Satisfactory outcome with robotic-assisted chest wall resection and reconstruction: a case report

The surgical management of chest wall tumors is challenging, particularly in balancing effective resection with preserving structural integrity, minimizing postoperative morbidity. While traditional open thoracotomy has been the standard approach, recently, minimally invasive techniques, especially robot-assisted thoracoscopic surgery (RATS), have emerged as effective alternatives with several benefits.

A 35-year-old asymptomatic woman, with no documented exposure to carcinogens and a clear medical history, underwent chest magnetic resonance imaging (MRI) and subsequent computed tomography (CT)-scan for a >10 cm rib alteration on the left chest wall, with no signs of tissue infiltration. Suspecting osteochondroma, we performed a radical resection via RATS. Using three surgical ports, the rib was dissected and resected with robotic assistance. A non-absorbable mesh was placed to restore chest wall integrity and prevent pulmonary herniation. The final diagnosis was fibrous dysplasia (FD). The procedure had no complications, with 150 mL blood loss, and the patient was discharged on postoperative day 4 with excellent pain control. The patient reported no ongoing pain at the surgical site, denies any respiratory issues, and has not developed a lung hernia. Although several rib resections have been described using robotic techniques, particularly for the first and second ribs in thoracic outlet syndrome, this is the first reported case of a wide rib resection requiring chest wall reconstruction. Moreover, this case represents the first documented instance of rib wall reconstruction with mesh using a robotic approach.

Robotic chest wall resection and reconstruction is feasible and safe. The use of robotic EndoWrist movement allows for easy chest wall reconstruction using mesh and running barbed sutures, without the need to make an additional skin incision at the level of the wall defect, potentially allowing for a reduction in post-operative pain and a quick recovery.