Robotic nerve-sparing enucleation of thoracic sympathetic trunk schwannoma with narrow-band imaging: technical considerations.

Schwannomas arising from the thoracic sympathetic trunk can cause Horner's syndrome, and surgical resection carries a risk of further nerve injury. We describe a technique for robotic nerve-sparing enucleation of a thoracic sympathetic trunk schwannoma presenting with Horner's syndrome. After exposure of the epineurium and perineurium, careful dissection of these neural sheath structures revealed a smooth tumor surface, along which enucleation was performed. Narrow-band imaging enhanced microvascular structures within the epineurium and perineurium and improved visual contrast with the relatively avascular tumor surface. The narrow-band imaging view was simultaneously displayed with the robotic view on the surgeon console using the TilePro function, allowing real-time comparison during dissection. Selective use of narrow-band imaging may provide supplementary information for identifying the dissection plane during robotic nerve-sparing enucleation.