Videothoracoscopic Excision of Mediastinal Tumors and Cysts Using the Harmonic Scalpel

Abstract

The aim of this study was to evaluate the safety and reliability of the harmonic scalpel for performing VATS excisions of mediastinal tumors and cysts. We have prospectively studied 19 cases presenting with a mediastinal tumor or cyst operated on consecutively since January 2003. We performed 10 left-sided and 9 right-sided VATS procedures; the mean age at operation was 50 +/- 15 years. Two masses were in the anterior mediastinum, 5 in the middle mediastinum and 12 in the posterior mediastinum. One patient required conversion to a minithoracotomy for bleeding. The maximum tumor diameter was 38 +/- 14 mm and the maximum cyst dimension was 55 +/- 20 mm. The mean operating time was 66 +/- 28 min. Three patients experienced minor complications. The postoperative hospital stay was 3.5 +/- 1.7 days, and we had no mortality. Histopathology revealed 1 esophageal leiomyosarcoma, 1 Langerhans cell histiocytosis X, 1 hamartoma, 5 schwannomas, 1 neurofibroma, 1 malignant peripheral nerve sheath tumor, 1 reactive lymphadenopathy, 1 tuberculous lymphadenopathy, 1 cystic hygroma, 2 bronchogenic cysts, 2 foregut cysts, 1 thymic cyst, and 1 pleuropericardial cyst. There has been no recurrence of tumor or cyst on follow-up. Videothoracoscopic excision of mediastinal tumors and cysts can be safely performed using the harmonic scalpel with a low morbidity and mortality.