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Lessons Learned: Minimally Invasive Resection of Mediastinal Pathology
Hannah M. Conn1, Conor Haynes2, Lorenzo De Marchi3, Margaret Blair Marshall4.
1Georgetown University School of Medicine, Washington, DC, USA, 2Georgetown University, Washington, DC, USA, 3MedStar Georgetown University Hospital, Department of Anesthesia, Washington, DC, USA, 4MedStar Georgetown University Hospital, Department of Thoracic Surgery, Washington, DC, USA.
OBJECTIVE: To review our experience using minimally invasive techniques including carbon dioxide (CO2) insufflation to resect pathology of the mediastinum.
METHODS: An IRB approved retrospective review of a prospectively maintained database was performed from January 2013 to October 2015. Patients undergoing minimally invasive resection of a mediastinal mass were selected for review.
RESULTS: Twenty-five patient charts were reviewed. Location of the pathology was anterior in 16, middle in 2 and posterior in 7. Pathologic diagnoses are seen in Table 1. CO2 insufflation was used in all cases. There were no adverse events related to CO2 insufflation. A single lumen tube was used in 19 of the 25 patients. Three patients underwent conversion: one was aborted and two underwent resection. Length of stay (LOS) ranged from 0-9 days with a mean of 2 days for VATS and a mean of 4 days for those that were converted (range 2-6 days). Of the VATS procedures, 3 patients were discharged on POD0, and 12 were discharged on POD1. There were no re-admissions. There were no complications.
CONCLUSIONS: The majority of mediastinal pathology is amenable to a minimally invasive approach. Large substernal goiters are least likely to be successfully resected with this approach. CO2 insufflation facilitates resection without the need for double lumen tube placement in many patients. The majority of patients undergoing a minimally invasive approach for mediastinal pathology have a short length of stay. The use of these techniques when possible will likely be associated with better outcomes and lower costs when compared with open approaches.
| VATS (n=22) | Conversion (n=2) | |
| Cyst | 3 | - |
| Goiter | 1 | 2 |
| Schwannoma | 4 | - |
| Thymic hyperplasia | 4 | - |
| Thymoma | 3 | - |
| other | 7 | - |
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