Thoracoscopic Excision Research Articles

An important finding for differential diagnosis in thymic cyst mimicking pericardial cyst: punctate calcification.

Mediastinal cysts are usually congenital but present in adulthood. A pericardial cyst is usually localized in the right cardiophrenic region. Thymic cysts are less common and are located in the cervical region or anterior mediastinal region. While thoracoscopic excision or aspiration can be applied in pericardial cysts, excision is recommended in thymic cysts. We present a case of a thymic cyst located in the localization of the pericardial cyst and radiologically containing wall punctate calcification.

Anaesthetic Considerations in the Video-assisted Thoracoscopic Excision of Pulmonary Aspergilloma: A Case Report

Video-assisted Thoracoscopy (VATS) is often used for diverse chest and lung ailments, which requires one-lung ventilation utilising a double-lumen tube. It involves small incisions and real-time imaging, resulting in enhanced postoperative recovery. A dry field allows the surgeon better visualisation of the thoracic cavity. To ensure that the patient is fit for prolonged single-lung ventilation, preoperative assessment is vital. While there are advantages and disadvantages to minimally invasive procedures, anaesthesia management and single-lung ventilation are key steps in a successful VATS procedure. Care must be taken to avoid elevated peak pressures intraoperatively. Hereby, the authors present a case report of a 49-year-old smoker with cough, fever, a known treated case of pulmonary Koch’s, and chronic lung disease. After a thorough clinical examination and imaging, he was diagnosed to have a cavitary lesion in the lung, suggestive of Aspergilloma. Authors performed thorough preoperative evaluation prior to surgery, which included pulmonary function tests to help identify the performance of the residual lung. For this patient, VATS was employed to resect the cavitary lesion along with the fungal ball. Single-lung ventilation with a double-lumen endotracheal tube was utilised to collapse the right lung and provide a better operative field. The surgery was uneventful with minimal blood loss, and histopathology confirmed the diagnosis. Due to the minimal access route, the duration of ventilation and recovery is hastened. Appropriate antibiotic/antifungal support, along with aggressive chest physiotherapy and incentive spirometry, is initiated early in such patients, as the pain following VATS is bearable.

Thoracoscopic Excision of Technically Challenging Mediastinal Bronchogenic Cysts in Children

Thoracoscopic Excision of Technically Challenging Mediastinal Bronchogenic Cysts in Children

MIS for enucleation of leiomyoma of the oesophagus-strategic approach and experience of 19 cases.

Leiomyoma of the oesophagus, although rare, is the most common benign tumour to occur in the organ. Surgical approaches have evolved over time from an open thoracotomy or laparotomy to video-assisted thoracoscopic or laparoscopic and now robotic enucleation. We report a series of 19 cases of leiomyoma of the middle- and lower-third oesophagus treated by minimally invasive surgery. A retrospective analysis of 19 cases operated at a single tertiary care centre in India was performed. After the diagnosis of a benign oesophageal neoplasm on computed tomography (CT) and endosonography, laparoscopic transhiatal enucleation of the tumour for lower third ( n = 16) and right-sided video-assisted thoracoscopic excision for middle-third tumours ( n = 3) were performed. Dor fundoplication was done after the excision of leiomyomas from the lower oesophagus. The most common symptom at presentation was retrosternal burning in lower oesophageal tumours, while tumours in the middle third of the oesophagus were asymptomatic and incidentally detected. The size of the tumour ranged from 3 cm to 8 cm in the largest dimension on contrast-enhanced CT scan. The mean operative time was 93 min ranging from 61 to 137 min. The average blood loss was 53 ml. No patient had an iatrogenic oesophageal mucosal injury. There were no conversions to open surgery or major complications including post-operative leak or death. Post-operative recovery was uneventful. The transhiatal approach to lower oesophageal leiomyomas is strategic to avoid complications of thoracoscopy, minimally invasive, cost-effective as compared to robotic surgery, suitable for adequate exposure and safe in the hands of an experienced laparoscopic surgeon.

Robotic excision of posterior mediastinal neurogenic tumours: Technique and surgical outcomes.

