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Minimally Invasive Resection of Large Duplication Cyst
Conor Hynes, MD, Marc Margolis, MD, M. Blair Marshall.
Georgetown University Medical Center, Washington, DC, USA.

OBJECTIVE: The resection of large symptomatic intra-thoracic lesions may be an indication for a traditional open approach. Open approaches are associated with increased pain and morbidity when compared with their minimally invasive counterpart. However, some surgeons may not be comfortable using minimally invasive approaches for such lesions. We demonstrate the technical aspects of a minimally invasive resection of a large complex duplication cyst.
METHODS: A symptomatic 47 year old woman presented with a symptomatic thoracic cyst measuring 9 by 8 cm spanning between the pulmonary veins. For surgical resection, she was positioned prone to facilitate exposure. We used 4 ports: (3) 5mm and (1) 10mm with a 5mm 30 degree camera. A combination of blunt and sharp dissection was used to prevent injury to surrounding structures. Intra-operative endoscopy was used, detaching the light cord from the thorascope to demonstrate the integrity of the esophageal mucosa.
RESULTS: Pathology revealed ciliated respiratory epithelium. There were no complications. The chest tube was removed on post-operative day 1 and the patient was discharged to home. She was seen in follow-up two weeks and is well without symptoms or recurrence at 18 months.
CONCLUSIONS: Large complex intra-thoracic lesions can be safely resected with a combination of techniques. The exposure obtained with a thorascopic approach with the magnified view may be better than that obtained with an open approach. Intra-operative esophagoscopy with trans-illumination of the esophageal mucosa is useful to insure the integrity of esophageal mucosa. Large size does not necessitate an open approach.

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