Robot-Assisted Thoracoscopic Surgery (RATS) in the Prone Position for a Posterior Mediastinal Tumor

Abstract

Posterior mediastinal tumors are typically addressed using video-assisted thoracoscopic surgery (VATS) or robot-assisted thoracoscopic surgery (RATS), both of which are usually performed with the patient in the lateral decubitus position. However, tumors in confined spaces require optimal surgical visualization and maneuverability. We report the successful resection of a schwannoma located between the thoracic vertebrae and the descending aorta using robot-assisted thoracoscopic surgery in the prone position. A 67-year-old man presented with a left posterior mediastinal tumor located between the sixth and eighth vertebrae and the descending aorta. Due to the tumor's proximity to critical structures, we opted for robot-assisted thoracoscopic surgery in the prone position to enhance visualization and maneuverability in the confined space. Following general anesthesia, the patient was placed in the prone position, and three robotic ports, along with one assist port, were inserted into the left thoracic cavity. The tumor was carefully dissected using robotics, with continuous monitoring of its surface, the aorta, and the intercostal arterial branch. The procedure was completed without complications, and the patient was discharged on postoperative day 4. This case highlights the feasibility and safety of robot-assisted thoracoscopic surgery in the prone position for the resection of posterior mediastinal tumors, particularly those in confined anatomical locations. This approach offers superior visualization and maneuverability, reducing the risk of intercostal artery injury and potential complications related to the Adamkiewicz artery.