title: Videothoracoscopic approach to primary mediastinal pathology.
abstract: OBJECTIVE
  Personal results and validity of videothoracoscopic (VTS) approach to primary mediastinal diseases are analyzed.
  
  
  METHODS
  Retrospective review of personal experience.
  
  
  METHODS
  Department of Surgery, San Giuseppe Hospital, University of Milano, Italy.
  
  
  METHODS
  From September 1991 to January 1999, of a personal series of 1,653 VTS procedures, 118 regarded primary mediastinal diseases. In 47 cases, diagnostic videothoracoscopy was performed to obtain large biopsy specimens or to carry out accurate staging; in 71 cases, full resection was anticipated.
  
  
  METHODS
  The patient, intubated with a double-lumen Carlen's tube and in the lateral decubitus position, underwent videothoracoscopy. Two ports and a small anterior utility thoracotomy were completed. Thorough exploration of the mediastinum and, if possible, complete resection of the lesion were accomplished.
  
  
  RESULTS
  Videothoracoscopy yielded adequate diagnosis or staging in all patients operated on for diagnostic purposes. Of 71 patients operated on with resective intent, 66 had complete thoracoscopic resection (22 stage-I thymomas, 4 thymic cysts, 21 myasthenia gravis associated with thymic hyperplasia, 19 miscellaneous tumors). Conversion was required in five cases, mostly for invasion of mediastinal structures. Complications included the following: one patient developed intraoperative bleeding controlled endoscopically, two patients experienced postoperative bleeding requiring re-thoracoscopy, and one patient had postoperative pneumonia requiring assisted ventilation. One recurrence of malignant thymoma occurred 4 years postoperatively.
  
  
  CONCLUSIONS
  Videothoracoscopy can attain a leading role in obtaining large samples in lymphatic mediastinal diseases. Dysembriomas, schwannomas, simple cysts, and similar lesions can benefit from VTS removal. Total thymectomy for myasthenia gravis associated with thymic hyperplasia can be performed thoracoscopically. Further data and more extensive experience are needed.
authors.affiliation: Department of General Surgery, San Giuseppe Hospital, Milano, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Roviaro
authors.forename: F
authors.initials: F
authors.lastname: Varoli
authors.forename: O
authors.initials: O
authors.lastname: Nucca
authors.forename: C
authors.initials: C
authors.lastname: Vergani
authors.forename: M
authors.initials: M
authors.lastname: Maciocco
mesh_terms: D001706:Biopsy / Q000379:methods; D003937:Diagnosis, Differential; D006801:Humans; D007902:Length of Stay; D008477:Mediastinal Diseases / Q000473:pathology / Q000601:surgery; D008479:Mediastinal Neoplasms / Q000473:pathology* / Q000601:surgery; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging / Q000379:methods; D015203:Reproducibility of Results; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted; D016896:Treatment Outcome