Chest
Minimally Invasive TechniquesVideothoracoscopic Approach to Primary Mediastinal Pathology
Section snippets
Patients
From May 1991 to January 1999, of 1,653 videothoracoscopic procedures, 118 regarded primary mediastinal lesions (Table 1). These do not include esophageal disease or metastatic mediastinal lymphadenopathy from lung cancer or from other primary neoplasms.
In 47 patients, the procedure was performed for diagnostic purposes. In 36 patients, the purpose was to obtain large and multiple biopsy specimens of suspected lymphoma. In three patients, thoracoscopy was aimed at staging malignant thymomas;
Results
The average operating time depends on the procedure, whether diagnostic or therapeutic. Adhesions, prior surgical interventions, or neoadjuvant chemotherapy treatment can individually influence the length of each procedure. For diagnostic purposes, large specimens can usually be acquired without particular difficulties, and the procedure from insertion of the first port to closure of the wound is relatively brief (range, 20 to 70 min). Removal can be more complex and also depends on the time
Discussion
Mediastinal pathologies encompass a wide spectrum of diseases, each requiring different surgical procedures with varying levels of difficulty, ranging from diagnostic procedure to simple resection of pedunculated masses or to complex removal of large masses with tenacious adhesions or invasion of contiguous structures.
Whenever incisions such as a thoracotomy or a sternotomy would appear to be disproportionate with relatively simple resections, videothoracoscopy offers an alternative that allows
Conclusion
We believe that a critical revision of outlook, indications, and attitude to videothoracoscopic approach to mediastinal disease is necessary. Videothoracoscopy can now attain a leading role in diagnosis and surgical treatment:
1. In cases of lymphatic diseases located primarily in the mediastinum, thoracoscopy allows for obtaining adequately large tissue samples that are essential for diagnosis and that are difficult to obtain otherwise.
2. Schwannomas, simple cysts, or other similar mediastinal
References (14)
- et al.
Present role of thoracoscopy in the diagnosis and treatment of diseases of the chest
Ann Thorac Surg
(1992) - et al.
Thoracoscopic resections of 85 pulmonary lesion
Ann Thorac Surg
(1992) - et al.
Videothoracoscopic wedge excision of the lung
Ann Thorac Surg
(1992) - et al.
Thoracoscopic diagnosis and treatment of mediastinal masses
Ann Thorac Surg
(1993) Approach to the diagnosis and staging of mediastinal masses
Chest
(1993)- et al.
“Maximal” thymectomy for myasthenia gravis: results
J Thorac Cardiovasc Surg
(1988) - et al.
Role of staging in prognosis and management of thymoma
Ann Thorac Surg
(1991)
Cited by (68)
Comparative effectiveness and cost-efficiency of surgical approaches for thymectomy
2020, Surgery (United States)Citation Excerpt :Thymectomy is indicated for a variety of indications, including thymic malignancies, benign thymic lesions, and myasthenia gravis.1 Although sternotomy is generally considered to be the traditional gold standard for thymectomy,2,3 minimally invasive approaches such as video-thoracoscopy (VATS)4–13 and robotic-assisted thoracic surgery (RATS)14–20 have gained popularity in the past decade, particularly for myasthenia gravis or tumors less than 6 cm. However, the efficacy and safety of these minimally invasive surgical approaches, in comparison to the traditional approaches, remains unclear.
Comparison of perioperative outcomes of videothoracoscopy and robotic surgical techniques in thymoma
2020, Asian Journal of SurgeryVideo-Assisted Thoracic Surgery Thymectomy Versus Sternotomy Thymectomy in Patients With Thymoma
2017, Annals of Thoracic SurgeryMinimally invasive versus open thymectomy for thymic malignancies: Systematic review and meta-analysis
2016, Journal of Thoracic OncologyGreat vessel injury in thoracic surgery
2015, Thoracic Surgery ClinicsSurgical techniques for early-stage thymoma: Video-Assisted thoracoscopic thymectomy versus transsternal thymectomy
2014, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :These patients both underwent radiotherapy for their recurrence and were alive at the last follow-up examination but with additional disease progression. Although TS thymectomy has been the traditional reference standard for the treatment of thymoma,9-13 VATS thymectomy has been increasing in popularity. At our institute, an increasing proportion of patients with Masaoka stage I and II thymoma have been undergoing VATS thymectomy.