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Ann Thorac Surg 2004;78:987-991
© 2004 The Society of Thoracic Surgeons

Original article: general thoracic

Video-assisted thoracoscopic surgery of mediastinal bronchogenic cysts in adults: A single-center experience

Thomas Weber, MD, PhDa,*, Thierry C. Roth, MDa, Morris Beshay, MDa, Peter Herrmann, MDb, Robert Stein, MDa, Ralph A. Schmid, MD, PhDa

a Division of General Thoracic Surgery, University Hospital Berne, Bern, Switzerland
b Division of Radiology, University Hospital Berne, Berne, Switzerland

Accepted for publication March 25, 2004.

* Address reprint requests to Dr Weber, Division of General Thoracic Surgery, University Hospital Berne, Freiburgstrasse, CH-3010 Berne, Switzerland
thomas.weber{at}insel.ch

BACKGROUND: Mediastinal bronchogenic cysts are rarely diagnosed in adults, hence surgical experience is limited particularly with regard to video-assisted thoracoscopic surgery. In support of the thoracoscopic approach we report our single-center experience in this rare entity.

METHODS: Between June 1995 and December 2002, a nonselected series of 12 consecutive patients presenting with mediastinal bronchogenic cysts underwent video-assisted thoracoscopic surgery. Six cysts (50%) had been diagnosed 2 to 22 years prior, only three of which became symptomatic. In asymptomatic patients (n = 7) surgery was performed because of increasing cyst size (n = 3), patient's request (n = 3), or suspected metastasis (n = 1).

RESULTS: Mediastinal bronchogenic cysts were correctly diagnosed by computed tomography in 83% (10/12) and by magnetic resonance imaging in 100% (9/9). Using a three-trocar technique thoracoscopic surgery was successfully performed in 11 of 12 cases (92%). We noted no signs of acute cyst infection. No serious postoperative complications were observed. In 1 patient conversion to open thoracotomy was necessary due to extensive pleural adhesions. In another case thoracoscopic excision of the cyst wall was incomplete. Patients with thoracoscopic excision were discharged after a median of 5.5 days (range 4 to 14 days). No recurrences or complications were observed during a mean follow-up of 40.5 months.

CONCLUSIONS: Considering the low conversion and complication rate in our series, video-assisted thoracoscopic surgery should be the primary therapeutic choice among adults with symptomatic mediastinal bronchogenic cysts. Surgical intervention in patients with asymptomatic and uncomplicated cysts appears optional.




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