Thoracoscopic resection of esophageal cancer with a tracheal diverticulum

Tracheal diverticulum, a benign entity characterized by single or multiple invaginations of the tracheal wall, is commonly asymptomatic and detected incidentally. We report the case of a 76-year-old man with a tracheal diverticulum who underwent thoracoscopic esophagectomy with a three-field lymphadenectomy for middle thoracic esophageal cancer. The tracheal diverticulum was located at the right posterolateral region of the trachea, which overlapped the region of dissection of the right recurrent laryngeal nerve lymph nodes. Paratracheal lymph node dissection is an important surgical procedure for thoracic esophageal cancer. In such cases, there is a risk of misidentifying a tracheal diverticulum as an enlarged lymph node and injuring it. Injury of a tracheal diverticulum causes serious complications such as mediastinal emphysema, mediastinitis, and pulmonary fistula. It is important to recognize its existence preoperatively and perform accurate lymph node dissection by taking full advantage of the magnified visual effect provided by thoracoscopic surgery.     

Thoracoscopic resection of a giant mediastinal parathyroid cyst

Parathyroid cysts are a rare situation, unusually in the mediastinum. The preoperative diagnosis could be more difficult in some atypical topographies and imaging characteristics in particular in case of huge mediastinal cyst. In the following years traditionally, in case of intrathoracic parathyroid cysts, sternotomy or thoracotomy have been the preferred approaches. We report a case of an older patient with a huge mediastinal parathyroid cyst removed successfully using videothoracoscopy.     

Thoracoscopic resection of a giant thymolipoma in a 4-year-old girl

Thymolipoma is a very rare, benign mediastinal tumor. In this paper, we report on the thoracoscopic resection of such a lesion in a 4-year-old girl.     

Thoracoscopic resection of a combined esophageal leiomyoma and diverticulum: a case report

We report the case of a 66-year-old male patient with a combined esophageal leiomyoma and diverticulum. On account of the low incidence, there is little literature available with regard to the management of those conditions. Our patient underwent a simultaneous thoracoscopic enucleation of the leiomyoma and resection of the diverticulum. Though endoscopic enucleations of myoma and resections of diverticula have been described earlier, to our knowledge, we are the first, who performed those procedures in a single operation, which seems to be feasible and safe.     

Thoracoscopic treatment of a pericardial diverticulum

A 35-year-old female patient presented with a history of recurrent chest pain. On chest x-ray, a regularly shaped lesion at the right cardiophrenic angle was observed. The lesion appeared smaller on a subsequent x-ray. Magnetic resonance imaging showed a cystic lesion that could be differentiated from the pericardium only in its lower part. Thoracoscopy revealed a pericardial diverticulum. Resection of the lesion was performed thoracoscopically, with complete remission of the symptoms.     

Giant midesophageal pulsion diverticulum: a report of two operated cases

A giant midesophageal pulsion diverticulum is a medical rarity. Two successfully operated cases are reported. One patient had no clinical symptoms and was misinterpreted as a mediastinal tumor. Esophageal myotomy was not performed.     

Laparoscopic transhiatal approach for resection of midesophageal diverticula

Resection of symptomatic midesophageal diverticula is traditionally performed with a thoracic approach, occasionally requiring additional laparoscopic surgery for management of associated pathologies, such as esophageal dysmotility and hiatus hernia. We present the resection of large midesophageal pulsion diverticula using a single laparoscopic transhiatal approach. Bariatric instrumentation was used to obtain extra intraoperative length, and concurrent on-table endoscopy was performed to ensure complete mucosal seal. The patient was discharged home on day 19 and remains well 12 months after surgery. Laparoscopic transhiatal resection of symptomatic midesophageal diverticula may be a safe alternative to the traditional thoracic or thoracoabdominal technique.     

Thoracoscopic wedge resection

Summary Thoracoscopic surgery is decidedly expanded by the ability to perform pulmonary wedge resections of the lung by using the Endo-GIA-stapler. In addition to thoracoscopic biopsies, since July 1991 we have carried out wedge resections in 12 patients suffering from spontaneous pneumothorax (nine) or peripheral bronchial carcinoma (three). Postoperatively one air fistula persisted over 9 days. The chest tube was removed within 48 h in all other patients. There was no other major complication. The postoperative hospitalization period lasted 4.6 days (1–9 days). Operating time was 44 min (30–70 min). The benefit for the patient consists in the little-impaired breathing mechanics, the short hospital stay, and the favorable cosmetic result.     

Thoracoscopic resection of a paraaortic bronchogenic cyst

We report three cases of symptomatic stenosis of the great vessels or supra-aortic trunks successfully treated surgically with aorto-subclavian and aorto-innominate bypass. Two were performed via manubriotomy and a third case via standard median sternotomy because of concomitant coronary revascularisation. There was complete symptomatic relief on follow-up, and radiological imaging confirmed good flow in the grafts and post-stenotic arteries.     

