Robotic-assisted costectomy using a Gigli saw for fibrous dysplasia

Fibrous dysplasia (FD) is the most common benign tumor of the ribs, with surgical resection being the preferred treatment modality for rib FD, leading to enhanced quality of life and favorable outcomes. The complexity of surgical intervention varies depending on the location of costal FD, presenting challenges for both open surgical and thoracoscopic approaches. In this study, we present a novel technique for three-port robotic-assisted costectomy utilizing a Gigli saw, detailing our initial findings and outcomes.

We reviewed five patients with benign rib tumors who underwent three-port robotic-assisted rib resection using a Gigli saw between May 2021 and December 2022. Data on patient characteristics, relevant short-term surgical outcomes and clinical long-term treatment effects were collected.

The surgery was successful in all five patients without any need for an additional port and emergency conversion to open surgery. Median operative time was 76.8 min (range, 73-116 min), and the median intraoperative blood loss volumes was 75 ml (range, 40- 105 mL). On average, chest tubes were removed 1.2 days postoperatively (range, 1-2 days), with a mean drainage volume of 93 ml on postoperative day 1 (range, 70-135 ml). Patients were discharged between the 2nd and 4th postoperative day. During 1-year follow-up period, no recurrence was observed in either patient.

The utilization of a three-port robotic-assisted costectomy in conjunction with a Gigli saw represents a viable, secure, and efficient approach for treating isolated benign rib lesions. Our aim is to provide clinical guidance on this technique and promote its broader application.