AB011. Robot-assisted subxiphoid approach for resection of a giant cervicothoracic junction tumor: a case report

Background: The cervicothoracic junction (CTJ) is an anatomically complex region marking the transition from cervical to thoracic structures. It encompasses several critical neurovascular elements. Resection of tumors in this region is particularly challenging when lesions are large, poorly defined, and closely adherent to adjacent structures. Conventional cervical or unilateral thoracic approaches often provide limited and asymmetrical exposure. In contrast, the subxiphoid approach offers superior visualization and bilateral access to the anterior mediastinum and thoracic inlet, particularly when combined with robotic assistance, particularly when combined with robotic assistance, offers superior visualization and bilateral access to the anterior mediastinum and thoracic inlet.

Case Description: A 56-year-old woman presented with a 1-month history of chest tightness. Contrast-enhanced computed tomography revealed an 8.0 cm × 3.5 cm mass at the cervicothoracic junction, demonstrating indistinct planes of separation from adjacent structures (Figure 1A). A robot-assisted subxiphoid resection was performed using the da Vinci Xi system. As shown in Figure 1B, a 3-cm vertical incision was made below the xiphoid process, through which a wound protector with a sealed access cap was inserted. This access system accommodated multiple trocars: one served as the robotic camera port, while the others allowed for assistant instrumentation. Additional robotic trocars were inserted bilaterally beneath the costal margins and connected to the robotic operating arms. The intraoperative findings revealed that the tumor tissue was densely adherent to the innominate vein (Figure 1C). To optimize the surgical field, carbon dioxide insufflation was used to establish an artificial pneumothorax, effectively expanding the retrosternal space. This technique, combined with the articulation and precision of robotic instrumentation, enabled excellent visualization without the need for sternal retractors. Finally, the tumor was completely excised without intraoperative complications, and vital structures were preserved (Figure 1D). Estimated blood loss was 50 mL. Postoperatively, the patient ambulated on day 2, had chest drains removed on day 3, and was discharged on postoperative day 5 without complications.

Conclusions: Robot-assisted subxiphoid resection is a safe and effective technique for managing large tumors at the cervicothoracic junction. It provides excellent exposure and operative control in anatomically constrained regions, while minimizing surgical trauma and promoting early recovery.

Keywords: Case report; cervicothoracic junction tumor (CTJ tumor); robot-assisted thoracic surgery; subxiphoid approach