Neurogenic tumours are the most common tumours of the posterior mediastinum and account for 75% of the tumours in this region. Till recently, open transthoracic approach has been the standard of care for their excision. Thoracoscopic excision of these tumours is being commonly employed because of lesser morbidity and shorter hospital stay. The robotic surgical system offers a potential advantage over conventional thoracoscopy. We herein report our technique and surgical outcomes of excision of posterior mediastinal tumours using the Da Vinci Robotic Surgical System. We retrospectively reviewed 20 patients who underwent Robotic Portal-Posterior Mediastinal Tumour (RP-PMT) Excision at our centre. The demographic data, clinical presentation, characteristics of the tumour, operative and post-operative variables including, total operative time, blood loss, conversion rate, duration of the chest tube, hospital stay and complications were noted. Twenty patients underwent RP-PMT Excision and were included in the study. The median age was 41.2 years. The most frequent presentation was chest pain. Schwannoma was the most common histopathological diagnosis. There were two conversions. The total operative time was 110 min with an average blood loss of 30 mL. Two patients developed complications. The postoperative hospital stay was 2.4 days. With a median follow-up of 36 months (6-48 months), all except patients are recurrence-free, except the patient with malignant nerve sheath tumour who developed local recurrence. Our study demonstrates the feasibility and safety of robotic surgery for posterior mediastinal neurogenic tumours with good surgical outcomes.

Sestamibi-guided thoracoscopic excision of functional mediastinal parathyroid adenoma in a child: A case report and review of literature.

Primary hyperparathyroidism secondary to ectopic parathyroid (in anterior mediastinum) is rare in children. We report the case of a 12-year-old girl with a history of multiple fractures, renal calculi and limb deformities. She was diagnosed with hyperparathyroidism secondary to an intrathymic parathyroid adenoma. Sestamibi scan showed a lesion in the anterior mediastinum. A biochemical evaluation revealed hypercalcaemia, elevated alkaline phosphatase and parathormone levels. The lesion was marked with radioisotope and confirmed intraoperatively using a gamma camera. The child underwent thoracoscopic left thymectomy with the adenoma. Immediate decrease in calcium and parathyroid hormone values were noted intraoperatively and serial monitoring showed a downward trend. On follow-up, the child is doing well. Ectopic parathyroid adenoma is very rare. CT with radioisotope scans is helpful in diagnosis. Thoracoscopic excision of ectopic adenoma is safe in children.

Video asistirana torakoskopska resekcija ektopičnih medijastinalno lokalizovanih paratireoidnih žlezda - iskustva našeg centra

Introduction: The majority of mediastinal ectopic parathyroid glands (MEPTG) can be successfully removed through the cervical approach, including parathyroid glands (PTG) located in the upper mediastinum. However, 1% - 3% of patients with hyperparathyroidism (HPT) require the thoracic surgical approach. The success of surgical treatment depends on the precise preoperative localization of MEPTGs and on the choice of the appropriate approach. In this group of patients, video assisted thoracoscopic excision of MEPTGs can be used as a reliable method, in order to avoid open surgery, but also because of its other advantages. We present the first 11 patients with MEPTGs who were successfully surgically treated at the Clinic for Cardiothoracic Surgery of the Military Medical Academy (MMA). Previous video assisted thoracoscopic resections in Serbia have not been reported. Materials and methods: Between March 2014 and October 2022, 11 patients with biochemically proven hyperparathyroidism were surgically treated at the Clinic for Cardiothoracic Surgery of the MMA. MEPTGs were identified preoperatively with a Tc-99m sestamibi scan, a CT scan of the chest, and single photon emission computed tomography (SPECT). Results: All MEPTGs were successfully excised using video assisted thoracoscopic surgery (VATS). There was no need for an open thoracic surgical approach (sternotomy or thoracotomy). The average length of the surgery was 80 minutes (between 34 and 150 minutes). The average length of hospitalization was 7 days. Postoperative wound infection occurred in one patient. Conclusion: MEPTGs can be safely and successfully excised using VATS, thus avoiding classical chest opening. VATS provides good visualization of the tumor, low tissue trauma, short duration of surgery and hospitalization, a low rate of complications, and a good cosmetic/aesthetic effect.

