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The Annals of Thoracic Surgery, Vol 58, 1679-1683, Copyright © 1994 by The Society of Thoracic Surgeons
G Roviaro, C Rebuffat, F Varoli, C Vergani, M Maciocco and SM Scalambra
Mediastinal masses are generally excised through wide thoracotomies or
median sternotomies. These lesions are often benign, usually asymptomatic,
discovered incidentally, and relatively easy to resect. For these reasons,
a minimally invasive approach is appropriate. Videothoracoscopy allows an
optimal exploration of the pleural cavity and a panoramic view of the mass.
Dissection is usually easy to perform, and the mass can be extracted from
the thorax through a trocar incision or through a limited "utility
thoracotomy." To avoid possible tumor seeding, the mass is inserted in a
plastic bag before extraction. From September 1991 to January 30, 1994, 20
mediastinal masses (6 thymomas, 2 thymic cysts, 1 hyperplastic thymus, 1
fibrous tumor of the mediastinum, 2 pleuropericardial cysts, 2 thoracic
teratomas, 2 large thoracic lipomas, 3 neurogenic tumors, and 1
bronchogenic cyst) were removed through such a minimally invasive approach.
Eighteen patients had an uneventful postoperative course. Two patients
hemorrhaged in the immediate postoperative period, and repeat thoracoscopy
was done. In 1 patient, electrocoagulation of a bleeding intercostal artery
controlled the hemorrhage. In the other, the source of bleeding could not
be found, and removal of the clots and irrigation of the cavity stopped the
hemorrhage. Further data and long-term follow-up are necessary, but
videothoracoscopy offers a new, less invasive approach for the management
of noninvasive mediastinal masses.
ARTICLES
Videothoracoscopic excision of mediastinal masses: indications and technique
Department of Surgery, S. Giuseppe Hospital, University of Milan, Italy.
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