Uniportal Endoscopic Resection Of A Lv Lipoma
Moritz C. Wyler von Ballmoos1, Qasim Al Abri2.
1University Hospital Zurich & University of Zurich, Zurich, Switzerland, 2Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.
Case description: A 55-year-old patient had an incidental finding of a leftventricular mass on a screening CT scan that was performed with IV contrast. Inthe year prior, she underwent radical mastectomy bilaterally for breast cancer,and a complex reconstruction with bilateral TRAM flaps and large volumesilicone implants (Figure 1). Further workup of the LV mass by TEE and CMRconfirmed a mobile, lobulated lipoma of approximately 1.5cm x 1cm in the leftventricle underneath the mitral valve. Given the size and mobility of the lipoma,the concern for possible thromboembolic events, resection was offered to thepatient who wanted to proceed with resection.Surgical technique: A standard sternotomy would have been the simplestapproach to resect the tumor. However, the patient expressed a strong desire fora less invasive, sternal-sparing approach. Given the bilateral TRAM flaps andlarge breast implant occupying most of the anterolateral chest wall, there waslimited space available to plan the access. 3-dimensional reconstructions of thecardiac CT scan were used to determine an access site away from the implantsand the right internal thoracic artery with the intent to proceed with a endoscopicresection of the LV lipoma. Percutaneous femoral arterial and venouscannulation was used for cardiopulmonary bypass. Using the endoscope, theaorta was opened after clamping the aorta and arresting the heart with del Nidocardioplegia. The endoscope was inserted into the LV and the lipoma wasidentified and completely resected. The aortotomy was then closed in a standardfashion, the heart deaired and the patient was weaned from CPB. The femoralarterial cannulation was closed with a MANTA device.Outcome: The patient was discharged home on postoperative day 2. Finalpathology confirmed a lipoma.Discussion: This presentation & video details CCTA planning for the mostsuitable approach and incision mapping given anatomic constraints as well asthe exact steps of performing an endoscopic cardiac surgery procedure througha single incision.
Figure 1. CT imaging demonstrating extent of large breast implants limitingaccess to the thorax anteriorly and laterally. 
Back to 2023 Abstracts