Totally endoscopic robotic-assisted excision of right ventricular papillary fibroelastoma

  • Sarah Nisivaco
  • Michael Henry
  • R. Parker Ward
  • Husam H. BalkhyEmail author
Case Report


Although they comprise a small number of primary tumors of the heart, papillary fibroelastomas (PFEs) are the second most common type of benign cardiac tumor. PFEs of the right heart are uncommon, and those arising from the right-ventricular (RV) wall are extremely rare, with only a handful of reported cases in the literature. Removal of these tumors has been described, primarily through a median sternotomy approach, with only one report of using a right-sided mini-thoracotomy technique. The advantages of endoscopic robotic-assisted cardiac surgery have been demonstrated and described extensively. We report on a case of an incidentally found PFE in the RV that was successfully removed with a totally endoscopic robotic-assisted approach. The focus of our report is on the uniqueness of both the right-sided nonvalvular PFE and the treatment with a robotic totally endoscopic surgical approach.


Cardiac tumor Papillary fibroelastoma Robotics Minimally invasive surgery Cardiac surgery Right ventricle mass 


Compliance with ethical standards

Conflict of interest

Author Husam Balkhy, MD is a proctor for Intuitive Surgical, manufacturer of the Da Vinci robot. Author Sarah Nisivaco declares that she has no conflict of interest. Author Michael Henry, MD declares that he has no conflict of interest. Author Parker Ward, MD declares that he has no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study. Written informed consent was obtained from the patient for publication of this Case Report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.


  1. 1.
    Hoffmeier A, Sindermann JR, Scheld HH, Martens S (2014) Cardiac tumors—diagnosis and surgical treatment. Dtsch Arztebl Int 111:205–211Google Scholar
  2. 2.
    Bossert T, Gummert JF, Battellini R, Richter M, Barten M, Walther T et al (2005) Surgical experience with 77 primary cardiac tumors. Interact Cardiovasc Thorac Surg 4:311–315CrossRefGoogle Scholar
  3. 3.
    Niino T, Satoshi U (2014) Papillary fibroelastoma of the right ventricular free wall. Case Rep Surg 2014:654641Google Scholar
  4. 4.
    Gowda RM, Khan IA, Nair CK, Mehta NJ, Vasavada BC, Sacchi TJ (2003) Cardiac papillary fibroelastoma: a comprehensive analysis of 725 cases. Am Heart J 146:404–410CrossRefGoogle Scholar
  5. 5.
    Ngaage DL, Mullany CJ, Daly RC, Dearani JA, Edwards WD, Tazelaar HD et al (2005) Surgical treatment of cardiac papillary fibroelastoma: a single center experience with eighty-eight patients. Ann Thorac Surg 80:1712–1718CrossRefGoogle Scholar
  6. 6.
    Balkhy HH, Wann LS, Krienbring DJ, Arnsdorf SE (2011) Integrating coronary anastomotic connectors and robotics toward a totally endoscopic beating heart approach: review of 120 cases. Ann Thorac Surg 92:821–827CrossRefGoogle Scholar
  7. 7.
    Maciolek K, Asfaw ZE, Krienbring DJ, Arnsdorf SE, Balkhy HH (2016) Robotic endoscopic off-pump total pericardiectomy in constrictive pericarditis. Innovations (Phila) 11:134–137Google Scholar
  8. 8.
    Kitahara H, Patel B, McCrorey M, Nisivaco S, Balkhy HH (2017) Morbid obesity does not increase morbidity or mortality in robotic cardiac surgery. Innovations (Phila) 12:434–439CrossRefGoogle Scholar
  9. 9.
    Poston RS, Tran R, Collins M, Reynolds M, Connerney I, Reicher B et al (2008) Comparison of economic and patient outcomes with minimally invasive versus traditional off-pump coronary artery bypass grafting techniques. Ann Surg 248:638–646Google Scholar
  10. 10.
    Chitwood WR Jr (2016) Robotic mitral valve surgery: overview, methodology, results and perspective. Ann Surg 5:544–555Google Scholar
  11. 11.
    Giambruno V, Chu MW, Fox S, Swinamer SA, Rayman R, Markova Z et al (2018) Robotic-assisted coronary artery bypass surgery: an 18-year single-centre experience. Int J Med Robot 14:e1891CrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2019

Authors and Affiliations

  • Sarah Nisivaco
    • 1
  • Michael Henry
    • 2
  • R. Parker Ward
    • 2
  • Husam H. Balkhy
    • 1
    Email author
  1. 1.Departments of Cardiothoracic SurgeryUniversity of Chicago MedicineChicagoUSA
  2. 2.Departments of CardiologyUniversity of Chicago MedicineChicagoUSA

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