Robot-Assisted Cardiac Surgery in Carney–Stratakis Syndrome: A New Frontier in Tumor Resection

Carney–Stratakis syndrome is a rare hereditary disorder characterized by the development of gastrointestinal stromal tumors (GISTs) and paragangliomas (PGLs). The syndrome results from mutations affecting the succinate dehydrogenase complex, leading to impaired mitochondrial function and tumorigenesis. Patients may present with abdominal pain, gastrointestinal (GI) bleeding, hypertension, palpitations, and tumor growth in the GI tract. Cardiac involvement is uncommon but poses significant challenges for both oncologic and cardiac surgical management. First described in 2002 by Carney and Stratakis, this condition involves the dyad of GISTs and PGLs and follows an autosomal dominant inheritance pattern with incomplete penetrance. It can affect both male and female patients, often manifesting during childhood or early adulthood. Management typically includes surgical resection, medical therapy, and genetic counseling. ¹

Robot-assisted cardiac surgery has emerged as a transformative approach in cardiovascular interventions by offering precise and minimally invasive access to intracardiac structures. Compared with conventional median sternotomy, robotic surgery is associated with reduced postoperative pain, minimal blood loss, shorter intensive care unit stays, and faster recovery. In the context of cardiac tumor excision, robotic systems allow delicate tumor resection through small incisions, thereby minimizing myocardial injury and postoperative complications. A recent retrospective series evaluating robotic cardiac tumor resections performed using 8 mm ports reported excellent safety outcomes, with no intraoperative mortality and a median hospital stay of less than 5 days. Furthermore, improved clinical outcomes are strongly associated with institutional expertise and surgical proficiency with robotic platforms.^2–4

Despite its promising potential, robot-assisted cardiac surgery has certain limitations. High costs of robotic systems, the requirement for specialized operating infrastructure, and the need for extensive surgeon training remain major barriers to widespread adoption. In addition, although robotic platforms provide enhanced 3-dimensional visualization, they lack tactile feedback, which surgeons often rely on to distinguish tumor tissue from normal structures. ⁵

In conclusion, robot-assisted surgery represents a promising frontier for managing cardiac tumors associated with Carney–Stratakis syndrome. However, broader implementation requires cost-effective strategies, structured training programs, and continued technological advancements to further improve surgical outcomes.