A uniportal video-assisted thoracoscopic surgery hybrid approach for posterior mediastinal dumb-bell tumours

Abstract

Posterior mediastinal dumb-bell tumours are neurogenic tumours that extend from the mediastinum to the intraspinal canal. They represent a surgical challenge because they may be resected using a staged or a single-stage approach. Until recently, a classic posterolateral thoracotomy was the gold standard for surgical resection for the intrathoracic segment. In the meantime, video-assisted thoracoscopic surgery has gained great acceptance among most thoracic surgeons because of the decreased surgical trauma, less operative blood loss and fewer postoperative complications and the shorter hospital stays. Proper selection of cases for thoracoscopic excision is crucial for ensuring good surgical outcomes. Factors such as tumour size, location and presence or absence of features suggesting malignancy should be considered. This procedure can offer great help in different case scenarios involving posterior mediastinal dumb-bell tumours. For giant tumours that will eventually need a thoracotomy, video-assisted thoracoscopic surgery helps the surgical team to choose an optimal site for a tailored thoracotomy incision and rule out any metastatic pleura seedings. In cases of small intrathoracic segments of dumb-bell tumours (≤ 6-8 cm) that require combined spinal and thoracic procedures in a single-stage approach, a combined posterior and video-assisted thoracoscopic surgical approach can be implemented for total resection of the tumour.

Keywords: Ganglioneuroma; Mediastinum; Neurogenic tumors; PMNT; Posterior mediastinal; Thoracoscopic surgery; Uniportal VATS; Uniportal thoracoscopic surgery; VATS; Videothoracoscopy.