title: Thoracoscopic resection of bulky intrathoracic benign lesions.
abstract: BACKGROUND
  Video-assisted thoracic surgery (VATS) is used for the diagnosis and treatment of some mediastinal lesions. However, large-size tumours are usually approached by thoracotomy or sternotomy. We report our experience of a full thoracoscopic approach for bulky intrathoracic lesions.
  
  
  METHODS
  From November 2002 to March 2007, 14 patients with a bulky intrathoracic mass were referred for resection. The study group consisted of eight females and six males with a mean age of 44 years (range: 13-74). We defined as bulky a mass with a minimal cross-sectional diameter equal to or larger than 50 mm, as measured on the specimen by the pathologist.
  
  
  RESULTS
  Thoracoscopic resection was completed in all patients. In 4 cases, the mass originated from the pleura, and in 10 cases from the mediastinum. The larger diameter of the lesion ranged from 50 mm to 160 mm, with a median of 90.2 mm. Operative time, calculated from insertion of the first trocar to skin closure, ranged from 40 to 190 min (mean: 102). Mean chest drain duration was 2.1 days (range: 1-4 days) and the mean hospital stay was 4.3 days (range: 3-11 days). There were no major postoperative complications. The final pathological diagnoses were the following: solitary fibrous tumours of the pleura (4), benign thymic cysts (2), teratomas (2), bronchogenic cyst (1), benign thymoma (1), pleuropericardial cyst (1) and benign neurogenic tumours (3).
  
  
  CONCLUSIONS
  With experience and use of appropriate instrumentation, resection of bulky intrathoracic lesions by thoracoscopy is feasible and safe. It should be considered as a reliable alternate for tumours that are benign and most often asymptomatic.
authors.affiliation: Thoracic Department, Institut Mutualiste Montsouris, 42 Bd Jourdan, F-75014 Paris, France. dominique.gossot@imm.fr
authors.forename: Dominique
authors.initials: D
authors.lastname: Gossot
authors.forename: Ricard Ramos
authors.initials: RR
authors.lastname: Izquierdo
authors.forename: Philippe
authors.initials: P
authors.lastname: Girard
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Stern
authors.forename: Pierre
authors.initials: P
authors.lastname: Magdeleinat
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008476:Mediastinal Cyst / Q000175:diagnosis / Q000601:surgery; D008479:Mediastinal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D054363:Solitary Fibrous Tumor, Pleural / Q000175:diagnosis / Q000601:surgery*; D013724:Teratoma / Q000175:diagnosis / Q000601:surgery; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome