VATS resection of a large mediastinal teratoma abutting great vessels.

Mature mediastinal teratomas are uncommon benign germ cell tumours that typically arise in the anterior mediastinum. Although minimally invasive resection has become standard for many mediastinal lesions, its application remains debated when tumours are closely associated with major vascular structures. We describe a case of a 22-year-old male diagnosed with a large anterior mediastinal teratoma abutting the superior vena cava, both brachiocephalic veins, the aorta, and the right phrenic nerve. After thorough evaluation, the patient underwent successful bilateral video-assisted thoracoscopic (VATS) resection with en bloc removal of the tumour and surrounding thymic tissue. The procedure lasted 450 minutes with an estimated blood loss of 400 mLs. He was discharged on postoperative day 2, and computed tomography scan of the thorax at three and six months confirmed no disease recurrence. This report illustrates how carefully selected patients with complex anatomy may benefit from a minimally invasive approach, provided that detailed preparation and expertise are present. It contributes further understanding to the evolving role of thoracoscopic surgery in challenging mediastinal tumour resections.