International Society For Minimally Invasive Cardiothoracic Surgery

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Robotic-assisted Resection Of Rib Tumors With Preservation Of Chest Wall Muscles
Hiroko Nakahama, MD, Wickii T. Vigneswaran, MD, MBA.
Loyola University Health System, Maywood, IL, USA.

OBJECTIVE: Robotic-assisted surgery has not been well described in resection of chest wall tumors. We present a case of a 68-year-old female with large fibrous dysplasia tumors of the ribs that were resected using the robot while preserving the chest wall muscles.
METHODS: A 68-year-old female with fibrous dysplasia of the right 3rd and 10th ribs that demonstrated interval increase in size on serial CT scan, was presented for surgical resection. On the CT scan the tumors were located laterally on the 3rd rib (7 x 6 cm) and the 10th rib (4 x 2.6 cm). The patient underwent Da Vinci robotic resection using the three arms including the camera, and a utility port. En-bloc resection of the rib tumors were performed while preserving the chest wall muscles. The ribs were divided using rib shear through the inferior utility port. The resected large mass was placed in an endo-bag. Then, using a 3 cm skin incision over the 10th rib, the second lesion was resected, dividing the ribs on both ends through the incision. This specimen was removed first, through that same incision. The large tumor was then extracted through the incision in endo-bag. Intercostal and incisional sites were infiltrated with liposomal bupivacaine.
RESULTS: The resected tumor measured 9 cm and 5 cm respectively, at their greatest dimension. The largest incision was 3 cm in the lower thoracic area. The patient recovered well following the operation and was discharged home the following day. The pathology confirmed fibrous dysplasia of both lesions with increased cellularity resembling giant cell reparative granuloma. At follow-up, the patient remained well with no disability.
CONCLUSIONS: Robotic-assisted surgery is an alternative method for thoracotomy or video assisted thoracospcopic approach for resection of chest wall tumors. The maneuverability of the instrument in the robotic approach and magnification facilitates dissection and resection of rib tumor while preserving muscles. Approach from inside the chest cavity allows resection of tumor that is behind the scapula with ease. smaller incisions and preservation of chest wall muscles cause rapid recovery and minimal disability to patient.

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