An analysis of video-assisted thoracoscopic resection for mediastinal masses in 150 cases - An overview of the pansternal approach, histology, and complications

Background. To clarify the usefulness of the diagnosis and treatment of med iastinal masses, by video-assisted thoracoscopic surgery (VATS), we perform ed a retrospective multiinstitutional study to delineate the type of approa ch, histopathology, and complications associated with these entities. Methods: We analyzed 150 patients who underwent the VATS procedure at sever al institutions between 1991 and 1999. Results: VATS resections were performed using various combinations of the " pansternal approach." The unilateral thorax approach was applied in 135 pat ients, the bilateral thorax approach combined with the suprasternum. approa ch in seven patients, the unilateral thoracic approach combined with the su praclavicular approach in three patients, the infrasternal approach in thre e patients, and the bilateral thoracic approach combined with both the infr asternal and the suprasternal approaches in two patients. Thoracoscopic res ections or biopsies diagnosed 140 benign and 10 malignant mediastinal masse s. There were operative complications in nine patients (6%). Eight patients (5.3%) were converted to conventional thoracotomy. Conclusion: VATS is a safe, effective, minimally invasive technique that ca n facilitate the resection of mediastinal masses when the pansternal approa ch is applied as appropriate for the location of the tumor.