Discussion:
TV tumor is a rare disease. In a collective review, only 51 cases of
myxoma originating from the TV were reported by 2008. Most tumors that
originated from the TV required TV repair or replacement and myxoma
resection (replacement, 22%; repair, 56.1%; tumor resection only,
22%) [3, 4]. The tumor size varies from 1 cm to 15 cm in diameter.
The larger tumor also appears to be a major risk factor for embolism
[5].
In the past two decades, minimally invasive techniques were applied in
all areas of cardiac surgery due to admirable cosmetics and speedy
postoperative recovery. [6] The Da Vinci robot-assisted cardiac
surgery provides stable scope, enhanced visualization by ten-fold, and
dexterous surgical arms. Nevertheless, the chest wounds must be widened
in extra-large tumor excision despite the minimal operations designed.
The morcellator was initially approved for laparoscopic uterine myoma
removal. However, the device was less used recently as per FDA
recommendation due to potential malignant tissue spreading. The FDA
recommends performing laparoscopic power morcellation for myomectomy
only within a well-protected containment system.
In this case, the huge myxoma was excised en-bloc and placed into the
endo bag within the pericardial cavity. A morcellator shaft (12 mm in
diameter) was inserted into the endo bag with an attached negative
pressure filter system. The downsized tumor strips were removed smoothly
with confined debris. In only 5 min, the procedure was completed through
the tiny working port.
To our knowledge, there were no previous reports on morcellator-assisted
cardiac tumor downsizing and port removal. With the first morcellator
application, this might be the smallest surgical wound reported after
the removal of a huge cardiac myxoma. With the Da Vinci system, the ICU
and hospital stays were shortened. The most concerned cosmetic problems
and wound pain were also alleviated. This might be effectively applied
to further minimally invasive surgeries for cardiac tumor excision.
Conflict of Interest: There is no acknowledgment, and the
authors declare no conflict of interest relevant to the manuscript.