Technical advances in mediastinal surgery: videothoracoscopic approach to posterior mediastinal tumors

Surgical treatment of a cystic neoplasm of the posterior mediastinum: Case report and literature review

INTRODUCTION AND IMPORTANCE

The study presents a clinical case of removal of a paravertebral tumour by thoracoscopic method and a review of the literature on the diagnosis and treatment of posterior mediastinal tumours.

CASE PRESENTATION

A 26-year-old female patient presented with an extradural, paravertebral posterior mediastinal tumour and complaints of low back pain. The mass was diagnosed by computer tomography (CT) and magnetic resonance imaging (MRI). The mass was mobilised from the adjacent vital structures without rupturing the capsule by thoracoscopic approach. The histological examination of the extracted mass was diagnosed as a bronchogenic cyst.

CLINICAL DISCUSSION

Thoracoscopic surgery provides sufficient volume in the mediastinum to perform instrument manipulations with minimal damage to adjacent structures and meets oncological criteria.

CONCLUSION

Thoracoscopic surgery of posterior mediastinal tumours demonstrates clinically significant benefits and treatment efficacy compared to open surgery, and is characterised by a low incidence of postoperative complications, short surgery duration, rapid postoperative recovery and better cosmetic effect.

Complete anterior-posterior minimally invasive thoracoscopic robotic-assisted and posterior tubular approach for resection of thoracic dumbbell tumor

Thoracic dumbbell tumors are relatively uncommon neoplasms that arise from the neurogenic elements. Surgical resection can be challenging as the tumor involves both the spinal canal and thoracic cavity. Historically, thoracotomy and laminectomy were utilized for the resection of these tumors. Although single-stage removal of such tumors has been described recently, there is no prior description of a total minimally invasive single-stage resection of a thoracic dumbbell ganglioneuroma. The current report describes a completely minimally invasive surgical resection for such a tumor performed using the posterior minimally invasive tubular approach to resect the intraspinal component with ligation of the T2 nerve root in conjunction with robotic-assisted thoracoscopic resection of the extraforaminal, intrathoracic component of the tumor. This report illustrates the safety and utility of a completely minimally invasive endoscopic resection of a thoracic dumbbell tumor that can potentially obviate the morbidity associated with open surgical resections for such tumors.

Video-assisted thoracoscopic surgery is a safe and effective method to treat intrathoracic unicentric Castleman's disease

Background

Castleman’s disease (CD) is a rare non-clonal lymphadenopathy. Application of video-assisted thoracoscopic surgery (VATs) in intrathoracic unicentric Castleman’s disease (UCD) is rarely reported. This study is aimed to clarify the role of VATs for diagnosis and treatment in intrathoracic UCD.

Methods

The authors reviewed and identified patients who had received a histologic diagnosis of CD through VATs at our hospital from January2010 to June 2018. Clinical and radiologic variables, histopathology, type of approach, complications, and long-term effect were analyzed to evaluate the safety and efficacy of VATs.

Results

A total of 10 patients were included in this study, with 8 hyaline vascular type and 2 plasma cell type. The mean maximum diameter of the lesions was 4.66 cm. Nine cases underwent complete surgical excision by VATs, and 1 case was converted to thoracotomy. All patients had no postoperative complications. With a median follow-up of 5 years (range: 1–9 years), no tumor recurrence was found in 9 patients receiving complete tumor resection, and 1 patient with incomplete tumor resection remained symptom free without clinical or radiographic progression.

Conclusions

VATs is an alternative, minimally invasive technique for the diagnosis and treatment in patients with intrathoracic UCD.

A giant ganglioneuroma accompanied with scoliosis

Ganglioneuroma is a rare benign neoplasm. Patients with ganglioneuroma show no symptoms. We describe a rare case of giant ganglioneuroma with scoliosis in a 35-year-old woman, who presented to our hospital for haemoptysis. We combined with neurosurgeons to remove the tumour successfully. After 16 months of follow-up, there is no evidence of tumour recurrence.

Approach to a Posterior Cervicomediastinal Ganglioneuroma

Posterior mediastinal masses centered on the thoracic inlet require a thoughtful operative approach. Herein, a case of a young woman with a symptomatic posterior cervicomediastinal ganglioneuroma is reported to highlight such considerations.

