Article Abstract

Initial experience with a combined sequential left-sided and subxiphoid video-assisted thoracic surgery approach for resection of large anterior mediastinal tumors

Authors: José Ramon Matilla, Magda Alvoeiro, Alberto Benazzo, Stefan Schwarz, Walter Klepetko, Bernhard Moser


Background: There is no standard surgical approach to deal with anterior mediastinal disorders specially tumors with a diameter larger than 4 cm. Radical resection and speciment retrieval in minimally invasive surgery can be challenging.
Methods: We describe the first 4 cases of our initial experience dealing with large anterior mediastinal masses in a minimally invasive way. We combined the left side video-assisted thoracic surgery (VATS) approach with a single subxiphoid incision to achieve radical resection and remove the specimen at the end of the procedure without rib spreading.
Results: The operative time ranged from 117 to 151 minutes. Blood loss was less than 150 mL during the procedures. Patients were discharged at the third post-operative day with minimal discomfort at the subxiphoid region. No morbidity/mortality was observed.
Conclusions: Such procedure offers a safe option to deal with lesions without apparent invasion of other organs (mainly thymic tumors), allowing a good exposure for safe radical resection and for preserving both phrenic nerves. In the future we will consider this combined approach for lesions with a diameter of more than 4 cm and no radiological signs of infiltration.