellent postoperative recovery. Robotic resection can be performed successfully when pericardial lung tumours are involved.