Totally 3D Endoscopic Minimally Invasive Resection of Papillary Fibroelastoma

Surgical resection is the first line of therapy for cardiac tumors. Some studies suggest that a totally endoscopic surgery technique results in better cosmetic outcomes (1, 2) and a 3D endoscopic view provides better visualization of structures deep in the chest cavity (2) compared with conventional sternotomy. Herein, the authors report a totally 3D endoscopic minimally invasive removal to papillary fibroelastoma on the posterior mitral leaflet in a young patient.

A 42-year-old otherwise healthy woman was admitted for stroke after complaining of right visual disturbance, right upper limb paralysis, and aphasia. On transthoracic echocardiography (TTE), she was found to have a 13.4 mm ~ 11.7 mm well circumscribed mass that was mobile and pedunculated on the posterior mitral leaflet. The authors performed a removal of the tumor through right minithoracotomy via totally endoscopic three-port minimally invasive mitral valve surgery using a 3D endoscope (3, 4). A 2 cm skin incision was made at the fourth intercostal space for the main working port. Cardiopulmonary bypass was established through femoral cannulation. The patient’s heart was arrested with antegrade cardioplegia. Through left atriotomy, the authors visualized a multilocular and fragile tumor attached on the posterior mitral leaflet. They resected the mass in its entirety so as not to leave a stalk of the tumor. Aortic cross-clamp time, cardiopulmonary time, and operation time were 44 minutes, 87 minutes, and 123 minutes, respectively.

There was no complication perioperatively. Postoperative TTE demonstrated no mitral regurgitation. The patient had an uneventful recovery and was discharged on the third postoperative day. Histopathological examination identified the tumor to be papillary fibroelastoma. There was no mitral regurgitation or tumor recurrence on TTE at the 6-month postoperative visit. Totally 3D endoscopic minimally invasive cardiac tumor resection is a safe and effective treatment with a cosmetic advantage and an excellent visualization.

References

1. Deng L, Zhang GW, Liu ZH, Meng WX, Liu HY. Totally thoracoscopic surgery for atrial myxomas resection and atrial septal defect repair. Eur Rev Med Pharmacol Sci. 2017;21:569-575.
2. Ruttkay T, Götte J, Walle U, Doll N. Minimally invasive cardiac surgery using a 3D high-definition endoscopic system. Innovations (Phila). 2015;10:431-434.
3. Ito T, Maekawa A, Hoshino S, Hayashi Y, Sawaki S, Yanagisawa J, et al. Three-port (one incision plus two-port) endoscopic mitral valve surgery without robotic assistance. Eur J Cardiothorac Surg. 2017;51:913-918.
4. Hosoba S, Ito T, Zaikokuji K. A novel ‘two-window’ technique to facilitate totally 3D-endoscopic mitral valve repair. Surg Today. 2019 Epub Nov 29.

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