Surgical management of teratoma located in pretracheal retrocaval space: from pre-operative 3D reconstruction to robotic surgery

The late 1990s saw the development of robotic surgery with its major application in cardiac surgery; since then, robotic technique revealed its huge potential in narrow spaces, like mediastinum. Robotic system properties consent to work safely in restricted areas, thanks to the tridimensional magnified vision and movement accuracy, without conflicts between the instruments. A case of surgical treatment by the robotic approach of teratoma located in pre-tracheal retrocaval space is reported. In the pre-operative phase, a three-dimensional (3D) reconstruction of chest computed tomography (CT) scan images was obtained, to define the correct location of the tumor and its anatomic relationship with adjacent structures. Therefore, preoperative 3D reconstruction ensures properly planning the operation, minimizing the risk of intraoperative unexpected complications. The surgical removal of the lesion was performed with a robotic 3-arms approach, without complications and with fast recovery. Over the years, robotic indications have been enlarged also to more complex cases, in parallel with the increase in surgeons' experience. Consequently, preoperative planning of the surgical procedures appears fundamental to establish operative strategies in detail. In this regard, 3D reconstruction of CT scan images may provide an exhaustive vision of the anatomical details, which is useful to plan the surgical procedure and reduce the risk of intraoperative unexpected complications.