Thoracoscopic excision of a thymoma situated in an aberrant anatomical location

No abstract available

A uniportal video-assisted thoracoscopic surgery hybrid approach for posterior mediastinal dumb-bell tumours

Posterior mediastinal dumb-bell tumours are neurogenic tumours that extend from the mediastinum to the intraspinal canal. They represent a surgical challenge because they may be resected using a staged or a single-stage approach. Until recently, a classic posterolateral thoracotomy was the gold standard for surgical resection for the intrathoracic segment. In the meantime, video-assisted thoracoscopic surgery has gained great acceptance among most thoracic surgeons because of the decreased surgical trauma, less operative blood loss and fewer postoperative complications and the shorter hospital stays. Proper selection of cases for thoracoscopic excision is crucial for ensuring good surgical outcomes. Factors such as tumour size, location and presence or absence of features suggesting malignancy should be considered. This procedure can offer great help in different case scenarios involving posterior mediastinal dumb-bell tumours. For giant tumours that will eventually need a thoracotomy, video-assisted thoracoscopic surgery helps the surgical team to choose an optimal site for a tailored thoracotomy incision and rule out any metastatic pleura seedings. In cases of small intrathoracic segments of dumb-bell tumours (≤ 6-8 cm) that require combined spinal and thoracic procedures in a single-stage approach, a combined posterior and video-assisted thoracoscopic surgical approach can be implemented for total resection of the tumour.

Complications and outcomes of thoracoscopic-assisted lung lobectomy in dogs.

To describe complications and outcomes of dogs undergoing thoracoscopic-assisted (TA) lung lobectomy. Multi-institutional, retrospective study. Client-owned dogs (n=30). Medical records of dogs that underwent TA lung lobectomy were reviewed. Signalment, bodyweight, clinical signs, imaging findings, surgical variables, complications, and short-term/long-term outcome were assessed. Thoracoscopic-assisted lung lobectomy was performed with a mini-thoracotomy. Twelve intraoperative complications were recorded in 11 dogs, 6 requiring conversion to open thoracotomy. Reasons for conversion were reported in 5/6 dogs and included adhesions (2), difficultly manipulating the lesion through the mini-thoracotomy (2), and acute oxygen desaturation (1). One lung ventilation was successful in 4 of the 7 dogs in which this was attempted. A linear stapling device (DST series Medtronic, Minneapolis, Minnesota) was used for lung lobe ligation in 14 dogs. Twenty-three dogs underwent surgery for a neoplastic lesion, with 19 of these being carcinoma. The median lesion size was 4.3 cm (range 1-10 cm); margins were clean, except in 1 dog. Complications were documented in 8 dogs prior to discharge, 5 of these being classified as mild. Twenty-nine dogs were discharged at a median of 47 h postoperatively (range 24-120 h). Death was reported in 9 dogs, with a median survival time of 168 days (range 70-868 days). Thoracoscopic-assisted lung lobectomy was achieved with few major complications in the population reported here. Dogs were able to be discharged from hospital quickly, with most surviving beyond the follow-up period. Thoracoscopic-assisted lung lobectomy may be considered to facilitate the excision of larger pulmonary lesions or to treat smaller dogs, in which a thoracoscopic excision may be technically more challenging.

548. THORACOLAPAROSCOPIC EXCISION OF ESOPHAGEAL DUPLICATION CYST

Abstract Esophageal duplication cysts are rare developmental anomalies. The prevalence is estimated at 1 in 8200 live births. In adults they are usually an asymptomatic incidental radiographic or endoscopic finding. Definitive diagnosis requires surgical excision and histological examination. Retrospective review of five consecutive patients with esophageal duplication cyst who were managed thoracolaparoscopically between January 2020 and March 2022 in a tertiary care teaching hospital. Four patients underwent thoracoscopic excision while one patient underwent transhiatal excision. The longitudinal muscle layer of the esophagus was opened. The proximal and distal limits of the lesion were delineated and then excised. The lesion was excised using endoGIA stapler in one patient where the lesion was tethered to the mucosa. The overlying layers were sutured. The size of the largest lesion was 9.2 cm x 5.8 cm. The median operating time was 150 minutes (90 to 220 minutes). The median hospital stay was 5 days (5-7 days). The post operative recovery was uneventful in all the patients. Esophageal duplication cysts can be safely managed with minimal morbidity by minimally invasive approaches even when the lesion is large.

One lung ventilation in left sided cystic hygroma: Anaesthesia challenges

Cystic hygroma [CH], also called as cavernous lymphangioma is a histologically benign congenital tumor of lymphatic origin. Its presence in the cervical region,most common site [25%] poses multiple challenges to the anaesthetist which includes tumor extension in oral and thoracic cavity, restricted neck movements, airway management, haemorrhage, post-operative respiatory obstruction and coexisting anomalies [down syndrome, turner syndrome, and congenital cardiac defects]. The recommended treatment is surgical excision which can be achieved with no mortality and little morbidity. The advantages of video assisted thoracoscopic surgery (VATS) in children have led to its increased usage over the years. VATS, however requires an efficient technique for one lung ventilation. Today there is an increasing interest in developing the technique for lung isolation to meet the anatomic and physiologic variations in infants and children. Significant differences exist between airways of the neonate and the adult. Anaesthetic management of the airway is challenging in neonates and young infants with large neck mass like huge cystic hygroma because these patients are at risk for sudden complete airway occlusion resulting in hypoventilation and hypoxemia. We report a successful anaesthesia management in an infant undergoing video assisted thoracoscopic excision of cystic hygroma in left side of neck which was extending to anterior mediastinum under general anaesthesia.

