[Complications of mediastinoscopy].
Mediastinoscopy is a minimum invasive investigation representing a reference in mediastinum exploration and having a major role regarding therapeutic strategies in patients with lung cancer or other mediastinal pathology. Research studies show that this surgical intervention, although having in reality low morbidity and mortality (0.6-3.7% morbidity and 0.2% mortality), is potentially dangerous in non properly trained hands. Mediastinoscopy related complications appear as a consequence of the following: (1) incision and access path; (2) surgical maneuvers and are also general complications as in any other surgical approach related to anesthesiology act or postoperative recovery course. The most frequent complications are surgical-related: hemorrhage, recurrent palsy, pneumothorax, tracheal laceration, esophageal lesions, wound dehiscence or anesthesiology-related such as: cardiac arrest and respiratory hypoxia, various arrhythmias, cerebral insufficiency, amaurosis fugax. From all the complications only 0.1-0.5% have clinical significance, the most dreadful remaining massive hemorrhage, which requires a trained team with a very well equipped operating theatre for thoracic, vascular and cardiac surgery. Frequently in cure and prevention of such disastrous events a close cooperation between radiologist, oncologist, surgeon is required (for method limits) and anesthesiologist and from a different perspective with the bronchologist, pneumologist and gastro-enterologist. In trained hands and in teaching hospitals mediastinoscopy remains the golden standard in mediastinal evaluation, a simple procedure, with low morbidity and mortality.
Paleru
Cristian
C
Clinica de Chirurgie Toracică, Institutul de Pneumologie, Marius Nasta, Bucureşti. cpaleru@yahoo.com
Dănăilă
Olga
O
Bolca
Ciprian
C
Cordoş
Ioan
I
D020757:Amaurosis Fugax / Q000209:etiology; D000768:Anesthesia, General / Q000009:adverse effects*; D001145:Arrhythmias, Cardiac / Q000209:etiology; D004947:Esophagus / Q000293:injuries; D006323:Heart Arrest / Q000209:etiology; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D002534:Hypoxia, Brain / Q000209:etiology; D033183:Interdisciplinary Communication; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008477:Mediastinal Diseases / Q000473:pathology / Q000601:surgery*; D008481:Mediastinoscopy / Q000009:adverse effects* / Q000379:methods; D011030:Pneumothorax / Q000209:etiology; D012720:Severity of Illness Index; D013529:Surgical Wound Dehiscence / Q000209:etiology; D014132:Trachea / Q000293:injuries; D014826:Vocal Cord Paralysis / Q000209:etiology