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Right thoracoscopic mediastinal mass resection and bronchial injury repair
The objective is to demonstrate our technique for thoracoscopic mediastinal mass excision with concomitant bronchial injury repair.
A 13-year-old boy presented with one-month of dysphagia and a history of a recent tick bite prophylactically treated. Esophagram showed a mid-esophageal externally compressing mass confirmed by endoscopy. Chest MRI showed a 5cm mediastinal mass. Differential diagnosis included infected esophageal duplication cyst versus histoplasmoma. A thoracoscopic mass resection was scheduled.
Upon accessing the right chest, a mid-thoracic lesion next to the esophagus was noted. The mass was adherent to the esophageal wall during dissection. Intraoperative biopsy revealed a cottage cheese-like substance in the mass. Frozen section suspected a duplication cyst in the esophageal musculature. As a result, we proceeded with the resection. The cavity was then irrigated and some fluid was noted at the endotracheal tube. A 5mm right mainstem bronchus tear was found. Flexible bronchoscopy was used to repair the injury with absorbable sutures. The mass was removed from the esophageal wall and repaired with absorbable sutures. A small pleural flap was created to prevent the sutures from communicating. The patient had a small persistent pneumothorax several days postoperatively. Repeat flexible bronchoscopy showed no leak or narrowing on postoperative day (POD) 7. The patient was discharged home on POD 8. Final pathology showed a mediastinal lymph node with a non-caseating granuloma. He had positive antibodies to Francisella tularensis (tularemia Ab). His final diagnosis was mediastinal tularemia.
This video demonstrates mediastinal mass diagnostic and treatment challenges. It also shows that concomitant bronchial injuries are safe and effective to repair thoracoscopically.
T Huy, AS Munoz Abraham, H Osei, C Cappiello, GA Villalona
Surgical intervention
3 months ago
837 views
8 likes
0 comments
05:17
Right thoracoscopic mediastinal mass resection and bronchial injury repair
The objective is to demonstrate our technique for thoracoscopic mediastinal mass excision with concomitant bronchial injury repair.
A 13-year-old boy presented with one-month of dysphagia and a history of a recent tick bite prophylactically treated. Esophagram showed a mid-esophageal externally compressing mass confirmed by endoscopy. Chest MRI showed a 5cm mediastinal mass. Differential diagnosis included infected esophageal duplication cyst versus histoplasmoma. A thoracoscopic mass resection was scheduled.
Upon accessing the right chest, a mid-thoracic lesion next to the esophagus was noted. The mass was adherent to the esophageal wall during dissection. Intraoperative biopsy revealed a cottage cheese-like substance in the mass. Frozen section suspected a duplication cyst in the esophageal musculature. As a result, we proceeded with the resection. The cavity was then irrigated and some fluid was noted at the endotracheal tube. A 5mm right mainstem bronchus tear was found. Flexible bronchoscopy was used to repair the injury with absorbable sutures. The mass was removed from the esophageal wall and repaired with absorbable sutures. A small pleural flap was created to prevent the sutures from communicating. The patient had a small persistent pneumothorax several days postoperatively. Repeat flexible bronchoscopy showed no leak or narrowing on postoperative day (POD) 7. The patient was discharged home on POD 8. Final pathology showed a mediastinal lymph node with a non-caseating granuloma. He had positive antibodies to Francisella tularensis (tularemia Ab). His final diagnosis was mediastinal tularemia.
This video demonstrates mediastinal mass diagnostic and treatment challenges. It also shows that concomitant bronchial injuries are safe and effective to repair thoracoscopically.
Thoracoscopy for voluminous left thoracic neuroblastoma in a 2-year-old girl
Video-assisted oncological surgery should be performed in strict compliance with surgical oncology requisites: complete excision, no risk of cancer cell dissemination, and no additional operative risks. Radical surgery requirements must be respected and adjacent organs must be preserved. Our team contributed to research articles on neurogenic tumor surgery, published in international medical journals in 2007 (J Pediatr Surg, 2007; 42 (10): 1725-8 and J Laparoendosc Adv Surg Tech A 2007; 17 (6): 825-9).
Our case study further demonstrates that the thoracoscopic resection of neurogenic tumors perfectly meets oncological surgery requirements, offering the parietal benefits of minimally invasive surgery. A magnified operative field is a major asset because it allows performing surgery safely. It is now possible to gain a perfect knowledge of the patient and tumor anatomy preoperatively by using a 3D modeling tool and preoperative CT-scan images of the patient.
C Klipfel, A Lachkar, F Becmeur
Surgical intervention
9 months ago
512 views
2 likes
1 comment
04:32
Thoracoscopy for voluminous left thoracic neuroblastoma in a 2-year-old girl
Video-assisted oncological surgery should be performed in strict compliance with surgical oncology requisites: complete excision, no risk of cancer cell dissemination, and no additional operative risks. Radical surgery requirements must be respected and adjacent organs must be preserved. Our team contributed to research articles on neurogenic tumor surgery, published in international medical journals in 2007 (J Pediatr Surg, 2007; 42 (10): 1725-8 and J Laparoendosc Adv Surg Tech A 2007; 17 (6): 825-9).
Our case study further demonstrates that the thoracoscopic resection of neurogenic tumors perfectly meets oncological surgery requirements, offering the parietal benefits of minimally invasive surgery. A magnified operative field is a major asset because it allows performing surgery safely. It is now possible to gain a perfect knowledge of the patient and tumor anatomy preoperatively by using a 3D modeling tool and preoperative CT-scan images of the patient.
Thoracoscopic approach to pericardial effusions
The description of the Thoracoscopic approach to pericardial effusions covers all aspects of the surgical procedure used for the management of (description de la pathologie en cause).
Operating room set up, position of patient and equipment, instruments used are thoroughly described. The technical key steps of the surgical procedure are presented in a step by step way: Introduction, Anatomy, Indications, Preop period, Operating room set-up, Trocar placement, Instruments, Access/pericardium, Puncture/pericardium, Pericardial opening, Pericardial exploration, Drainage, Complications, Postop period, Reference.
Consequently, this operating technique is well standardized for the management of this condition.
D Gossot
Operative technique
18 years ago
1700 views
51 likes
0 comments
Thoracoscopic approach to pericardial effusions
The description of the Thoracoscopic approach to pericardial effusions covers all aspects of the surgical procedure used for the management of (description de la pathologie en cause).
Operating room set up, position of patient and equipment, instruments used are thoroughly described. The technical key steps of the surgical procedure are presented in a step by step way: Introduction, Anatomy, Indications, Preop period, Operating room set-up, Trocar placement, Instruments, Access/pericardium, Puncture/pericardium, Pericardial opening, Pericardial exploration, Drainage, Complications, Postop period, Reference.
Consequently, this operating technique is well standardized for the management of this condition.