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At least 19 recordsLinked to original sources
PubMed2006

Video-assisted mediastinoscopic surgery: clinical feasibility and accuracy of mediastinal lymph node staging.

BACKGROUND: This study was conducted to assess indications, procedures, complications, and clinical feasibility of video-assisted mediastinoscopic surgery (VAMS). It also assessed the accuracy of mediastinal lymph node staging by video-assisted mediastinoscopic lymphadenectomy (VAMLA) with bimanual dissection through the twin-bladed, expanding Linder-Dahan mediastinoscope. METHODS: From 2000 to 2004, we documented and assessed 226 consecutive procedures in a prospective database. RESULTS: A total of 144 VAMLAs for the staging of resectable bronchial carcinoma, and 82 less extensive procedures for other indications were performed, combined with extended mediastinoscopy in 72 patients and with mediastinoscopic sonography in 26. Mean operation time was 54.1 minutes for VAMLA and 36.6 minutes for less extensive procedures. We observed nine complications: five recurrent nerve paralyses, one arterial and two venous injuries, and one mediastinitis. The complication rate was 3.98%, which dropped from 5.3% to 2.6% with growing experience. VAMS detected mediastinal lymph node involvement in 61 (32.8%) of 186 patients with bronchial carcinoma (N2, 45; N3, 16). Mediastinal reassessment at open surgery was done in the 130 resected patients and showed for VAMLA a specificity of 93.75%, a sensitivity of 100%, and a false-negative rate of 0.9%. CONCLUSIONS: In our institutional practice, VAMS has replaced conventional mediastinoscopy for reasons of extended surgical options, safety, precision, education, documentation, and enhanced accuracy of pretherapeutic mediastinal staging. Mediastinal staging of resectable bronchial carcinoma is done by VAMLA, because the accuracy is equal to open lymphadenectomy and the access to the left paratracheal and tracheobronchial lymph nodes is improved. No increase in the complication rate was observed. Prolonged operation time was due to more extended procedures not possible with conventional mediastinoscopy, like VAMLA.

Adolescent↗
PubMed2005

Detection of disseminated tumor cells in mediastinoscopic lymph node biopsies and lymphadenectomy specimens of patients with NSCLC by quantitative RT-PCR.

OBJECTIVE: Detection of disseminated tumor cells in mediastinoscopic biopsies could improve staging and might be helpful concerning indications for neoadjuvant therapy regimens. This prospective study was performed to evaluate a simple and observer-independent polymerase chain reaction (PCR)-based method for the detection of disseminated tumor cells in regional lymph nodes. METHODS: Lymph nodes of 32 consecutive patients without neoadjuvant therapy were removed by systematic lymphadenectomy during resection of primary NSCLC. One hundred of these lymph nodes were cut into two equal halves which were examined using either routine histopathology or quantitative reverse transcriptase PCR (qRT-PCR). qRT-PCR amplification of cytokeratin 19 (CK19) transcripts was applied for the detection of tumor cell-specific RNA. We differentiated between illegitimate marker gene transcription and cancer-specific expression by using a cut-off value that was obtained from the analysis of 18 lymph nodes of patients with benign lung diseases. Subsequent to the evaluation of qRT-PCR, a pilot project with five additional patients was conducted to examine 19 mediastinoscopic biopsies, which were cut into two equal halves and proceeded as described above. RESULTS: Ninety-four (94%) lymph nodes were tumor-free by histopathology. qRT-PCR detected disseminated tumor cells in 26 (28%) of these lymph nodes. All of the remaining six lymph nodes that were judged by the pathologist to contain tumor cells exhibited CK19 transcripts. Twenty-three patients had a pN0 status. qRT-PCR detected disseminated tumor cells in 13 (56%) of these pN0 patients. The mediastinoscopic biopsies showed disseminated tumor cells in four (21%) out of 19 histopathologically tumor-free samples. CONCLUSIONS: CK19 qRT-PCR is a sensitive and specific tools for the detection of disseminated tumor cells in regional lymph nodes of patients with operable NSCLC. Further studies are required to asses if this molecular method might improve mediastinoscopic staging.

Aged↗
PubMedDate not supplied

[Thoracoscopy with mediastinoscope in pediatric complicated parapneumonic effusion]

OBJECTIVE: To evaluate our experience with thoracoscopy with small mediastinoscope in complicated parapneumonic effusion in children.METHODS: From July 1995 to June 1997, seven children with complicated parapneumonic pleural effusion underwent thoracoscopy with mediastinoscope at Hospital de Clínicas de Porto Alegre. The procedure was carried out with a small mediastinoscope built in our hospital.RESULTS: There were six girls and one boy. The procedure was preformed under general anesthesia, without selective intubation. Six patients had previous intercostal tube drainage; one underwent thoracoscopy as a primary procedure. No complication was observed after the procedure. During follow-up, two children underwent pleurotomy due to residual pleural effusion with persistent fever; two others presented asymptomatic small pleural effusion.CONCLUSION: Thoracoscopy with small mediastinoscope is safe, efficient and without severe complications. It is very useful to remove loculated complicated parapneumonic effusion at fibrinopurulent stage and to enable lung expansion.

