Videothoracoscopic approach to primary mediastinal pathology

Study objectives: Personal results and validity of videothoracoscopic (VTS) approach to primary mediastinal diseases are analyzed. Design: Retrospective review of personal experience. Setting: Department of Surgery, San Giuseppe Hospital, University of Milano , Italy. Patients: From September 1991 to January 1999, of a personal series of 1,65 3 VTS procedures, 118 regarded primary mediastinal diseases. In 47 cases, d iagnostic videothoracoscopy was performed to obtain large biopsy specimens or to carry out accurate staging; in 71 cases, full resection was anticipat ed. Interventions: The patient, intubated with a double-lumen Carlen's tube and in the lateral decubitus position, underwent videothoracoscopy. Two ports and a small anterior utility thoracotomy were completed. Thorough explorati on of the mediastinum and, if possible, complete resection of the lesion we re accomplished. Measurements nun results: Videothoracoscopy yielded adequate diagnosis or s taging in all patients operation for diagnostic purposes. Of 71 patients op erated on with resective intent, 66 had complete thoracoscopic resection (2 2 stage-I thymomas, 4 thymic cysts, 21 myasthenia gravis associated with th ymic hyperplasia, 19 miscellaneous turners). Conversion was required in fiv e cases, mostly for invasion of mediastinal structures. Complications inclu ded the following: one patient developed intraoperative bleeding controlled endoscopically, two patients experienced postoperative bleeding requiring re-thoracoscopy, and one patient had postoperative pneumonia requiring assi sted ventilation, One recurrence of malignant thymoma occurred 4 years post operatively. Conclusions: Videothoracoscopy can attain a leading role in obtaining large samples in lymphatic mediastinal diseases. Dysembriomas, schwannomas, simp le cysts, and similar lesions can benefit from VTS removal. Total thymectom y for myasthenia gravis associated with thymic hyperplasia can be performed thoracoscopically. Further data and more extensive experience are needed.