Mediastinoscopy in the treatment of mediastinal cysts.
OBJECTIVE
Primary cysts constitute 25% of all masses in the mediastinum. Because radiological investigations are often inconclusive, many adults require mediastinoscopy, thoracotomy, video-assisted thoracic surgery, or computed tomography-guided transbronchial, transesophageal, or transcutaneous aspiration to confirm the cystic nature of these lesions. Minimally invasive procedures fail when the cyst contents are gelatinous and mucoid (failure to aspirate) or when the cyst wall continues to secrete fluid. Though Pursel reported mediastinoscopic extirpation of benign cysts 35 years ago, it remains a "therapeutic curiosity" with sporadic reports of its usage. We report 2 successful mediastinal cyst extirpations performed as outpatient procedures and review the literature with regards to its management.


METHODS
A rigid, 8-mm mediastinoscope was inserted into the anterior mediastinum following the creation of a 2-cm suprasternal incision and dissection along the anterior surface of the trachea. After aspiration, cytology of the contents revealed their benign nature. Right paratracheal cysts in 2 adult males were successfully removed mediastinoscopically by blunt and sharp dissection.


RESULTS
Histopathology revealed benign mesothelial cysts in both instances. Both patients had an uncomplicated procedure and were discharged within 23 hours. No other pathology was detected on mediastinoscopy, and follow-up at 3 months and 6 months has revealed no recurrence.


CONCLUSIONS
Mediastinoscopic cyst removal is a minimally invasive procedure with a very low morbidity and mortality rate. Morbidity, recovery, and discharge times are much less than those of more invasive procedures (video-assisted thoracic surgery / thoracotomy). We suggest that it should be the first-choice procedure for the excision of appropriately located benign mediastinal cysts.
Department of Surgery, Creighton University, 601 North 30th St, Ste 3700, Omaha, NE 68131, USA. sathyabc@creighton.edu
Sathyaprasad C
SC
Burjonrappa
Raymond
R
Taddeucci
Joseph
J
Arcidi
D000368:Aged; D006801:Humans; D008297:Male; D008476:Mediastinal Cyst / Q000000981:diagnostic imaging / Q000601:surgery*; D008481:Mediastinoscopy / Q000379:methods*; D008875:Middle Aged; D018301:Neoplasms, Mesothelial / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed