Robotic resection of large anterior mediastinal masses.
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ABSTRACT:
SUBMITTER: Chow N
PROVIDER: S-EPMC10493612 | biostudies-literature | 2023
REPOSITORIES: biostudies-literature
Publications
Robotic resection of large anterior mediastinal masses.
Chow Nelly N Villamizar Nestor N
Mediastinum (Hong Kong, China) 20230719
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| S-EPMC10493617 | biostudies-literature
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| S-EPMC10493616 | biostudies-literature
Project description:Between April 2016 and October 2017, we retrospectively reviewed all patients undergoing excision of large mediastinal masses using a hybrid robotic thoracic approach at the Unit of Thoracic Surgery of Monaldi Hospital in Naples. The inclusion criteria for this approach were: evident unilateral predominance of the mass; absence of invasion to surrounding structures. Planned conversion to sternotomy was necessary in one patient for tenacious adhesions between the mediastinal goiter and the left innominate vein. In all cases the postoperative course was uneventful. The hybrid robotic approach, adopted in our Unit, consists of a thoracic procedure performed completely with articulated surgical instruments under three-dimensional vision and followed by final extension of a port-site incision to retrieve the voluminous specimen. This approach uses all the advantages of robotic technology that enables to perform a fine dissection in the small space of the anterior mediastinum and at the same time, through the simple extension of a minimally invasive access, avoids the painful sequelae of thoracotomy. In selected cases, with increased experience in robotic surgery, it can be proposed for excision of large mediastinal masses, although a longer follow-up period is necessary to validate our findings.
| S-EPMC5994465 | biostudies-literature
Project description:BackgroundWhile the subxiphoid approach (SA) in thoracoscopic thymectomy offers benefits in terms of fat removal and pain reduction, it remains unclear which patients with anterior mediastinal masses benefit most from the subxiphoid vs. the lateral intercostal approach (LA).MethodsThis retrospective study analyzed patients treated for anterior mediastinal masses at our center from January 2019 to December 2023. Patients were categorized into two groups based on the surgical approach: SA (35 cases) and LA (56 cases). Demographic data, clinical characteristics, perioperative metrics, and short-term outcomes were compared.ResultsNinety-one patients were included, with diagnoses including thymic cysts (43), thymomas types A, AB, and B1 (24), B2 thymomas (18), thymic carcinoma (6).No significant differences were found between the groups in terms of gender, age, tumor size, body mass index, conversion to sternotomy, or blood loss. The LA group, however, experienced shorter surgical durations (P < 0.001), less drainage (P = 0.021), shorter hospital stays (P < 0.001), and lower hospitalization costs (P = 0.024). Pain scores on the visual analogue scale were similar between groups on the day of surgery and the first postoperative day.ConclusionThe findings suggest that the lateral intercostal approach is preferable for patients with thymic cysts and Masaoka stage I-II thymomas without myasthenia gravis due to its efficiency and cost-effectiveness.
| S-EPMC11649629 | biostudies-literature
Project description: Not available
| S-EPMC11632316 | biostudies-literature
Project description:BackgroundTo demonstrate the effectiveness and feasibility of robotic portal resection (RPR) for mediastinal tumour using a prospectively collected database.MethodsData from 73 consecutive patients with mediastinal tumours who underwent RPRs were prospectively collected from August 2018 to April 2023. All patients underwent chest and abdominal enhanced computed tomography (CT) and preoperative multidisciplinary team (MDT) discussion. The patients were stratified into two groups based on tumour size: Group A (tumour size < 4 cm) and Group B (tumour size ≥ 4 cm). General clinical characteristics, surgical procedures, and short outcomes were promptly recorded.ResultsAll of the cases were scheduled for RPRs. One patient (1/73, 1.4%) was switched to a small utility incision approach because of extensive pleural adhesion. Two patients (2.8%) converted to sternotomy, however, no perioperative deaths occurred. Most of the tumours were located in the anterior mediastinum (51/73, 69.9%). Thymoma (27/73, 37.0%) and thymic cyst (16/73, 21.9%) were the most common diagnoses. The median diameter of tumours was 3.2 cm (IQR, 2.4-4.5 cm). The median total operative time was 61.0 min (IQR, 50.0-90.0 min). The median intraoperative blood loss was 20 mL (IQR, 5.0-30.0 ml), and only one patient (1.4%) experienced an intraoperative complication. The median length of hospital stay was 3 days (IQR, 2-4 days). Compared with Group A, the median total operative time and console time of Group B were significantly longer (P = 0.006 and P = 0.003, respectively). The volume of drainage on the first postoperative day was greater in group B than in group A (P = 0.013).ConclusionRPR is a safe and effective technique for mediastinal tumour treatment, which can expand the application of minimally invasive surgery for the removal of complicated mediastinal tumours.
