Name of the Procedure:

Thoracoscopy, surgical; with excision of mediastinal cyst, tumor, or mass

Summary

Thoracoscopy, often referred to as video-assisted thoracoscopic surgery (VATS), is a minimally invasive surgical procedure used to diagnose and treat conditions within the chest. This specific procedure involves the removal of cysts, tumors, or masses from the mediastinal area—the central part of the chest cavity.

Purpose

This procedure addresses the presence of abnormal cysts, tumors, or masses within the mediastinum, which could potentially be malignant, cause symptoms, or interfere with normal organ function. The goal is to safely remove these growths to alleviate symptoms, confirm a diagnosis, and prevent potential complications.

Indications

• Presence of a mediastinal cyst, tumor, or mass detected through imaging studies.
• Symptoms such as chest pain, coughing, difficulty breathing, or swallowing.
• Unclear diagnosis that requires tissue biopsy.
• Potential or confirmed malignant growth requiring excision.

Preparation

• Patients may be instructed to fast for several hours before the procedure.
• Medications that increase bleeding risk might need to be adjusted or temporarily stopped.
• Preoperative imaging tests like a CT scan or MRI may be performed to map the area of concern.
• Assessment of overall health through blood tests and a physical examination.

Procedure Description

1. Anesthesia: The patient receives general anesthesia.
2. Incision: Small incisions (ports) are made in the chest wall.
3. Thoracoscope Insertion: A thoracoscope (a thin, flexible tube with a camera) is inserted through the incisions to provide a visual of the inside of the chest.
4. Excision: With the aid of surgical instruments passed through other ports, the surgeon excises the cyst, tumor, or mass.
5. Closure: After the excision, any necessary biopsies are taken, and the incisions are stitched closed.

Duration

Typically, the procedure takes between 1 to 3 hours, depending on the complexity and size of the growth being removed.

Setting

This procedure is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Thoracic surgeon
• Anesthesiologist
• Surgical nurses
• Surgical technologist

Risks and Complications

• Infection at the incision sites
• Bleeding, which may require additional intervention
• Pain at the incision sites or within the chest
• Risks associated with general anesthesia
• Rare complications such as pneumothorax (collapsed lung) or damage to nearby organs

Benefits

• Minimally invasive with smaller incisions compared to open surgery, leading to reduced pain and faster recovery.
• Effective removal of abnormal growths to improve symptoms and confirm diagnosis.
• Lower risk of infection and complications compared to traditional open surgery.

Recovery

• Patients may need to stay in the hospital for a few days.
• Post-operative instructions include pain management, wound care, and activity restrictions.
• Follow-up appointments to monitor recovery and check for complications.
• Full recovery can take several weeks, with gradual resumption of regular activities.

Alternatives

• Open thoracotomy: A more invasive surgery with a larger incision.
• Radiation or chemotherapy for tumors if surgery is not advisable.
• Observation and regular monitoring if the growth is asymptomatic and not immediately dangerous.

Patient Experience

During the procedure, patients are under general anesthesia and will not feel any pain. Post-operatively, patients may experience discomfort around the incision sites and inside the chest, which can be managed with pain medications. The return to normal activities will be gradual, and patients will be encouraged to follow post-operative care instructions closely to ensure a smooth recovery.