Starting and Staying Minimally Invasive For Removal Of Large Posterior Mediastinal Mass
URMC, Rochester, NY, USA.
BACKGROUND - Video-Assisted Thoracoscopic Surgery We present a case of successful removal of an 8.5 cm noncompliant mass with a broad attachment to the parietal pleura.
METHODS - We describe a complex clinical case report of a patient who underwent VATS mass resection.
RESULTS - We describe a 34 y.o. male who presented to University Medical Center after an acute onset of dyspnea. A chest radiograph and subsequent CT chest revealed a large posterior mediastinal mass at 8.0 x 8.0 x 8.5 cm. Mass excision was scheduled by Video-Assisted Thoracoscopic Surgery (VATS) versus thoracotomy. The attachment to the parietal pleura was very broad with an array of venous and arterial vasculature. A 30-degree camera scope was able to maneuver tight imaging windows. Some bleeding was encountered that was easily controlled with sponge stick and pressure. The posterior mediastinal mass was successfully removed by VATS resection.
CONCLUSIONS - VATS as a minimally invasive surgical resection for a large posterior mediastinal mass is not well described. Tumors greater than 4 cm is a soft contraindication to VATS removal. The benefits of VATS versus thoracotomy have been thoroughly explored. Knowing when to convert given bleeding, loss of visualization inability to perform with appropriate dexterity are all reasonable concerns leading to thoracotomy conversion. An algorithm must also exist for the more senior surgeon contemplating when one should and could remain in VATS.
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