Minimally Invasive Thoracoscopic Resection of a Giant Right‐Atrial Lipoma on the Beating Heart: A Case Report

Primary cardiac lipomas are rare benign tumors that are usually indolent but may cause compression or arrhythmia when large. We sought to describe the safety and feasibility of a totally thoracoscopic, off‐pump approach for their resection. A 33‐year‐old asymptomatic woman was found to have a 5.1 × 3.6 cm fat‐density mass at the roof of the right atrium compressing the superior vena cava. Under general anesthesia, a three‐port right‐sided thoracoscopic resection was performed on the beating heart without cardiopulmonary bypass. The tumor was completely excised with an intact capsule. Operative time was 120 min and blood loss was 50 mL. Histopathology confirmed a mature cardiac lipoma. The patient was discharged on postoperative day 5 and remained recurrence‐free at 1‐month echocardiographic follow‐up. A totally thoracoscopic, off‐pump technique is a safe, minimally invasive alternative to median sternotomy for selected right‐atrial lipomas, providing shorter recovery and superior cosmesis. Early elective resection is warranted when the tumor reaches ≥ 5 cm or causes compression, even in asymptomatic patients.