Subcostal single-port robot-assisted resection of a posterior mediastinal tumor in an infant

Abstract Robot-assisted thoracic surgery is increasingly used in pediatric patients; however, its application in infants weighing less than 8 kg remains limited. We report a case of posterior mediastinal tumor resection in a 6-month-old female infant weighing 5.46 kg. A subcostal approach using the da Vinci Single Port system was employed to minimize instrument collision within the small thoracic cavity. A 3.5-cm subcostal incision was created, and the access port was secured without intercostal rib manipulation. The operative field was maintained using CO 2 insufflation at 3 mmHg. A 7.0-cm cystic tumor was successfully resected. The total operative time was 132 min. This intercostal-sparing technique may reduce intercostal nerve injury and subsequent long-term musculoskeletal complications. Subcostal single-port robotic surgery appears to be a safe and feasible minimally invasive option for infants weighing less than 8 kg.