Journal Article↗
PubMed2004

Infrasternal mediastinoscopic surgery for anterior mediastinal masses.

BACKGROUND: Infrasternal mediastinoscopic surgery is a new alternative to the thoracoscopic approach for patients with anterior mediastinal masses. METHODS: We applied this technique to 18 thymectomies, one thymomectomy, and one cystectomy in a total of 20 patients with anterior mediastinal masses and then assessed the surgical results. RESULTS: Infrasternal mediastinoscopic surgery was accomplished in 18 of the 20 patients (90%). The pathological diagnoses included 13 Masaoka stage I thymomas, one stage II thymoma, two stage III thymomas, one thymic cyst, one pericardial cyst, one thymic granuloma, and one mature teratoma. Two patients with stage III thymoma required conversion to sternotomy, one for invasion into the innominate vein and the other for invasion into the pericardium. There was no surgically related mortality or complications in any patients. CONCLUSION: Infrasternal mediastinoscopic surgery is safe and feasible for stage I thymoma and other benign tumors in the anterior mediastinum.

Adult↗
PubMed2001

Infrasternal mediastinoscopic thymectomy in myasthenia gravis: surgical results in 23 patients.

BACKGROUND: Infrasternal mediastinoscopic surgery is a new approach to resection of the anterior mediastinal mass. METHODS: We evaluated this new approach in 23 patients with myasthenia gravis who underwent total thymectomy assisted by infrasternal mediastinoscopy between 1998 and 2000. The results were analyzed with special reference to morbidity and short-term improvement of the disease severity determined according to quantitative myasthenia gravis (QMG) scores. RESULTS: Complete removal of the thymic gland with the pericardial adipose tissue was accomplished through an infrasternal mediastinoscopic approach in 21 of the 23 (91.3%) patients. The remaining 2 patients required conversion to sternotomy, the one for insufficient sternal lifting with vascular tape and the other for invasion of a thymoma to the innominate vein. There was no related mortality and only one complication, a phrenic nerve injury in 1 patient (4.3%). Significant clinical improvement of disease was achieved in the short term and several advantages were apparent. CONCLUSIONS: Infrasternal mediastinoscopic thymectomy is safe and feasible for patients with myasthenia gravis.

Adult↗
PubMed1999

[Mediastinoscopic resection combined with a sternum lift technique in a case of thymic cyst].

We report on a case of thymic cyst which was successfully treated with mediastinoscopic resection combined with a sternum lift technique. A 62-year-old man was admitted to our hospital with a thymic cyst, which was causing chest discomfort and was increasing in size. The tumor was located above the pulmonary artery in the anterior mediastinum. He underwent mediastinoscopic resection while lifting the inferior portion of the sternum with a Laparolift. The cyst was resected sharply and bluntly with the Harmonic Scalpel without rupture. The patient was discharged on the 6th postoperative day in a good condition. Mediastinoscopic resection of a thymic cyst through a xiphoid approach is a useful surgical approach because of the absence of postoperative pain and because it allows early discharge from the hospital.

Endoscopy↗
PubMed1992

[An assessment of the separation of mediastinal lymph nodes by preoperative mediastinoscopic examination as a dissecting measure in the surgical treatment of lung cancer].

The availability of the separation of mediastinal lymph nodes by preoperative mediastinoscopic examination as a dissecting measure was analyzed according to prognosis retrospectively because mediastinal lymph nodes dissection is made with ease and certainty after the examination. The separation by mediastinoscopic examination did not have an impact on the mediastinal lymph nodes dissection for carcinoma of the left lung and superior mediastinal lymph nodes metastases (# 1-4), but an influence on the dissection for carcinoma of the right lung and middle and lower mediastinal lymph nodes metastases (# 5-9). This result showed the existence of occult metastases and the good effects caused by the separation of mediastinal lymph nodes. In the histological type, the effects were present in squamous cell carcinoma and p-N0 adenocarcinoma, but it was concluded that the prognosis in adenocarcinoma was associated with other factors rather than lymph node metastasis. Therefore, it can be seen that the separation of mediastinal lymph nodes by preoperative mediastinoscopic examination is available as a dissecting measure.

Adult↗
PubMed2004

Mediastinoscope-assisted transhiatal esophagectomy for esophageal cancer.

