Robotic-assisted Thoracoscopic Resection of Anterior Mediastinal Cystic Teratoma: A Case Report and Literature Review

BackgroundMediastinal teratomas are rare tumors that most frequently occur in the anterior mediastinum. The majority of these tumors are benign and slow growing. Due to their low malignant potential, the treatment for these tumors is surgical resection. The surgical management has shifted from invasive approaches such as a sternotomy to minimally invasive ones such as robotic-assisted thoracoscopic resections. Though many cases of mediastinal teratomas have been reported, we present a rare case of a locally advanced mediastinal teratoma requiring patient repositioning and change in ventilatory management mid-procedure to facilitate complete resection.Case PresentationA 43 year-old female was found to have an anterior mediastinal mass during work-up for an intermittent cough in 2009. Chest imaging and biopsy at the time showed evidence of a cystic teratoma without concerning features. She underwent imaging surveillance until 2018, when chest imaging showed increasing growth and worrisome radiologic features concerning for malignant degeneration. She underwent an elective robotic-assisted thoracoscopic resection utilizing double lung ventilation, but due to extensive involvement of the right lung, pericardium, superior vena cava, and right phrenic nerve the patient had to be repositioned and started on single lung ventilation mid-procedure to facilitate a safe and complete resection.ConclusionsAnterior mediastinal teratomas can be successfully removed by robotic-assisted thoracoscopic resections utilizing single lung ventilation. Though robotic-assisted thoracoscopic resection utilizing double lung ventilation can be effective in performing lung wedge resections and pleural biopsies, it is limited in removing locally advanced mediastinal tumors.