Symptomatic pericardial cyst with a mass effect on the right heart

Pericardial cysts comprise 6–7% of mediastinal masses. On average, they have a diameter of 5.4 cm and are rarely symptomatic. It is even more rare for pericardial cysts to be greater than 10 cm in diameter, which are preferentially excised via an open approach. There is limited literature on robotic video-assisted thorascopic surgery (VATS) for giant symptomatic pericardial cysts. We present the case of a 66-year-old with a symptomatic pericardial cyst and coexisting loculated pleural effusion successfully treated with robotic VATS excision. Our patient presented with worsening shortness of breath and yellow-sputum production. Work-up revealed a 12.3 x 10.9 x 6.8 cm pericardial cyst with mass effect on the right atrium and ventricle. He underwent a right robotic assisted (VATS). He required pneumolysis for adequate exposure of the pericardium because of loculated pleural effusion. Excision was performed with electrocautery along the rim of the cyst for decompression and resection. The patient's hemodynamics remained stable throughout the procedure. For our patient, robotic VATS was a safe and effective approach for resecting a pericardial cyst in a hostile thoracic cavity. There is limited reporting giant pericardial cysts resected via a robotic VATS approach in patients with challenging anatomic exposure secondary to loculations. This supports robotic VATS for excision of giant symptomatic pericardial cysts, including in select patients with an anatomically hostile thoracic cavity.