Robotic-assisted thoracoscopic rib resection for fibrous dysplasia: a case report

Background: Fibrous dysplasia is an uncommon, benign, congenital skeletal anomaly of failed bone maturation. There is no treatment to prevent systemic disease progression, and medical therapy focuses on maintaining adequate bone density. Surgical treatment is utilized for treatment of pathologic fractures, symptomatic lesions, and significant deformities. We present a case of robotic-assisted rib resection for a symptomatic lesion secondary to fibrous dysplasia with minimally invasive rib transection and extraction techniques using a high-speed drill. Case Description: A 21-year-old male patient presented after an incidental finding of a lytic-appearing mass of the right eighth rib on abdominal computed tomography (CT) scan. History included multiple years of intermittent, focal right-sided chest pain and a "popping" sensation along the right chest wall. Biopsy confirmed the diagnosis of fibrous dysplasia. The patient underwent robotic-assisted thoracoscopic surgery for removal of the rib. Percutaneous rib transection was performed using a stylus-style surgical drill and the rib was removed through a port-site incision. There were no surgical complications. The diagnosis of benign fibrous dysplasia was confirmed on final pathology, and the patient had an unremarkable postoperative course. Conclusions: Fibrous dysplasia is an uncommon, benign, congenital bone deformity condition that can result in symptomatic lesions that require surgical removal. When rib resection is required, there are many approaches available with varying levels of morbidity. Our experience with robotic-assisted thoracoscopic rib resection utilizing minimally invasive rib transection and extraction techniques demonstrates a reproducible, low-morbidity approach.