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Robot-Assisted Resection of a Left Apical Schwannoma

Tuesday, August 12, 2014

A 41-year-old female had an abnormal chest x-ray when assessed for a productive cough. A CT scan showed an apical posterior mass on the left side, and a needle biopsy demonstrated schwannoma. An MRI demonstrated no foraminal invasion. This video demonstrates the robot-assisted resection in this case. The robot is ideally suited for surgery at the thoracic inlet.


Good video but the instrumental movements of the robotic tools look clumsy and inefficient compared to what any experienced VATS surgeon could achieve without robot in this rather routine operation. Would be interesting to discuss when and how the postoperative Horner syndrome could have been avoided.
I agree wholeheartedly with Iglassman. There is no particular advantage to using the robot in this case. One may argue that only the robot could negotiate the difficult angles at the apex. Well, this is basically what all of us have been doing for hyperhidrosis for decades without the robot. From now on, I believe that whenever one of these videos is posted, the author should be obliged to provide the operative time for the procedure....surgeon start time to surgeon end time.
Very nice video, and to the point narration. I disagree with above comments. I think there is an advantage doing it with the robot due to improved precision and visualization. This is especially true considering the proximity of the subclavian vessels and the nerves. I have not done these robotically, but I think the next time I will try!
I have not been a "robot" fanatic by any means but this IS one instance when the robot can help. The dissection around a larger mass in the smaller area of the thoracic apex around multiple structures is facilitated by the degrees of freedom that the robot can offer. I have done these BOTH ways and when you use thorascopic means, you have to push harder with higher risk of uncontrolled bleeding and tumor disruption. When I use the robot, however, I do not use a bipolar instrument as it is a very inefficient dissection tool. If you use the harmonic scalpel in this instance, it will go very fast with minimal to no bleeding. You just have to be careful up near the thoracic inlet. I have resected tumors identical to this and larger even farther into the inlet without Horner's symptoms so it can be quite rewarding

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