Multidisciplinary Surgical Approach Utilizing Augmented Reality Pre-Planning for Resection of Giant Thoracic Schwannoma with Robotic Assisted Thoracoscopic Mobilization

Introduction: In adults, primary spinal cord tumors account for 5% of all primary tumors of the central nervous system with schwannomas making up about 74% of all nerve sheath tumors. Thoracic schwannomas can pose a threat to neurovasculature, presenting a significant challenge to safe and complete surgical resection. For patients presenting with complex pathologies invading thoracic cavity, a dual surgeon approach may be utilized to optimize patient care and improve outcomes. This study presents the case of a 73-year old female diagnosed with a large thoracic dumbbell schwannoma of the fourth thoracic vertebra. The novelty in this case was the use of augmented reality volumetric rendering and robotic assistance for complete resection of the tumor.

Methods: Augmented reality (AR) volumetric rendering was used to clarify anatomic relationships of the mass for both pre- and peri-operative evaluation and decision-making. A dual surgeon approach was utilized for complete resection. First, a ventrolateral left Video Assisted Thoracoscopic Surgery (VATS) was performed using robotic assistance from the DaVinci XI Surgical System for partial tumor resection followed by a posterior resection and thoracic stabilization.

Results: The patient did well postoperatively and MRI showed complete resection of the upper thoracic mass. X-rays showed proper re-expansion of the left lung postoperatively. The patient reported no active complaints on follow up and was doing well.

Conclusion : Although surgical treatment of large thoracic dumbbell tumors presents a myriad of risks, pre- and peri-operative evaluation with AR, new robotic surgical techniques and a dual surgeon approach can be implemented to mitigate these risks.