BACKGROUND: Transthoracic esophagectomy (TTE) is a radical strategy for treatment of esophageal cancer, and the morbidity and mortality are high. Transhiatal esophagectomy (THE) is advantageous because it avoids thoracotomy and has a shorter surgical time, but risk of intraoperative morbidity stresses the surgeon and lymph node sampling is not possible. METHODS: Mediastinoscope-assisted transhiatal esophagectomy (MATHE) was performed in 42 patients with esophageal cancer. Patients with superficial esophageal cancer and medical risk were included. Feasibility and efficacy of this procedure are discussed by examining short- and long-term morbidity, mortality, and survival. RESULTS: With the mediastinoscope, esophagectomy was performed safely under direct vision. There was only a small amount of bleeding, and surgical time was short. Little morbidity and no deaths were recorded. CONCLUSION: MATHE is a safe and minimally invasive technique that allows direct visualization of mediastinal structures Lymph node sampling was feasible because of clear visualization of the mediastinum.

Adenocarcinoma↗
PubMed1994

Mediastinoscopic treatment of mediastinal cysts.

Selected patients with mediastinal cysts can be managed safely and effectively by mediastinoscopic techniques. Small cysts in favorable locations can be excised partially or nearly completely. Cysts that are intimately associated with vital structures are better suited to mediastinoscopic cystotomy and chemical sclerosis. Three cases are presented and technical aspects are discussed.

Adult↗
PubMed2004

Mediastinoscopic ultrasonography (MUS).

Correct pre-therapeutic T4 staging is mandatory for neo-adjuvant studies and for the decision on surgical therapy of high-risk patients. T4-staging of centrally located lung-cancer by means of non-invasive imaging techniques is either of low accuracy (CT and NMR) or important regions are not accessible due to air interference with the tracheo-bronchial tree (trans-esophageal-endosonography, TEE). We here describe for the first time the new technique of mediastinoscopic ultrasonography (MUS). A fingertip ultrasound probe is introduced through the video-mediastinoscope. The probe lies in front of the tracheo-bronchial tree and in direct contact with the vena cava and pulmonary artery. This position allows examining those regions that are not accessible with TEE. In a pilot study with 12 patients, visualization of central vessels and their relation to the tumor was excellent and without artifacts. In 3 patients, MUS did not confirm the T4 stage predicted by CT Scan. Those three patients underwent successful pneumonectomy (R0-resection) while the other nine patients received induction treatment. MUS is a promising addition to CT scanning, NMR, and transesophageal ultrasound in staging of centrally located tumors.

Feasibility Studies↗
PubMed2003

Video-assisted mediastinoscopic lymphadenectomy (VAMLA)--a method for systematic mediastinal lymphnode dissection.

OBJECTIVE: Video-assisted mediastinal lymphadenectomy (VAMLA) increases quality of mediastinal lymph node staging in bronchial carcinoma. The video-mediastinoscope allows systematic lymphadenectomy by bimanual preparation. Complete bilateral resection of lymph nodes in stations 1, 2, 3, 4 and 7 (Naruke) can safely be done after visualization of limiting structures (trachea, main bronchi, oesophagus, pericardium, pulmonary artery, aorta, upper vena cava and azygos vein). In this initial study, we compared histopathological findings from VAMLA with final lymph node staging from subsequent thoracotomy. METHODS: Between January 2001 and December 2001, 25 patients were operated by VAMLA (among 162 mediastinoscopies), two patients for diagnostic purposes and 23 for staging of bronchial carcinoma. Eighteen patients underwent subsequent thoracotomy for tumor resection and systematic lymphadenectomy. Pathological findings were reviewed. RESULTS: In VAMLA, lymph node dissection of station 2R, 2L and 4R was achieved in 96, 28 and 92%, respectively, whereas resection of lymph nodes in station 7 and 4L was performed in 100%. Other locations were dissected in 44%. A mean of 8.6 lymph nodes were removed in each patient. No residual lymph node tissue was found in the subcarinal compartment at open surgery. When comparing histopathological staging from VAMLA with final pathology, there were no false negative results. Seventeen patients who had N0 disease at VAMLA proved to be N0 or N1 at thoracotomy, one patient diagnosed as N2 at mediastinoscopy had N2 disease at final pathology. The only complication observed in VAMLA was a blood loss of >100 ml in 12% of patients without need for transfusion or surgical intervention. CONCLUSION: Mediastinal lymph node staging is improved by VAMLA. A systematic lymphadenectomy is performed bimanually through the video mediastinoscope. The number of lymph nodes removed is doubled compared to standard mediastinoscopy. There were no false negative results at final pathology. This new technique presents the basis for video-assisted thoracic surgery (VATS) lobectomy because complete resection of the mediastinal lymph nodes can be achieved by VAMLA. Potential complications of VAMLA such as injury of major mediastinal vessels, airways, pneumothorax or recurrent laryngeal nerve injury indicate the need for a full thoracic surgical infrastructure.

