title: Thorascopic resection of an apical paraspinal schwannoma using the da Vinci surgical system.
abstract: BACKGROUND
  Posterior mediastinal neurogenic tumors have traditionally been resected via an open posterolateral thoracotomy. Video-assisted thorascopic surgery has emerged as an alternative technique allowing for improved morbidity with decreased blood loss, less postoperative pain, and a shorter recovery period, among others. The da Vinci surgical system, as first described for urologic procedures, has recently been reported for lung lobectomy. This technique provides the advantages of instrumentation with 6 degrees of freedom, stable operating arms, and improved visualization with the three-dimensional high-definition camera.
  
  
  METHODS
  We describe the technique for thorascopic resection of an apical paraspinal schwannoma of the T1 nerve root with the da Vinci surgical system. This technique used a specialized intraoperative neuromonitoring probe for free-running electromyography (EMG) and triggered EMG.
  
  
  RESULTS
  We demonstrate successful resection of a posterior paraspinal schwannoma with the da Vinci surgical system while preserving neurologic function. The patient displayed stable intraoperative monitoring of the T1 nerve root and full intrinsic hand strength postoperatively.
  
  
  CONCLUSIONS
  The technique described in this article introduces robotic system accuracy and precludes the need for an open thoracotomy. In addition, this approach demonstrates the ability of the da Vinci surgical system to safely dissect tumors from their neural attachments and is applicable to other such lesions of similar size and location.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, United States.
authors.forename: David
authors.initials: D
authors.lastname: Finley
authors.affiliation: Department of Neurosurgery, The George Washington University, Washington, District of Columbia, United States.
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Sherman
authors.affiliation: Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York, United States.
authors.forename: Edward
authors.initials: E
authors.lastname: Avila
authors.affiliation: Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York, United States.
authors.forename: Mark
authors.initials: M
authors.lastname: Bilsky
mesh_terms: D006801:Humans; D008297:Male; D008479:Mediastinal Neoplasms / Q000601:surgery*; D008875:Middle Aged; D009442:Neurilemmoma / Q000601:surgery*; D013126:Spinal Nerve Roots / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*; D013904:Thoracic Vertebrae / Q000601:surgery*; D016896:Treatment Outcome