Robotic-assisted thoracoscopy in the treatment of pleuropulmonary blastoma: A case report

Robotic-assisted thoracic surgery in the management of pleuropulmonary blastoma (PPB) remains extremely rare. A 12-year-old female with a known heterozygous DICER-1 mutation developed mild chest pain. She had a history of multifocal follicular thyroid carcinoma and a history of a small cystic lesion in the upper lobe of the left lung, measuring 3.0 x 4 x 4 cm. The cyst had been stable in size for several years. At the time of presentation, she underwent a chest computerized tomography (CT) that showed that the cyst had increased in size to 14 x 8 x 8.6 cm and had new calcifications. We took her to the operating room for an exploratory thoracoscopy. We initially drained the cyst with a thoracoscopic needle. Once the cyst was decompressed, we added 2 ports, docked the DaVinci ® robotic device, and did a robotic-assisted wedge resection on the upper lobe. The specimen was placed in a bag before removing it from the chest. The pathology analysis confirmed the diagnosis of PPB Type II and confirmed clear margins. We left a chest tube, which was removed 36 hours later. Post-operative imaging showed no residual tumor. The oncology service recommended no additional surgical resection. She was enrolled in a therapeutic trial and is currently receiving adjuvant chemotherapy and radiotherapy. Robotic-assisted thoracoscopy may be a safe and effective approach for the management of type II PPB.