Successful resolution of ectopic Cushing syndrome by minimally invasive thoracoscopic resection of the neuroendocrine tumor of the thymus: a rare case report

BackgroundEctopic Cushing syndrome (ECS) is a sporadic condition. Even uncommon is an ECS that derives from a carcinoid tumor of the thymus. These tumors may pose several diagnostic and therapeutic conundrums. This report discusses the differential diagnosis, clinicopathological findings, and effective treatment of a rare case of ECS using a minimally invasive approach.Case presentationA 29-year-old woman with Cushing syndrome presented with facial flushing. Physical examination revealed hypertension (blood pressure: 141/100 mmHg). A mediastinal tumor was discovered to be the cause of the patient’s chronic hypokalemia and hypercortisolemia. Cortisol levels increased in the morning, reaching 47.7 ug/dL. The levels of the hormones ACTH, aldosterone, and renin were determined to be 281 pg/mL, 3.0 ng/dL, and 2.1 pg/mL, respectively. The presence of hypertension, hypokalemia, and alkalinity suggested Cushing’s syndrome, which was proven to be ACTH-dependent ECS by a dexamethasone suppression test. A chest CT scan revealed inflammation in the posterior basal region of the right lower lobe. The superior anterior mediastinum was characterized by round-shaped isodensity lesions with distinct borders. She underwent thoracoscopic anterior mediastinal tumor excision via the subxiphoid technique (R0 resection); following surgery, her blood pressure returned to normal, and the hypernatremia/hypopotassemia resolved. The tumor was determined to be a thymic carcinoid. Most notably, cortisol levels fell to half of their presurgical levels after one hour of surgery, and other abnormalities corrected substantially postoperatively.ConclusionThoracoscopic excision of thymic tumors by subxiphoid incision may be a useful treatment option for ECS caused by neuroendocrine tumors of the thymus

Thoracoscopic removal of a posterior mediastinal parathyroid adenoma

Ectopic Parathyroid Adenomas (EPA) can occur in many anatomical locations and the most frequent one was the mediastinum region. Traditionally, the adenoma resection has been performed through conventional thoracotomy or sternotomy. Recently, a few cases of thoracoscopic excision of mediastinal adenoma were reported. We report here the case of a successful exclusive thoracoscopic removal of a mediastinal parathyroid adenoma. A 58-year-old female patient presented with bilateral renal stones and fatigue. Biology results showed elevated serum calcium and parathyroid hormone levels. The diagnosis of primary hyperparathyroidism caused by solitary EPA in lateralesophageal region was confirmed by imaging tools. The patient underwent successful thoracoscopic resection. He was discharged on the 2rd postoperative day. Keywords: primary hyperparathyroidism; parathyroid adenoma; mediastinum; thoracoscopic excision.

Thoracoscopic excision of an intrathoracic para-cardiac lymphangioma of a child

A three year old boy was incidentally detected to have a right intrathoracic cystic mass while being investigated for an anterior abdominal wall lymphangioma. The intrathoracic mass was located in the costo pericardial recess very closely related to pericardium. He didn't have symptoms related to the thoracic mass and the imaging characteristics were evident of an intrathoracic lymphangioma. Since it was closely related to pericardium, radiologically guided sclerotherapy was not considered as a treatment. Thoracoscopic excision of the mass was done and he recovered uneventfully. Intrathoracic lymphangioma is a rare congenital lymphatic anomaly which needs definitive surgical treatment to prevent future complications. Minimally invasive thoracoscopic excision is a viable treatment option in children with intrathoracic lymphangioma.

