Study objectives: Personal results and validity of
videothoracoscopic (VTS) approach to primary mediastinal diseases are
Design: Retrospective review of personal
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
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