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.