The application of video-assisted thoracic surgery(VATS) in the examination of the thoracic cavity can be a new option in patients with mediastinal tumor because it provides outstanding visibility of the structures of the mediastinum. By clear
viewing
through the thoracoscope, a mediastinal tumor can be biopsied or resected, depending on the findings during an operation.
We reviewed all patients who underwent curative or diagnostic operations from March 1990 to August 1995 under the impression of a mediastinal mass. The total number of patients were 113 with 59 males and 54 females. Group A underwent resection
resection
of tumor by thoracotomy(38 patients: 18 males, 20 females), and group B underwent resection of tumor by VATS(36 patients: 20 males and 16 females). Seven patients in group B were excluded because they underwent thoracotomy due to pleural adhesion
or
intra-operative bleeding ; therefore, the true VATS group numbered 29 cases. Group C underwent lymph node biopsy by VATS(33 patients: 16males, 17 females), and group D(6 patients: 5 males, l female) underwent lymph node biopsy through anterior
mediastinotomy.
The mean age in group A was 36.2 years compared to 41.3 years in group B. We compared operation time, frequency of injection for pain control, of chest tube insertion, postoperative hospital stay, and diagnostic yield. In group A, they were 164
minutes,
3.4 times, 5.2 days, and 11.3 days, respectively, in comparison to 152 minutes, 2 times, 4.7 days, and 8,3 days, respectively, in group B. these data revealed that the day of discharge was significantly shorter in group B(p value=0.03).
In group C, the mean age was 45.8 years(range 1~7). The operation time was from 30 to 335 minutes (mean 105), pain control was required from 0 to 15 times(mean 3.2), and a chest tube was needed for l to 36 days(mean 6.1). In group D, mean age was
53.3
years, operation time 121 minutes, pain control injection frequency 2.6 tines, and mean chest tube duration 10.5 days. The diagnostic yield in group C was 8% compared to 100% in group D although the number of patients in group D is small.
There was no significant difference in the rate of postoperative complications; therefore, VATS can be a method of choice in selected patients with mediastinal tumors or enlarged lymph nodes.
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