Feasibility of Minimally Invasive Sub-Xiphoid Mediastinoscopy as an Alternative Approach to Chamberlain Procedure
Mohommad A. Rafay, FRCS, Khaled M. Al Kattan, FRCS.
King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.
OBJECTIVE: Chamberlain procedure is performed for tissue diagnosis of anterior superior mediastinal tumors when other less invasive procedures fail to achieve the tissue diagnosis.The objective of this study is to assess the feasibility of minimally invasive Sub-Xiphoid Mediastinoscopy for biopsy to established the tissue diagnosis, to assess the pain and cosmetic advantage of skin incision.
METHODS: We performed Sub-Xiphoid Mediastinoscopy in 3 male and 3 female patients age range 12 years to 49 years, for tissue diagnosis of anterior mediastinal tumors, under general anesthesia. 2 to 3 cm mid line incision was placed below xiphoid process. The standard cervical video-mediastinoscope was used for the procedure. The study of CT chest with contrast and sagital sections were the road map to the procedure. Patients with tendency for cardiac arrhythmias were excluded from study. The patients were monitored for anticipated arrhythmias and hypo-tension during the procedure. The pain score and requirements of analgesics were recorded to asses the pain.
RESULTS: The tissue diagnosis was established in all six patients. There were no anticipated complications, like arrhythmias and hypo-tension. The pain on one to ten scale was 3. No patients required narcotic analgesics. Pain was adequately controlled with oral non-steroidal analgesics.
CONCLUSIONS: The Sub-Xiphoid Mediastinoscopy is feasible procedure with excellent results. The skin incision is 2 to 3 cm long just below xiphoid process and in desired location cosmetically. The pain caused by procedure is minimal. The tissue obtained for diagnosis was adequate for histo-pathology and additional study for immuno-histo-chemistry.
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