The robotic approach for mediastinal lesions.

Background: We report here our institutional experience and reflect the relevant literature concerning the robotic approach in diagnostic and therapeutic interventions for mediastinal lesions.

Methods: During August 2001-December 2005, 33 patients (15 males and 18 females aged 18-77 years) with mediastinal masses were operated on minimally invasively using the da Vinci robotic system. There were 22 thymectomies (nine thymomas), four resections of paravertebral neurinomas, one ectopic mediastinal parathyroidectomy, one resection of a lymphangioma, one resection of ectopic goitre, one resection of lymph node metastasis of thyroid carcinoma and three oesophageal procedures (one leiomyoma, one traction diverticulum and one foregut cyst).

Results: There were three (9%) open conversions due to surgical problems, 30 procedures (91%) were completed successfully using the da Vinci robot. There was no surgical mortality, no relevant intraoperative blood loss and no major surgical complication in any of the patients. As a minor complication (3%), an incomplete and transient palsy of the left laryngeal recurrent nerve was observed after resection of a tumour from the aortopulmonary window. The median overall operation time was 134 (range 54-314) min, including 103 (range 39-272) min for the robotic act.

Conclusions: Various different mediastinal procedures have been shown to be feasible and safe when performed with the robot. As the technical benefits of the da Vinci system are most advantageous in tiny and difficult-to-reach anatomical regions, the mediastinum should remain an area of special interest for robotic surgeons. Randomized trials and follow-up studies have been initiated in order to evaluate the clinical impact of the robotic approach.