Robotic resection of an anterior mediastinal mass en bloc with the left innominate vein and pericardium post induction treatment for thymic carcinoma

This case report describes the robot assisted resection of a 70 year old man's anterior mediastinal mass. Preoperative imaging showed an 85 × 45 mm thymic squamous cell carcinoma invading the pericardium and occluding the left innominate vein. After neoadjuvant chemotherapy, a bilateral robotic approach was used. The phrenic nerves and great vessels were skeletonized; the left innominate vein was encircled and transected with a vascular stapler; the mass was mobilized off the sternum; the pericardium was opened and resected en bloc with the tumour; and the robot was re docked on the right to dissect the right phrenic nerve and control the superior vena cava, which underwent stapled plasty before division of the left innominate vein. Reconstruction included a bovine pericardial patch. Operative time was 300 minutes with no intraoperative complications; the patient developed transient atrial fibrillation and was discharged on Day 9. Final pathology confirmed an R0 resection. This case highlights that robot assisted thoracic surgery can safely manage complex mediastinal tumours involving the pericardium and great vessels, offering advantages in blood loss and recovery compared with sternotomy.