Thoracoscopic excision of pediatric thymic cysts

Thymic cysts are rare lesions that may be congenital or acquired, and should be considered in the differential diagnosis in pediatric neck-thoracic masses. They are most of the time asymptomatic, presenting as slow-growing, painless masses. Evolution is generally benign, however surgical excision is considered the first choice for treatment, and could be performed via open technique (sternotomy) or with minimally invasive technique (thoracoscopy). Both techniques are safe and present little risk of postoperative recurrence, although thoracoscopic approach presents some advantages in terms of reduced postoperative pain, reduced surgical time and reduced length of hospital stay. A retrospective review of medical records of all patients admitted to our center in the last 5 years for surgical treatment for thymic cysts was performed. We recorded and evaluated clinical data, surgical data and follow-up data. In the reference period 3 patients were admitted with thymic cysts at our center. They all underwent complete minimally invasive excision by video assisted thoracoscopic surgery (VATS). Histopathological analysis revealed in 2 cases multilocular thymic cysts and in 1 case cystic thymic teratoma. Mean follow-up was 21 months. In the follow-up period any patients developed sympthoms, complications or relapses. According to our experience, thoracoscopic approach to thymic cyst is feasible, safe and allows a radical treatment of lesion offering excellent cosmetic results.

Cervicothoracic lipoblastoma: three case reports and review of literature

BackgroundLipoblastoma is a rare benign mesenchymal tumor of embryonal fat affecting mainly children below 3 years of age. It presents usually as a painless rapidly growing soft lobular mass in the extremities, trunk, and less frequently in the head-neck region. Preoperative imaging is used to assess the extent of disease and aid surgical planning. Complete surgical excision without injury to surrounding vital structures is the treatment of choice.Case presentationWe report three interesting lipoblastoma cases: mediastinal lipoblastoma with airway compression and ipsilateral diaphragmatic eventration, neck lipoblastoma with intrathoracic extension, and huge thoracic inlet lipoblastoma with compression of common carotid and Lt subclavian arteries, brachial plexus, and ipsilateral diaphragmatic eventration. Complete excision of lipoblastoma mass was done via neck incision in two cases, and the third case required thoracoscopic excision of intrathoracic remnant 6 months later. All three patients had an excellent outcome.ConclusionsManagement of cervicothoracic lipoblastoma is a surgical challenge due to the potential for rapid growth and extension to different fascial planes; however, successful excision can be achieved via a neck approach. Complete surgical excision is essential to prevent local recurrence and improve the outcome.

Anaesthetic considerations during video-assisted thoracoscopic excision of a mediastinal ectopic parathyroid adenoma.

Anaesthetic considerations during video-assisted thoracoscopic excision of a mediastinal ectopic parathyroid adenoma.

In Search of a Missing Adenoma

Background: The most common cause of primary hyperparathyroidism (PHPT) is overproduction of PTH by a parathyroid gland adenoma. While definitive therapy is parathyroidectomy, 4% of patients develop persistent PHPT - a sustained hypercalcemic state that is detected within six months of parathyroidectomy. A missed parathyroid adenoma is the most common cause of persistent PHPT, and accurately locating these glands presents a diagnostic challenge. We describe a rare case of persistent PHPT due to a missed mediastinal parathyroid adenoma.Case: A 54-year-old woman with a history of PHPT presented with abdominal pain, nausea, and decreased oral intake. She underwent parathyroidectomy six months ago with reimplantation of one parathyroid gland into the right sternocleidomastoid muscle (SCM). She was now hypercalcemic to 13.9 mg/dL (8.5–10.5) with intact PTH 1273 pg/mL (15.0–65.0), vitamin D 25-OH 31.4 ng/mL (>30.0), and normal PTHrP. She was not taking calcium, and other causes of hyperparathyroidism were excluded. Sestamibi scintigraphy localized only to the right SCM, and the initial impression was recurrent HPT due to the previously implanted gland. Follow-up CT neck with and without contrast failed to localize any regrowth in the SCM, but did reveal a 1.4 cm mediastinal soft tissue mass, suspicious for an ectopic parathyroid adenoma. She subsequently underwent video-assisted thoracoscopic excision, and pathology was consistent with ectopic hypercellular parathyroid tissue. Post-operatively, her PTH down-trended and calcium normalized.Conclusion: This case describes a small yet biochemically aggressive mediastinal adenoma causing persistent PHPT. While sestamibi scans have ~90% sensitivity for localization of ectopic adenomas, they can fail to identify a small culprit lesion in 12% of patients, whereas CT imaging with and without contrast has increased sensitivity for adenomas <2 cm. Thus, diagnosing persistent PHPT requires sestamibi scan in combination with other imaging modalities for accurate diagnosis of missed adenomas.

Right video assisted thoracoscopic surgery excision of neurogenic tumour in prone position

Right video assisted thoracoscopic surgery excision of neurogenic tumour in prone position