A rare case of posterior mediastinal myelolipoma resected using robot-assisted thoracic surgery.

Introduction: Myelolipomas are rare tumors containing adipose tissue and normal hematopoietic cells that mainly occur in the adrenal cortex. Mediastinal myelolipomas are extremely rare. The three-dimensional, high-definition view with up to 10 times image magnification, 7 degrees of freedom of surgical instruments, and filtration of physiologic hand tremors with robotic systems are ideal for removing mediastinal tumors in a small space. Herein, we report a case of posterior mediastinal myelolipoma treated using robotic resection.

Case Presentation: A 72-year-old man with an abnormal shadow on a chest roentgenogram was referred to our hospital. Computed tomography revealed extrapulmonary paravertebral lesions in the right posterior mediastinum. Despite the tumor's fragility, complete resection was achieved with robot-assisted thoracic surgery while preserving the lesion integrity. The tumor was diagnosed as a myelolipoma using histopathology of the resected section, and the patient was discharged with no complications on the fifth postoperative day.

Clinical Discussion: Mediastinal myelolipomas are fragile tumors with a thin capsule, consisting of adipose tissue and normal hematopoietic cells. Robot-assisted thoracic surgery is particularly effective for resecting posterior mediastinal tumors like myelolipomas that contain adipose components.

Conclusions: With delicate manipulation, robot-assisted thoracic surgery can be used to safely and completely resect fragile posterior mediastinal tumors, including myelolipomas.