| S-EPMC10964499 | biostudies-literature
Project description:PURPOSE:To investigate the prevalence and CT image characteristics of anterior mediastinal masses in a population-based cohort and their association with the demographics of the participants. MATERIALS AND METHODS:Chest CT scans of 2571 Framingham Heart Study participants (mean age 58.9 years, 51% female) were evaluated by two board-certified radiologists with expertise in thoracic imaging for the presence of anterior mediastinal masses, their shape, contour, location, invasion of adjacent structures, fat content, and calcification. For participants with anterior mediastinal masses, a previous cardiac CT scan was reviewed for interval size change of the masses, when available. The demographics of the participants were studied for any association with the presence of anterior mediastinal masses. RESULTS:Of 2571, 23 participants (0.9%, 95% CI: 0.6 to 1.3) had anterior mediastinal masses on CT. The most common CT characteristics were oval shape, lobular contour, and midline location, showing soft tissue density (median 32.1 HU). Fat content was detected in a few cases (9%, 2/23). Six out of eight masses with available prior cardiac CT scans demonstrated an interval growth over a median period of 6.5 years. No risk factors for anterior mediastinal masses were detected among participants' demographics, including age, sex, BMI, and cigarette smoking. CONCLUSIONS:The prevalence of anterior mediastinal masses is 0.9% in the Framingham Heart Study. Those masses may increase in size when observed over 5-7 years. Investigation of clinical significance in incidentally found anterior mediastinal masses with a longer period of follow-up would be necessary.
| S-EPMC4332399 | biostudies-literature
Project description: Not available
| S-EPMC11519743 | biostudies-literature
Project description:BackgroundSubxiphoid approach for mediastinal tumor resection was reported to provide a better view and less postoperative pain. Non-intubated video-assisted thoracic surgery (NI-VATS) without muscle relaxant would decrease the possibility of postoperative airway collapse for anterior mediastinal mass operation. Herein, we sought to describe the use of NI-VATS through subxiphoid approach for anterior mediastinal tumor resection.MethodsIn this retrospective cohort study, patients that underwent subxiphoid VATS resection for anterior mediastinal tumor between December 2015 and September 2019 were divided into two groups: NI-VATS and intubated VATS (I-VATS). Intraoperative and postoperative variables were compared.ResultsA total of 40 patients were included. Among them, 21 patients received NI-VATS (52.5%) and 19 were treated with I-VATS (47.5%). In total, intraoperative (4/21 vs. 2/19; P=0.446) and postoperative complications (5/21 vs. 7/19; P=0.369) were similar between NI-VATS and I-VATS group. The anesthesia time (231.76 vs. 244.71 min; P=0.218), the operation time (152.35 vs. 143.64 min; P=0.980), chest tube duration (1.81 vs. 1.84 days; P=0.08), the total volume (351.95 vs. 348.00 mL; P=0.223), post-operative pain scores (2.79 vs. 2.93, P=0.413), and the length of stay (9.47 vs. 10.57 days; P=0.970) were all comparable between two groups.ConclusionsNI-VATS for mediastinal tumor resection via subxiphoid approach is a safe and technically feasible option in selected patients, which leads to comparable perioperative clinical outcomes when compared with I-VATS via the subxiphoid approach. This technique could be used as an alteration when intubation is not available.
| S-EPMC8033331 | biostudies-literature
Project description:Background and objectiveThe management of large mediastinal tumors requires a complex multidisciplinary approach, particularly in the perioperative setting due to increased risk of hemodynamic compromise. The utilization of extracorporeal membrane oxygenation (ECMO) provides a useful adjunct in the surgical management for biopsy and resection of these mediastinal masses. The objective of this article is to review indications and implementation of ECMO in the surgical management of mediastinal disease.MethodsA literature review of the PubMed database was completed evaluating articles discussing 'extracorporeal circulation', 'cardiopulmonary bypass', 'anesthesia', 'mediastinal disease', and 'mediastinal cancer'. These articles were evaluated for contribution to the discussion of indications and implementation of ECMO in the management of these patients.Key content and findingsLarge mediastinal tumors place patients at risk of hemodynamic collapse on induction of anesthesia due to compression of vascular structures, tracheobronchial tree and creation of V/Q mismatch. Patients may be stratified regarding their risk of perioperative complications by evaluation of postural symptoms, cross sectional imaging findings and pulmonary function tests. Those patients at elevated perioperative risk may benefit from the utilization of ECMO, most commonly veno-arterial (V-A) ECMO. Guidewires or ECMO cannulas may be placed under local anesthesia prior to induction. Those patients with hemodynamic compromise may receive mechanical circulatory support to allow completion of the operation.ConclusionsThe use of a multidisciplinary team consisting of surgeons, anesthesiologists, perfusionists and OR team is critical to the success in the use of ECMO in the resection of mediastinal masses. With diligent preparation, these high-risk patients may be optimally managed at the time of resection.
| S-EPMC10586946 | biostudies-literature