Malignant chest wall tumour is rare. The presentation is usually aggressive that requires extensive resection to prevent recurrence. However, the extensive resection is to the expense of causing defect on the chest wall and hence, respiratory mechanics. Two cases of chest wall tumour are discussed including the surgical approach of radical tumour resection which was combined with placement of titanium mesh and Tranverse Rectus Abdominis Myocutaneus (TRAM) flap to cover the defect and preserve respiratory mechanical functions. The morbidity of using titanium mesh demonstrated in the case series were infection and injury to surrounding tissue due to its rigidity and large size which required its removal. However the formation of ‘pseudopleura’ made the thoracic cage return back as closed cavity even after the removal of the titanium mesh and allow normal respiratory functions.

We report a 39-year-old male with accidental findings of posterior mediastinum mass at right superior aspects, located at T2 with close proximity to trachea, superior vena cava, azygus vein, right subclavian artery and oesophagus. Apart from intermittent right shoulder pain, there was no other significant symptom. He opted for conservative management initially, given the benign nature and proximity to important structures. We postulated that robotic approach will be of advantage for this particular case which was successfully performed with uneventful recovery. This case illustrated the advantages of robotic-assisted surgery, compared to conventional VATS in otherwise potentially difficult case to undertake.