Abstract
Background:
Bronchogenic cysts may occur anywhere in the mediastinum. Recently, there have been reports of the thoracoscopic treatment of bronchogenic cysts of the mediastinum. 1 –5 However, a left thoracoscopic approach is technically difficult because of the small thoracic space relative to the right side and the beating heart. We herein report a case in which left thoracoscopic extirpation was safely and effectively performed to treat a pediatric patient with a multilocular bronchogenic cyst in the posterior mediastinum located in proximity to the beating heart.
Patient and Methods:
The patient was a 9-month-old boy with high-grade fever who was transferred to our hospital. A multilocular cystic tumor was incidentally detected by enhanced computed tomography. The 2.6 cm tumor originated from the posterior mediastinum. The main location of the tumor was the left side of the mediastinum; thus, a left thoracoscopic approach was planned.
The Operative Findings and Procedure:
Under general anesthesia in the right three-quarter prone position, a camera port was inserted at the fifth intercostal space (ICS) of the middle axillary line using optical methods. Two working ports were inserted at the sixth ICS (5 mm, operator's right hand) of the anterior axillary line and the fourth ICS (3 mm, operator's left hand) of the posterior axillary line. A 45° 5-mm endoscope was used to obtain a wide view. A multilocular cystic tumor was recognized at the posterior mediastinum just above the diaphragm. The parietal pleura was opened using bipolar scissors (Robi; Karl Storz, Tutlingen, Germany). Careful dissection of the tumor was performed to detect the origin of the tumor, preventing injury of the vagus nerve. The tumor was found to have originated from the lower esophagus. A bougie was placed inside the esophagus. Sharp and blunt dissection was performed for complete resection. Finally, the tumor was extirpated; however, part of the outer sheath and muscle wall was resected. The muscle defect of the esophagus was transversely closed by interrupted 6-0 monofilament absorbable sutures (PDS; Ethicon, Cincinnati, OH) to prevent stenosis. The opened parietal pleura of the mediastinum was closed by continuous suturing using 5-0 monofilament absorbable sutures (PDS; Ethicon). The tumor was placed into an endosurgical bag and extracted. No drain was inserted.
Results and Conclusion:
There were no intraoperative or postoperative major complications and no thoracic organ injuries were observed. The postoperative course was uneventful, and the patient showed a good clinical course. Left thoracoscopic extirpation was a safe and feasible approach to the treatment of a pediatric patient with bronchogenic cyst in the posterior mediastinum located in proximity to the beating heart.
No competing financial interests exist.
Runtime of video: 4 mins 59 secs
Presented on April 13, 2018, at IPEG's 27th Annual Congress for Endosurgery in Children.
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