Left robotic assisted thoracic surgery (RATS) stellate ganglion ganglioneuroma resection with post-operative Harlequin syndrome

Ganglioneuromas are rare, benign neurogenic tumours, most often located in the posterior mediastinum. We present an exceptional case of a stellate ganglion ganglioneuroma at the left cervicothoracic junction, abutting the subclavian artery, oesophagus, sympathetic chain and vertebral bodies. The patient presented with significant shortness of breath and paraesthesia in the left arm. Cross-sectional imaging confirmed a well-encapsulated paravertebral mass in the left posterior mediastinum. Given the intricate anatomy of the thoracic inlet and proximity to multiple critical structures, a robotic-assisted thoracic surgical approach using the da Vinci Xi platform was employed. Robot-assisted resection transformed this complex and confined space into a clear, magnified operative field, enabling micro-instrument precision to safely mobilize the mass while avoiding injury to adjacent neurovascular structures. Complete excision was achieved with histopathology confirming ganglioneuroma. The patient's compressive symptoms resolved, though she developed Harlequin syndrome as a direct consequence of partial stellate ganglion resection. This case highlights both the rarity of stellate ganglion ganglioneuromas and the unique value of robotic-assisted surgery in navigating anatomically complex regions. The enhanced visualization and precision of the da Vinci Xi system enabled safe resection with reduced morbidity and expedited recovery.