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Objective: Neurogenic superior sulcus tumors are rare. Historically there have been multiple surgical approaches that have been dictated by the location of the tumor and its relation to the contiguous structures such as the vertebral bodies, subclavian vessels, and chest wall. Resection is hampered by difficulties with visualization and access within a narrow working space. The shortcomings associated with the traditional surgical approaches create a potential of injury to nearby structures. We present a case of patient with a superior sulcus neurogenic tumor impinging on the left subclavian vein.
Methods: The patient is a 43 year old woman presenting with a 3cm mildly enlarging superior sulcus mass, along with vague symptoms of left arm numbness and fullness. Robotic surgical resection was planned with goals of avoiding a large incision, dissecting the tumor carefully away from neurovascular structures, and minimizing the risk for Horner’s syndrome.
Results: The patient underwent a resection without injury to nearby structures. We found that a robotic thoracoscopic approach improved visualization of the tumor and nearby structures and increased instrument maneuverability relative to an open approach. Pathology found that this was a benign schwannoma arising from the second thoracic sympathetic ganglion. The patient was discharged on postoperative day 3 after her chest tube drainage was minimal. She had no major complications on 1 month follow up.
Conclusions: This experience suggests that robotics provides a promising alternative for excision of superior sulcus neurogenic tumors that may reduce associated morbidity.