Staged Transmediastinal Drainage Followed by Robot-Assisted Thoracoscopic Resection for a Giant Anterior Mediastinal Cystic Teratoma: A Case Report.

Giant cystic anterior mediastinal tumors pose a significant challenge for minimally invasive surgery because of limited working space and the risk of cyst rupture. A 26-year-old woman presented with a large anterior mediastinal cystic tumor strongly suggestive of a benign lesion on imaging. To secure an adequate operative field and reduce the risk of intraoperative rupture, computed tomography-guided transmediastinal drainage was performed preoperatively. Tumor volume reduction improved surgical exposure and maneuverability and reduced the risk of rupture, enabling robot-assisted thoracoscopic surgery. Despite dense inflammatory adhesions between the tumor and surrounding tissues, precise dissection was achieved with robotic assistance, allowing complete tumor resection without rupture. This case suggests that a staged strategy combining preoperative drainage and robotic surgery may represent a safe and effective minimally invasive approach for selected patients with giant benign mediastinal cystic tumors.