Single Incision Robotic Surgery Via Axillary Approach For Lung, Mediastinal And Thyroid Tumor
Ishikawa Norihiko, Yumiko Ohtake, Go Watanabe.
NewHeart Watanabe Institute, Tokyo, Japan.
OBJECTIVE: The objective of this case report is to describe the simultaneous endoscopic resection for 3 lesions of lung, mediastinum and thyroid tumors, performed through gasless axillar approach with the use of the da Vinci surgical system.
METHODS: A 66-year-old woman was referred to our institute for increase tumor of the thyroid and a neck and chest CT scan revealed a right thyroid mass (41 mm), anterior mediastinal mass (12 mm), and ground-glass nodule in the right upper lobe of the lung (13 mm). Because of persisting symptoms, increasing thyroid mass and possibility of the lung cancer, excision of the tumors was proposed. Surgical procedure: A 6-cm vertical skin incision was made on the right axilla and a mini-thoracotomy was made in the 3rd intercostal space, and the additional port was made in the 5th intercostal space. VTAS partial resection of the right upper lobe of the lung was performed first. Then, the robotic camera and the left robotic arm were introduced through the mini-thoracotomy, and the right robotic arm was introduced from the port. The mediastinal tumor was then excised circumferentially using robotic instruments. After resection of the lung and mediastinum tumor, the da Vinci was undocked and a subcutaneous tunnel from the axillar incision to the thyroid was made using flap dissection technique. The da Vinci was re-introduced and the robotic camera and the left robotic arm were inserted through the axillary incision, and the right robotic arm was inserted through the incision of the port. A long camera port was used and elevated the skin flap to maintain adequate working space during maneuver in the neck, and the thyroid tumor was resected robotically.
RESULTS: Total operating time was 277 minutes, and postoperative course was uneventful. The histopathological examination of the lung, mediastinal and thyroid tumor were adenocarcinoma, thymolipoma and adenomatous goiter, respectively.
CONCLUSIONS: Single incision robotic surgery for three lesions was achieved safely with good clinical results and excellent cosmetic results.
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