Carcinoma, Bronchogenic↗
PubMed1992

The role of mediastinoscopic biopsy in preoperative assessment of lung cancer.

Between 1970 and 1989, mediastinoscopy and thoracotomy were performed on 619 patients admitted to our clinic with lung cancer. When mediastinoscopy was analyzed by lymph node location, the highest sensitivity (95.7%) was for the left paratracheal nodes and the lowest (64.0%) was for nodes at the bifurcation (p < 0.01). The 5-year survivals according to the results of mediastinoscopy were 47% for negative results, 14% for false-negative results, and 6% for positive results. The 5-year survival rate however, was significantly higher (28%) in patients (n = 13) with positive mediastinoscopic findings who underwent complete resection of the primary tumor and all involved nodes than in patients (n = 78) who underwent incomplete resection (p < 0.01). These data support our opinion that patients with positive mediastinoscopic results should not always be excluded from treatment by thoracotomy. The role of mediastinoscopy is not to select patients for thoracotomy but to evaluate lung cancer at the pretreatment stage.

Biopsy↗
PubMed2004

[Lung biopsy using mediastinoscope in the time of VATS].

Patients with diffuse lung disease need lung biopsy for accurate diagnosis and treatment. Both traditional open lung biopsy through a thoracotomy and video assisted thoracoscopic lung biopsy are effective methods for obtaining parenchymal samples. The authors present their surgical method and experience. Thirty patients were operated on for lung biopsy using mediastinoscope between 1999-2003. Lung parenchymal samples were eligible for histological examination. No serious postoperative complications developed. The method is simple, safe and low-cost.

Adolescent↗
PubMedDate not supplied

Mediastinoscope: another use.

We describe a technique for the retrieval of left atrial pressure monitoring catheters using a mediastinoscope. The procedure is simple, safe and it can be accomplished quickly without re-opening the sternum.

Cardiac Catheterization↗
PubMed1997

Endoscopic ligation of perforating veins using a mediastinoscope.

Incompetent perforating veins play a major role in venous ulceration and recurrence of varicose veins. To reduce postoperative wound problems associated with classic subfascial exploration of the lower leg, endoscopic approaches have been developed. We describe a technique that makes use of a mediastinoscope to explore the subfascial area. This inexpensive and readily available instrument is present in most operating rooms. Although a learning curve must be anticipated, the results of this technique in retrospective studies are promising.

Endoscopes↗
PubMed2000

Video-assisted mediastinoscopic resection of a thymic cyst by sternum lifting.

We performed mediastinoscopic surgery on two patients with a thymic cyst using a new instrument by sternum-lifting with tape. The merits of this technique are that a resection of the thymus and cyst can be achieved without a midline sternotomy, and under bilateral ventilation, and in cases with pleural adhesion. This technique can be applicable to most benign thymic lesions including thymectomy for myasthenia gravis and to selected cases with a malignant thymic tumor.

Aged↗
PubMed1998

[Mediastinoscopic drainage for descending necrotizing mediastinitis].

A case of descending necrotizing mediastinitis that was treated by mediastinoscopic drainage is reported. The patient was a 56-year-old diabetic woman. A hypopharyngeal abscess extended to the mediastinum through the neck. No septic condition was noted. Chest CT showed that the abscess reached 4 cm below the tracheal bifurcation. Pus was drained under direct observation by mediastinoscopy, and a drain was placed in an appropriate position. After operation, lavage was performed through the drain, and cure was achieved on the 42nd postoperative day. This technique should be considered as surgical treatment for descending necrotizing mediastinitis in the absence of serious complication such as sepsis, because it has a more reliable drainage effect than the conventional transcervical method, and because it is less invasive than thoracotomy.

Drainage↗
PubMed2003

Mediastinal bronchogenic cyst treated by mediastinoscopic drainage.

Bronchogenic cysts are rare congenital anomalies located in the mediastinum and lung parenchyma. We present the clinical findings and describe the mediastinoscopic treatment of a bronchogenic cyst at the subcarinal space in a 50-year-old man. CT revealed a lesion at the subcarinal space with soft tissue density. Initially, mediastinoscopy was performed for diagnostic purposes. Histopathological evaluation of biopsy material taken from the cyst wall confirmed that the lesion was a bronchogenic cyst. The cyst contents were drained and a sclerosant agent was applied to the cyst lumen via the drainage tube. Mediastinoscopy not only provides diagnostic information but can also be used safely in the treatment of anterior bronchogenic cysts in patients not amenable to a second operation.

Bronchogenic Cyst↗