A 20-year-old female with a second rib mass

A. Nguyen
Mayo Clinic, Rochester, Minnesota

Please explain the educational or technical point that this video addresses.: This patient presented with a mass arising from her second rib. We considered multiple open approaches, including supra- and infraclavicular as well as a transaxillary approach, but decided on robotic resection, which allowed excellent visualization.

Please provide a 250 word summary of the surgical video being submitted.: A 20-year-old female with a medical history of exercise induced asthma presented to our clinic following an ED visit and antibiotic treatment for strep pharyngitis. In the ED, a CT of the neck was performed, which showed an irregular osseous mass arising from the anterolateral right 2nd rib, measuring 4.4 x 3.7 cm. The patient was counselled in clinic that the mass appeared to be a benign osteochondroma. Surgery was offered, and different approaches, including both open and minimally invasive techniques were considered. Because of the morbidity associated with open surgery, we decided on a robotic approach. The patient was brought to the operating room and underwent general anesthesia. She was intubated with a double-lumen endotracheal tube. Following port placement and docking of the robot, the tumor mass was visualized arising from the 2nd rib. Medially, we were able to identify the rib margin and came around this using a spatula. The rib was cut using the Scanlan thoracoscopic rib cutter. We carried our dissection laterally and once we were able to identify the posterior margin, we came across the rib using the Medtronic long rongeur. We were then able to dissect deep to the rib. We stayed completely free from any major vessels and the T1 nerve root. The specimen was removed with an Endocatch bag. The patient tolerated the procedure well. Her postoperative course was uneventful and she was discharged on POD 3. Final pathology revealed a low grade parosteal osteosarcoma with negative surgical margins.