title: Troubleshooting thoracoscopic anterior mediastinal surgery: lessons learned from thoracoscopic lobectomy.
abstract: Video-assisted thoracoscopic surgery (VATS) lobectomy is safe, oncologically effective, and increasingly utilized for lung cancer resection. Lessons from VATS lobectomy experience can guide the use of a VATS approach to resect mediastinal masses. Exposure and dissection when using VATS to resect anterior mediastinal masses has unique challenges. Several maneuvers acquired from experience with VATS lobectomy can reduce the technical difficulty and often prevent conversion to an open approach. In this troubleshooting guide, we offer 'tips' to both avoid and manage numerous intra-operative technical difficulties that commonly arise during VATS anterior mediastinal procedures. Avoiding an open approach may improve outcomes, although conversion for safety or complete resection can be necessary. Techniques and experiences derived from VATS lobectomy can facilitate VATS resection of mediastinal masses.
authors.affiliation: 1 Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, NC, USA ; 2 Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Sameer A
authors.initials: SA
authors.lastname: Hirji
authors.affiliation: 1 Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, NC, USA ; 2 Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Scott S
authors.initials: SS
authors.lastname: Balderson
authors.affiliation: 1 Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, NC, USA ; 2 Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Mark F
authors.initials: MF
authors.lastname: Berry
authors.affiliation: 1 Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, NC, USA ; 2 Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: D'Amico
keywords: Thoracoscopy; exposure; incisions; mediastinal tumor; surgery; techniques; video-assisted thoracoscopic surgery (VATS)