Robotic resection of a mediastinal liposarcoma

A 76-year-old man presented with new onset atrial fibrillation. During his workup, he underwent a computed tomography angiogram of his coronary arteries that revealed multivessel disease and an incidental heterogeneous fat and complex fluid density in the posterior aortopulmonary window space. The mass was further characterized with the use of magnetic resonance imaging and a dedicated computed tomography scan of the chest showing a complex fat-containing tumour most consistent with either an atypical lipomatous tumour or a well-differentiated liposarcoma. Given this differential, the patient was offered and agreed to proceed with robot-assisted surgical resection. Four ports were placed along the eighth intercostal space. The inferior pulmonary ligament was lysed, and the mediastinal pleura was opened to access the mass. The mass was dissected free laterally and superiorly from the aorta and the recurrent laryngeal nerve and medially from the lung and pulmonary vasculature. After circumferential dissection of the mass, it was completely freed and removed from the chest with an endo catch bag. The final pathological analysis revealed a 6-cm, well-differentiated liposarcoma with prominent myxoid changes, so the patient was treated with a 59.4 Gy, 33 fraction course of radiation. The patient was doing well at the 6-month follow-up with no adverse surgical events or signs of recurrent disease.