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ObjectiveMinimally invasive surgery is challenging for masses located in the superior mediastinum, especially for those close to the chest outlet. This study aimed to evaluate the feasibility and safety of robotic-assisted thoracic surgery (RATS) for these masses.MethodsFrom June 2015 to January 2020, 35 patients (19 males, 16 females), with a mean age of 41.6 (range, 13–66) years, underwent RATS for the treatment of superior mediastinal masses. Data regarding the operation time, blood loss, pathology, conversion rate, morbidity, mortality, and cost were collected and analyzed.ResultsThe mean (±standard deviation) operation time, blood loss, chest tube use duration, and postoperative hospital day were 117 ± 45.2 (range, 60–270) min, 59.7 ± 94.4 (range, 10–500) ml, 4.1 ± 2.1 (range, 1–10) days, and 5.1 ± 2.1 (range, 2–11) days, respectively. The pathological diagnoses included schwannoma (26 cases), ganglioneuroma (4 cases), bronchogenic cysts (3 cases), ectopic nodular goiter (1 case), and cavernous hemangioma (1 case). The mean diameter of the resected tumor was 4.6 ± 2.0 (range, 2.5–10) cm. No conversion or mortality occurred. Postoperative complications included Horner’s syndrome (18 cases: 6 patients with preoperative Horner’s syndrome), weakened muscular power (2 cases), and chylothorax (2 cases). The mean cost was $ 8,868.7 (range, $ 4,951–15,883).ConclusionsOur experience demonstrated that RATS is safe and feasible for superior mediastinal mass resection. However, the high incidence of postoperative Horner’s syndrome requires further research.

Paraganglioma is a rare tumor arising from paraganglia. Few reports have described paragangliomas in the superior mediastinum. We report a case of superior mediastinal paraganglioma treated in our department. A 28-year-old woman visited our department because of suspected mediastinal tumor during a medical checkup. Contrast-enhanced CT showed a 39 × 35 × 65-mm tumor with a well-defined border extending from the lower pole of the left thyroid gland to the superior mediastinum. Laboratory tests showed no evidence of catecholamine overproduction. Mediastinal thyroid goiter was the most suspected preoperative diagnosis. We decided to perform a transcervical excision for both diagnosis and treatment. The tumor was easily detached from the lower pole of the left thyroid gland and was not continuous. The tumor capsule was brittle and bled easily. The operating time was 3 h and 11 min, and the amount of bleeding was 571 mL. The pathological diagnosis was paraganglioma. Paragangliomas are characterized by abundant blood flow and are likely to result in a high intraoperative bleeding volume. In addition, if the tumor is functional, circulatory abnormalities can occur during the perioperative period. Accurate preoperative diagnoses are important, and the possibility that paragangliomas can develop in the superior mediastinum should be considered. [ABSTRACT FROM AUTHOR]

Ectopically located parathyroid adenoma is one of the major causes of persistent and recurrent hyperparathyroidism and hypercalcemia. Approximately 0.3–8% of parathyroid adenoma is found in an ectopic location. Ectopic parathyroid adenomas are uncommon causes of persistent hypercalcemia and can be present at uncommon locations, including the hypoglossal nerve, the posterior triangle of the neck, axilla, and pericardium 3. A high index of suspicion is warranted when we see persistently elevated levels of parathyroid hormones (PTHs) and calcium levels post parathyroidectomy. Here, we present a patient who persistently had elevated calcium and PTH levels after parathyroidectomy.

Ectopically located parathyroid adenoma is one of the major causes of persistent and recurrent hyperparathyroidism and hypercalcemia. Approximately 0.3–8% of parathyroid adenoma is found in an ectopic location. Ectopic parathyroid adenomas are uncommon causes of persistent hypercalcemia and can be present at uncommon locations, including the hypoglossal nerve, the posterior triangle of the neck, axilla, and pericardium 3. A high index of suspicion is warranted when we see persistently elevated levels of parathyroid hormones (PTHs) and calcium levels post parathyroidectomy. Here, we present a patient who persistently had elevated calcium and PTH levels after parathyroidectomy. [ABSTRACT FROM AUTHOR]

Objective: Minimally invasive surgery is challenging for masses located in the superior mediastinum, especially for those close to the chest outlet. This study aimed to evaluate the feasibility and safety of robotic-assisted thoracic surgery (RATS) for these masses., Methods: From June 2015 to January 2020, 35 patients (19 males, 16 females), with a mean age of 41.6 (range, 13-66) years, underwent RATS for the treatment of superior mediastinal masses. Data regarding the operation time, blood loss, pathology, conversion rate, morbidity, mortality, and cost were collected and analyzed., Results: The mean (±standard deviation) operation time, blood loss, chest tube use duration, and postoperative hospital day were 117 ± 45.2 (range, 60-270) min, 59.7 ± 94.4 (range, 10-500) ml, 4.1 ± 2.1 (range, 1-10) days, and 5.1 ± 2.1 (range, 2-11) days, respectively. The pathological diagnoses included schwannoma (26 cases), ganglioneuroma (4 cases), bronchogenic cysts (3 cases), ectopic nodular goiter (1 case), and cavernous hemangioma (1 case). The mean diameter of the resected tumor was 4.6 ± 2.0 (range, 2.5-10) cm. No conversion or mortality occurred. Postoperative complications included Horner's syndrome (18 cases: 6 patients with preoperative Horner's syndrome), weakened muscular power (2 cases), and chylothorax (2 cases). The mean cost was $ 8,868.7 (range, $ 4,951-15,883)., Conclusions: Our experience demonstrated that RATS is safe and feasible for superior mediastinal mass resection. However, the high incidence of postoperative Horner's syndrome requires further research., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Yang, Chen, Li, Fan, Lin and Liu.)