Giant Pediatric Lymphangioma Resected by Robotic Surgery in the Mediastinum – Case Report

Abstract

Lymphangiomas are slow-developing benign malformations of the lymphatic system. They are characterized by lymphatic proliferation in mucous membranes. The diagnosis is based on clinical history and, mainly, imaging findings, such as CT and NMR. Standard treatment demands total surgical excision for curative purposes A 1 year and 4 months old boy went to the hospital’s ER presenting with cough and fever. Chest X-rays showed enlarged mediastinum, and computed tomography (CT) revealed a large cystic lesion in the anterior mediastinum measuring 91x40x68 mm. Propaedeutic was extended with nuclear magnetic resonance (NMR) and transthoracic echocardiogram. A multidisciplinary team formed by pediatricians, pediatric oncologists and thoracic surgeons decided for surgical resection of the mass with the thoracic robotic surgery. Although sternotomy and thoracotomy are classic surgical choices, resection by robotic surgery was preferred in this case. Port placement: the optical portal was positioned at the level of the ninth intercostal space in the posterior axillary line, and the others were positioned under vision, respecting a minimum distance of 7 cm between them. In this case, the trochanters positioning outside of the “remote center” was important, because of the small pleural cavity with less room for tweezers mobility. The dissection and release of tumor adhesions to the brachiocephalic vein, superior vena cava and internal thoracic veins were carried out and the tumor was removed. The patient’s condition improved in the postoperative period, being discharged from the ICU in the first postoperative day and hospital discharge was on the third postoperative day, without any complications. The anatomopathological confirmed mediastinal cavernous lymphangioma.