Videothoracoscopic approach to primary mediastinal pathology

Giancarlo Roviaro, Federico Varoli, Ombretta Nucca, Contardo Vergani, Marco Maciocco

Research output: Contribution to journalArticle

58 Citations (Scopus)

Abstract

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 1,653 VTS procedures, 118 regarded primary mediastinal diseases. In 47 cases, diagnostic videothoracoscopy was performed to obtain large biopsy specimens or to carry out accurate staging; in 71 cases, full resection was anticipated. 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 exploration of the mediastinum and, if possible, complete resection of the lesion were accomplished. Measurements and results: Videothoracoscopy yielded adequate diagnosis or staging in all patients operated on for diagnostic purposes. Of 71 patients operated on with resective intent, 66 had complete thoracoscopic resection (22 stage-I thymomas, 4 thymic cysts, 21 myasthenia gravis associated with thymic hyperplasia, 19 miscellaneous tumors). Conversion was required in five cases, mostly for invasion of mediastinal structures. Complications included the following: one patient developed intraoperative bleeding controlled endoscopically, two patients experienced postoperative bleeding requiring re-thoracoscopy, and one patient had postoperative pneumonia requiring assisted ventilation. One recurrence of malignant thymoma occurred 4 years postoperatively. Conclusions: Videothoracoscopy can attain a leading role in obtaining large samples in lymphatic mediastinal diseases. Dysembriomas, schwannomas, simple cysts, and similar lesions can benefit from VTS removal. Total thymectomy for myasthenia gravis associated with thymic hyperplasia can be performed thoracoscopically. Further data and more extensive experience are needed.

Original languageEnglish
Pages (from-to)1179-1183
Number of pages5
JournalChest
Volume117
Issue number4
Publication statusPublished - 2000

Fingerprint

Pathology
Mediastinal Diseases
Thymus Hyperplasia
Thymoma
Myasthenia Gravis
Mediastinal Cyst
Hemorrhage
Thoracoscopy
Thymectomy
Neurilemmoma
Mediastinum
Lymphatic Diseases
Thoracotomy
Reproducibility of Results
Italy
Ventilation
Cysts
Pneumonia
Biopsy
Recurrence

Keywords

  • Mediastinal neoplasms
  • Myasthenia gravis
  • Thoracoscopy
  • Thymectomy
  • Thymoma

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Roviaro, G., Varoli, F., Nucca, O., Vergani, C., & Maciocco, M. (2000). Videothoracoscopic approach to primary mediastinal pathology. Chest, 117(4), 1179-1183.

Videothoracoscopic approach to primary mediastinal pathology. / Roviaro, Giancarlo; Varoli, Federico; Nucca, Ombretta; Vergani, Contardo; Maciocco, Marco.

In: Chest, Vol. 117, No. 4, 2000, p. 1179-1183.

Research output: Contribution to journalArticle

Roviaro, G, Varoli, F, Nucca, O, Vergani, C & Maciocco, M 2000, 'Videothoracoscopic approach to primary mediastinal pathology', Chest, vol. 117, no. 4, pp. 1179-1183.
Roviaro G, Varoli F, Nucca O, Vergani C, Maciocco M. Videothoracoscopic approach to primary mediastinal pathology. Chest. 2000;117(4):1179-1183.
Roviaro, Giancarlo ; Varoli, Federico ; Nucca, Ombretta ; Vergani, Contardo ; Maciocco, Marco. / Videothoracoscopic approach to primary mediastinal pathology. In: Chest. 2000 ; Vol. 117, No. 4. pp. 1179-1183.
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