Thoracoscopic and cervical excision of bilateral thoracic and mediastinal lipomas with 3D spatial display planning and intraoperative guidance: A case report

Introduction 3D reconstruction technology is an evolving field with increasing application in surgery. It provides distinct advantages in navigating anatomically unusual pathologies requiring alternative surgical approaches as demonstrated in this case report. Case presentation An 11-year-old male with history of Cowden syndrome presenting with orthopnea was found to have fat-containing masses in bilateral hemithoraces and anterior mediastinum extending superiorly to the inferior border of the thyroid. Due to a familial history of early thyroid cancer and presence of a left thyroid nodule, the patient was scheduled for concurrent thyroidectomy and excision of the masses. A thoracoscopic approach was planned by utilizing a stereoscopic spatial display to view 3D reconstructions of the chest and neck; these images were transmitted into the operating room during the procedure. Thoracoscopic mediastinal dissection of the masses was completed, followed by thyroidectomy with cervical mobilization. The masses were extracted via the cervical incision. The patient was extubated on postoperative day one and discharged on postoperative day four. He noted improvement of his orthopnea on one month follow up. Final pathology demonstrated benign lipomas and benign follicular thyroid nodule. Conclusion Mediastinal masses that extend through the thoracic inlet into the neck may be amenable to extraction via a cervical incision. This may be a suitable approach for patients who require a cervical incision in addition to the thoracic approach. 3D reconstruction and extended reality technologies may be useful for preoperative surgical planning.