Robotic-Assisted Resection of a Giant Anterior Mediastinal Lipoma

Mediastinal lipomas are benign, slow-growing masses that can present as large masses due to their insidious onset (1). Symptoms associated with these lipomas are generally due to mass effect, such as dysphagia, shortness of breath, palpitations, and/or chest pain. In most cases, large mediastinal masses are removed via thoracotomy or sternotomy (1, 2).

In this case, a 56-year-old male presented with progressive shortness of breath, chest fullness, and chest wall discomfort with deep inhalation. A computed tomography (CT) angiogram was performed and revealed a large lipomatous mass within the anterior and middle mediastinum measuring 10 cm x 12 cm x 9.3 cm. This mass caused extrinsic pressure on the trachea, esophagus, aortic arch, and arterial branches from the aorta. Given the size of this lesion, it likely would have required a hemi-clamshell thoracotomy; however, a robotic platform was utilized to perform a minimally invasive excision.

The patient was positioned in a supine position with the left side elevated. The ports were placed with the camera in the lateral fifth intercostal space along the inframammary fold, a left-handed port in the fourth intercostal space at the midclavicular line, and a right-handed port in the third intercostal space at the anterior axillary line. Upon entry into the chest, there was no evidence of pleural disease or lymphadenopathy. Based on operative assessment, including a soft texture with no invasion and intraoperative frozen section, the mass was determined to be a likely benign lipoma.

The mass was meticulously dissected, preserving the phrenic and vagus nerves and vascular structures. Due to the encasement of the aortic arch, subclavian artery, and proximity to the phrenic nerve, the mass was taken out in pieces by dissecting along vascular planes. The procedure was well tolerated, and the mass was removed in its entirety. There were no complications, and the patient was discharged home. Final pathology confirmed a benign lipoma. By using robotic technology, the mediastinal lipoma was completely resected, avoiding the need for a hemi-clamshell thoracotomy.

References

1. Khan MA, Patel YB, Nwaezeapu KI, El Nayir MH, Lyons RC, Goraya TY. Mediastinal Lipoma: An Unusual Cause of Progressive Dyspnea. JACC Case Rep. Aug 6 2025;30(22):104426. doi:10.1016/j.jaccas.2025.104426
2. Weng X, Jiang L, Zhou M. Massive anterior mediastinal lipoma causing cardiac arrest in a middle-aged male: a case report and literature review. Future Cardiol. Dec 2023;19(15):747-752. doi:10.2217/fca-2023-0107

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