Giant neurogenic tumors of mediastinum: report of two cases and literature review

Neurogenic tumors are commonly found in the mediastinum, especially in the posterior mediastinum or in the chest wall, neurogenic tumors may reach large size before becoming symptomatic. If the neurogenic tumor occupied more than half size of the chest wall accompanied by mediastinal shift, tracheal compression, or superior vena reflux disorder, it may be called giant intrathoracic neurogenic tumors. Giant intrathoracic neurogenic tumors are relatively rare. Most of intrathoracic neurogenic tumors were benign or low-grade malignant tumors in nature. Complete surgical excision should be the rule for these patients. We report two cases of giant neurogenic tumors, and study the clinical manifestations, diagnostic methods, surgical management, and prognosis in the light of the most important published data.

Experience of video-assisted thoracoscopic resection for posterior mediastinal neurogenic tumours: a retrospective analysis of 58 patients

INTRODUCTION

The objective of this study was to review the experience of video-assisted thoracoscopic resection of posterior mediastinal neurogenic tumours and to investigate the technical features and difficulties of this thoracoscopic approach.

METHODS

From May 2001 to June 2011, 58 consecutive patients underwent thoracoscopic resection of posterior mediastinal tumours sequentially in our institution, including 36 males and 22 females. The median age of the patients was 38.7 years. The median tumour size was 4.9 cm. Twenty-four lesions were located at the left side, 33 lesions at the right side and 1 lesion at the bilateral side. All procedures generally required three ports, and intracapsular enucleation was preferred. For bulky tumours, dense adhesion and massive bleeding, conversion to thoracotomy was performed by extending the anterior incision to 6-10 cm.

RESULTS

All procedures were successfully performed without death or serious complications occurring. The average operating duration was 127.2 min. The average intraoperative blood loss was 206.4 mL. The average chest tube drainage duration was 2.72 days. The average post-operative stay was 5.19 days. Fifty-three procedures were performed entirely under thoracoscopy to achieve gross total resection. There were five cases (8.6%) of conversion to thoracotomy procedure. Seven patients suffered from post-operative complications, including four Horner syndromes. No local recurrence occurred after an average follow-up of 44.9 months.

CONCLUSION

Video-assisted thoracoscopic resections of the posterior mediastinal tumours were safe and reliable for selected patients with mastered thoracoscopic skills. Intracapsular enucleation was demonstrated to be a safe procedure. For tumours larger than 6 cm and located in the apex, the risk of the operation increased significantly.

U-clip for airway reconstruction: an experimental study of the feasibility of a robot-assisted endoscopic procedure

BACKGROUND

The U-clip anastomotic device was developed to facilitate interrupted anastomoses without the need to tie sutures. Recently, this technology has been expanded into various fields of surgery. However, in the field of airway reconstruction, there have been no previous reports of this technology being used. The present study examined the technical feasibility of performing safe and efficient robot-assisted endoscopic airway reconstruction using nitinol U-clips in rabbits.

METHODS

A total of six tracheal anastomoses with S60 U-clips were performed using the da Vinci Surgical System. Anastomosis time and complications were recorded. The effectiveness of anastomoses was evaluated by postoperative observation of rabbits for 8 weeks and measurement of anastomotic strictures and pathological findings.

RESULTS

All procedures were completed safely. Mean procedure time was 14 ± 1.8 min (mean ± SD). There were no perioperative complications; however, all animals died between postoperative days 14-27, and anastomotic stricture was the likely cause of death. All anastomoses had severe strictures; the mean stricture rate was measured as being 51.1 ± 33.3 (%).

CONCLUSIONS

Although the technical feasibility of robot-assisted endoscopic airway reconstruction using U-clips has been demonstrated in rabbits, the safety of this technique has not been evaluated. Our data suggest that U-clips are not a feasible approach for airway reconstruction surgery because of the occurrence of severe postoperative anastomotic stricture.

Video assisted thoracoscopic resection of a posterior mediastinal Castleman's tumor

Castleman's disease (CD) or angiofollicular lymph node hyperplasia is a rare spectrum of lymphoproliferative disorders. CD tumors are commonly localized in the mediastinum and are usually asymptomatic. The mainstay of treatment is surgical resection and has typically been performed using open thoracotomy. Few reports in the literature describe video assisted thoracoscopic resection of these tumors. The differential diagnosis for mediastinal masses is extensive, and CD tumors, although uncommon, should be considered. We describe a case report of a posterior mediastinal Castleman's tumor adherent to the esophagus, which was resected thoracoscopically and review the literature.