Video 1 Case 4 intraoperative findings. A median sternotomy and lateral thoracotomy were performed. Although the tumor was resected along with the pericardium, left upper lobe, and left phrenic nerve, some remained on the wall of the aortic arch. Because of invasion of the aortic arch, and root of the left common carotid artery and subclavian artery, the residual tumor was removed as much as possible. Clips were placed at the site of the residual tumor at the end of the reduction surgery procedure.
Video 2 Case 6 intraoperative findings. A median sternotomy and lateral thoracotomy were performed. After opening the pericardium, massive bloody pericardial effusion was aspirated, the tumor was detached from the superior vena cava (SVC), and the left brachiocephalic vein was dissected. The upper lobe of the left lung was invaded by the tumor, thus partial resection was performed. The tumor was detached along the ascending aorta and divided halfway through. Continuity of tumor invasion from the pulmonary trunk to aorta dorsal side was noted, and surgery was continued under a cardiopulmonary bypass to maintain the visual field and for patient safety. The rest of the tumor was then resected in pieces along the pulmonary trunk. Invasion of the left coronary artery and left atrium was noted, with no resection performed there.