Robotic Mediastinal Procedures

Mediastinal procedures were traditionally performed with sternotomy, thoracotomy, and clamshell incisions requiring long hospital stays and recovery time. Since the advent of video-assisted thoracoscopic surgery, minimally invasive techniques have been developed for mediastinal procedures. Robotic surgery has added another dimension to the surgeon’s ability to perform dissection in the mediastinum. Robotics provides the surgeon advantages in the mediastinum due to the increased ability to visualize vital structures, as well as instrumentation providing improved dexterity to dissect in tight spaces. Mediastinal procedures can be differentiated into three anatomical locations, which include the anterior, middle, and posterior mediastinum. Anterior mediastinal masses include thymus/thymoma, germ cell tumors, thyroid, and ectopic parathyroid. Approach to robotic anterior mediastinal mass excision with thymectomy as an example is discussed. Middle mediastinal masses include lymph nodes, congenital bronchogenic cysts, pericardial cysts, and on rare occasion, solid tumors such as ectopic thyroid or parathyroid glands. Approach to robotic middle mediastinal cyst as an example is explored. Posterior mediastinal masses include cystic masses of foregut origin or solid tumors of neurogenic origin. Approach to robotic posterior mediastinal masses with Schwannoma excision as an example is examined.