An analysis of video-assisted thoracoscopic resection for mediastinal masses in 150 cases. An overview of the pansternal approach, histology, and complications

Short-term outcomes of single- versus multi-port video-assisted thoracic surgery in mediastinal diseases

OBJECTIVES

Although there is growing interest in single-port video-assisted thoracic surgery for a number of thoracic operations, there is still not enough known about its use for mediastinal pathologies. The present study was aimed at assessing the safety and efficacy of single-port video-assisted thoracic surgery in comparison with the multi-port variants in terms of short-term perioperative outcomes.

METHODS

From July 2013 to December 2015, 285 consecutive non-myasthenic adult patients undergoing single- or multi-port video-assisted thoracic surgery for mediastinal diseases including thymoma were retrospectively reviewed. Patients were stratified depending on whether the pathology was thymoma. A propensity score matching pertaining to the approach used was performed within each stratified category. Perioperative outcomes were compared between matched cohorts.

RESULTS

During the study period, 141 (49.5%) patients were treated with single-port thoracoscopic surgery. Preoperative variables were comparable between both pairs of cohorts after matching. No morbidity or mortality occurred, except 1 case of empyema in a 2-port case. Single-port technique exhibited shorter operation time (thymoma: 78.8 vs 120.0 min, P = 0.011; non-thymoma: 78.4 vs 107.9 min, P < 0.001), less intraoperative blood loss (thymoma: 42.0 vs 78.4 ml, P = 0.002; non-thymoma: 46.0 vs 62.2 ml, P = 0.001) and a lower postoperative 10-point visual analogue scale pain score (thymoma: 2.6 vs 3.3, P = 0.026; non-thymoma: 2.4 vs 3.2, P < 0.001) than multi-port techniques in both patient categories.

CONCLUSIONS

Single-port video-assisted thoracic surgery is a safe approach for patients with loco-regional mediastinal disease, with potential advantages of shorter operative time, less intraoperative bleeding and less postoperative pain when compared with multi-port techniques.

History of thoracoscopic surgery in Japan and the world

PURPOSE

The aim of this study was to review articles to learn how current thoracoscopic surgery was developed to the present status.

MATERIALS AND METHODS

The Internet literature search engines PubMed and Index Medicus were used to search for the published articles. Interpretation of the articles was reflected in the reviewer's personal experience, who was closely associated with the developmental history.

RESULTS

Altogether, 49 articles were selected and reviewed.

CONCLUSIONS

A variety of applications of thoracoscopy have been developed. It remains the major surgical technique in thoracic surgery.

The robotic approach for mediastinal lesions

BACKGROUND

We report here our institutional experience and reflect the relevant literature concerning the robotic approach in diagnostic and therapeutic interventions for mediastinal lesions.

METHODS

During August 2001-December 2005, 33 patients (15 males and 18 females aged 18-77 years) with mediastinal masses were operated on minimally invasively using the da Vinci robotic system. There were 22 thymectomies (nine thymomas), four resections of paravertebral neurinomas, one ectopic mediastinal parathyroidectomy, one resection of a lymphangioma, one resection of ectopic goitre, one resection of lymph node metastasis of thyroid carcinoma and three oesophageal procedures (one leiomyoma, one traction diverticulum and one foregut cyst).

RESULTS

There were three (9%) open conversions due to surgical problems, 30 procedures (91%) were completed successfully using the da Vinci robot. There was no surgical mortality, no relevant intraoperative blood loss and no major surgical complication in any of the patients. As a minor complication (3%), an incomplete and transient palsy of the left laryngeal recurrent nerve was observed after resection of a tumour from the aortopulmonary window. The median overall operation time was 134 (range 54-314) min, including 103 (range 39-272) min for the robotic act.

CONCLUSIONS

Various different mediastinal procedures have been shown to be feasible and safe when performed with the robot. As the technical benefits of the da Vinci system are most advantageous in tiny and difficult-to-reach anatomical regions, the mediastinum should remain an area of special interest for robotic surgeons. Randomized trials and follow-up studies have been initiated in order to evaluate the clinical impact of the robotic approach.

Robotic Resection of an Ectopic Goiter in the Mediastinum

We report the first robotic resection of an ectopic mediastinal thyroid adenoma in a 72-year-old woman. This intervention was part of staged management for excessive bilateral cervical goiter with intrathoracic dispersion. The robotic resection was found to be feasible and safe. The robotic operating system offers better visual control and operative accuracy than does conventional thoracoscopy.

Thoracoscopic resection of Castleman disease: case report and review

Castleman disease is an uncommon entity, most often occurring in patients presenting with localized mediastinal lymph node enlargement. While surgical resection is the preferred treatment, there are concerns about approaching this highly vascular tumor with thoracoscopy. We present the second reported case of thoracoscopic resection of a patient with Castleman disease and review the literature.