A new approach for posterior mediastinal tumors: thoracoscopic resection in the prone position

Thoracoscopic management of posterior mediastinal neurogenic tumours

Background:

This study describes the surgical technique of thoracoscopic resection of posterior mediastinal neurogenic tumours and reporting the surgical outcomes.

Methods:

This is a retrospective analysis of 21 patients operated over 7 years in a dedicated thoracic surgery centre. The demographic and post-operative parameters along with complications were recorded and analysed.

Results:

Twelve patients had right-sided tumours, while 9 had left-sided lesions, and 9 were on the left side. The most common diagnosis was schwannoma (n = 15, 71.42%), followed by neurofibroma (n = 4, 19.04%). The average surgery duration was 104 min (85–135 min), and the mean blood loss was 120 ml (25 ml–250 ml). The average lesion size was 4.8 cm (2 cm–7 cm). Conversion to open procedure was required in one patient. Two patients (14.2%) developed complications. One patient developed Horner's Syndrome and the other developed post-operative lung atelectasis. The median follow-up was 36 months (6–90 months). No recurrence was observed during the follow-up period.

Conclusions:

Thoracoscopic approach to posterior mediastinal neurogenic tumours is feasible and allows for low morbidity, short hospital stay and superior cosmesis.

Left thoracoscopic surgery in the prone position for a bronchogenic cyst localized to the lower thoracic esophagus: A case report

A 60-year-old woman with an abnormality discovered during a chest X-ray was referred to the authors' hospital for diagnosis and treatment. Upon enhanced computed tomography (CT), endoscopic ultrasonography, and magnetic resonance imaging, a tumor on the left side of the lower thoracic esophagus was detected. We diagnosed mediastinum cyst. One year after the first visit, a CT examination confirmed an increase in lesion size. Therefore, surgery was performed using a left thoracoscopic approach in the prone position. Before surgery, 3D models were used for simulation. Excision was performed without leakage of the contents. The histopathological diagnosis was a bronchogenic cyst. The left thoracoscopic surgery in the prone position is an uncommon approach but is useful for resecting tumors in the left side of the lower mediastinum. The authors were well-prepared and able to perform safe and reliable surgery.

Lateral- or prone-position video-assisted thoracic surgery for dumbbell-type posterior mediastinal tumors: pros and cons

Surgery for dumbbell-type posterior mediastinal tumors (D-PMTs) is difficult because surgeons should confirm the tumor’s extension into the spinal cord and pay attention to the Adamkiewicz artery. We describe two patients of D-PMTs who underwent lateral- or prone-position video-assisted thoracic surgery (VATS). In patient 1 (a 70-year-old woman), the tumor extended to the spinal canal through the fourth thoracic intervertebral foramen. After hemi-laminectomies, she was moved to the lateral position, and the tumor was resected. In patient 2 (a 16-year-old boy), the tumor extended to the spinal canal through the seventh thoracic intervertebral foramen. Additionally, 320-row high-resolution computed tomography showed Adamkiewicz arteries running through the sixth and eighth thoracic intervertebral foramina. After laminectomy, the tumor was resected without repositioning. Prone-position VATS is a useful approach for D-PMTs because it provides a better view of the vertebrae compared with the lateral position. We discuss the advantages and disadvantages of both approaches.

Prone position surgery for a subcarinal bronchogenic cyst

Background

Prone position surgery has become widespread for esophageal cancer instead of the traditional lateral decubitus approach. Carbon dioxide insufflation and the gravity effect provide a better operative field without parenchymal retraction. We herein report a case of a subcarinal bronchogenic cyst, which was successfully removed by the prone position surgery.

Case presentation

A 65-year-old man presented with a subcarinal mass and was planned to undergo a surgical resection in the prone position. Although he required bilateral ventilation due to hypoxemia, the excellent operative field was maintained and we completed the thoracoscopic surgery without any additional parenchymal retractions.

Conclusions

Thoracoscopic surgery in the prone position is a feasible option for subcarinal tumors with an excellent operative view and would facilitate a solo surgery without the need for a skilled assistant.

Prone-position thoracoscopic resection of posterior mediastinal lymph node metastasis from rectal cancer

Mediastinal lymph node metastasis from colorectal cancer is rare, and barely any reports have described resection of this pathology. We report herein a successful thoracoscopic resection of mediastinal lymph node metastasis in a prone position. A 65-year-old man presented with posterior mediastinal lymph node metastasis after resection of the primary rectal cancer and metachronous hepatic metastasis. Metastatic lymph nodes were resected completely using thoracoscopic surgery in the prone position, which provided advantages of minimal invasiveness, good surgical field, and reduced ergonomic burden on the surgeon. Thoracoscopic resection in the prone position was thought to have the potential to become the standard procedure of posterior mediastinal tumors.

Analysis of ICU treatment on resection of giant tumors in the mediastinum of the thoracic cavity

OBJECTIVE

The purpose of this study was to assess prognosis after resection of giant tumors (including lobectomy or pneumonectomy) in the mediastinum.

MATERIALS AND METHODS

Patients with resection of a giant tumor in the mediastinum of the thoracic cavity received ICU treatment including dynamic monitoring of vital signs, arterial blood pressure and CVP detection, determination of hemorrhage, pulmonary function and blood gas assay, treatment of relevant complications, examination and treatment with fiber optic bronchoscopy, transfusion and hemostasis as well as postoperative removal of ventilators by invasive and non-invasive sequential mechanical ventilation technologies.

RESULTS

Six patients were rehabilitated successfully after ICU treatment with controlled postoperative errhysis and pulmonary infection by examination and treatment with fiber optic bronchoscopy without second application of ventilators and tubes after sequential mechanical ventilation technology. One patient died from multiple organ failure under ICU treatment due to postoperative active hemorrhage after second operative hemostasis.

CONCLUSIONS

During peri-operative period of resection of giant tumor (including lobectomy or pneumonectomy) in mediastinum of the thoracic cavity, the ICU plays an important role in dynamic monitoring of vital signs, treatment of postoperative stress state, postoperative hemostasis and successful removal of ventilators after sequential mechanical ventilation.