Robotic resection of posterior mediastinal lesions: indications, tips and tricks

The video-assisted thoracoscopic resection of posterior mediastinal lesions is feasible and safe in the majority of cases and is associated with a significant reduction of hospital stay, chest tube duration as well as a sensible reduction in patient’s morbidity and mortality. However, we have to consider that some of mediastinal lesions can present anatomical features that make a traditional VATS approach technically challenging or at risk of injuring surrounding structures. In these patients that could be excluded from a traditional VATS approach, the robotic assisted procedure could be effective in resecting lesions that would otherwise require an open resection. Moreover, the robotic technique, extending the ability in the surgical tissue dissection thanks to three-dimensional view and dexterity due to the use of endowrist, can reduce the risk of damage to mediastinal structures and blood loss. As happened in general surgery for upper GI, prostatectomy or low rectum resections, the robotic surgery can be indicated for procedures in narrow space like the thoracic inlet or the posterior pericardiophrenic angle, where the traditional minimally invasive surgery shows technical limitations due to the use of straight instruments.