Asian Journal of Case Reports in Surgery

Background: Robotic-assisted thoracic surgery provides magnified three-dimensional vision, tremor filtration, and wristed instrumentation, enabling least-morbidity resections. It is usually preferred for small, well-encapsulated tumors. The authors have used robotic assistance for challenging tumors which would otherwise necessitate sternotomy, thereby reducing the morbidity of sternotomy. Median sternotomy remains the classical exposure for challenging anterior mediastinal tumors, but it is associated with higher morbidity, prolonged length of stay (LOS), and long-term functional limitations.

Methods: We describe three challenging anterior mediastinal tumors managed robotically: (1) thymectomy for a large thymoma in a 60-year-old man with myasthenia gravis, (2) excision of a large teratoma in a 22-year-old man with raised serum alpha-fetoprotein (AFP), and (3) resection of a pretreated thymoma in a 70-year-old man with poor performance status and post-chemotherapy fibrosis.

Results: All three operations were completed robotically without conversion or sternotomy. Mean operative time was 210 minutes; mean blood loss <50 mL. Pain (VAS ≤2 by 24 hours), early ambulation (Day 1), mean drain removal on Day 2.3, and mean hospital stay of 3.6 days reflected low morbidity. No patient required intensive care stay beyond 24 hours.

Conclusion: Robotic-assisted thoracic surgery reduces morbidity and broadens operability in difficult anterior mediastinal tumors, including those otherwise unfit for sternotomy. Tumor biology still dictates surgical complexity, but robotics transforms many borderline cases into safe, feasible operations.