Thoracoscopic rib resection using a Gigli saw

When a conventional approach is used to perform a rib resection, a skin incision longer than the rib to be resected must be made. As a result, a conventional rib resection leaves a rather large and esthetically unfavorable scar. After considering pain management, esthetics, and quality of life, we devised a new technique for thoracoscopic rib resection that uses a Gigli saw. This new technique was performed on an overweight woman with a solitary metastatic bone tumor of the right eighth rib, whose case is described herein. The patient's postoperative course was satisfactory. Since this technique does not require a long skin incision, pain management and aesthetic results are improved compared with conventional techniques.     

Ruptured giant colonic diverticulum

Giant colonic diverticulum (GCD) is a rare complication of diverticular disease with less than 150 cases reported in the English literature. The clinical presentation ranges from asymptomatic to that of an acute abdomen. In most cases, giant colonic diverticulum is found in the sigmoid colon. The ideal treatment is elective resection of the sigmoid colon with primary anastomosis. When the diverticulum presents with perforation or obstruction, however, the treatment is a sigmoid colectomy with diverting colostomy (Hartmann procedure).     

Thoracoscopic resection of extralobar sequestration in a neonate

The authors report a case of extralobar pulmonary sequestration (ELS) located at the right costophrenic recessus and resected thoracoscopically in a 22-day-old girl. Prenatally, spontaneous resolution of a cystic adenomatoid lung lesion (CCAM) occuring independently in the upper right hemithorax was observed. ELS with preceding complete resolution of CCAM in the ipsilateral hemithorax has not been reported before. This is the first neonate reported with ELS treated by thoracoscopy.     

Thoracoscopic resection of a mediastinal intrathymic parathyroid adenoma

Mediastinal parathyroid adenomas and thymomas can be resected via a transcervical approach, median sternotomy, or less invasive surgical option of video-assisted thoracoscopic resection and more recently by way of the da Vinci robot. We present a case of a mediastinal parathyroid adenoma in a 55-year-old female with primary hyperparathyroidism. MRI also confirmed a mediastinal adenoma localized on sestamibi scan. Significant laboratory values were elevated parathyroid hormone (PTH) of 171 pg/mL (normal range = 15 to 65 pg/mL) and calcium of 11.6 mg/dL (normal range = 8.5 to 10.5 mg/dL). Inability to hyperextend her neck due to cervical fusion made the transcervical approach unfavorable. To avoid a median sternotomy, we performed thoracoscopic resection of the adenoma via the left chest with the patient in a right lateral decubitus position. Three ports were placed; two in the anterior axillary line in the 4th and 6th intercostal spaces and one in the midaxillary line in the 5th intercostal space. Initial intraoperative PTH measurement was 192.9 pg/mL, and after adenoma removal the PTH level fell to 9 pg/mL. She was discharged home on postoperative day 1 without complications. At 3 months postprocedure, she remains asymptomatic with PTH and calcium levels within normal range. The 4 g, 2.4 cm intrathymic parathyroid adenoma had no evidence of malignancy. Thoracoscopic resection of an intrathymic parathyroid adenoma, a safe and less morbid alternative to median sternotomy, is an option when the transcervical approach is not viable.     

Thoracoscopic enucleation of a giant submucosal tumor of the esophagus

Since the introduction of thoracoscopy in the surgical field, many thoracic interventions have been considered feasible via thoracoscopic route. The authors reported a case of thoracoscopic enucleation of a giant esophageal submucosal tumor (8.5 cm in diameter) situated along the left side of the midesophagus. Histopathologic evaluation revealed a gastrointestinal stromal tumor (GIST). Postoperative period was uneventful and the patient was discharged on the eighth postoperative day. Given the well-known advantages of minimally invasive surgery, we assume that the removal of esophageal submucosal tumors can first be attempted by thoracoscopic approach, even if the tumor is of a big size. In cases of histopathologically unknown tumors preoperatively, definitive examination of the complete specimen provides the basis for further therapeutic decisions.     

Thoracoscopic middle lobe resection]

The authors report a case of middle lobectomy by a thoracoscopic procedure. A forty-year old patient had carcinoma of the middle lobe (6 cm diameter). The use of staplers and ligatures by this way allows the control of the different vessels and bronchus. The indications of that technique must be evaluated in the future.     

Thoracoscopic resection of a pulmonary lymphangioma: a case report

We report a extremely rare case of a 57-year-old man who was found to have a solitary tumor in the right middle lobe of his lung during an annual check-up. Chest X-ray and CT scan showed a well-circumscribed spherical mass adjacent to the chest wall. The tumor, which was removed by thoracoscopic surgery, was a cystic mass, 17 x 15 mm. Histological examination confirmed the diagnosis of a pulmonary lymphangioma. A brief review of the available literature on this extremely rare type of lung tumor follows the case report.