Objective: The aim of this study was to evaluate the safety and reliability of the harmonic scalpel for performing VATS excisions of mediastinal tumors and cysts.
Methods: We have prospectively studied 19 cases presenting with a mediastinal tumor or cyst operated on consecutively since January 2003.
Results: We performed 10 left-sided and 9 right-sided VATS procedures; the mean age at operation was 50 +/- 15 years. Two masses were in the anterior mediastinum, 5 in the middle mediastinum and 12 in the posterior mediastinum. One patient required conversion to a minithoracotomy for bleeding. The maximum tumor diameter was 38 +/- 14 mm and the maximum cyst dimension was 55 +/- 20 mm. The mean operating time was 66 +/- 28 min. Three patients experienced minor complications. The postoperative hospital stay was 3.5 +/- 1.7 days, and we had no mortality. Histopathology revealed 1 esophageal leiomyosarcoma, 1 Langerhans cell histiocytosis X, 1 hamartoma, 5 schwannomas, 1 neurofibroma, 1 malignant peripheral nerve sheath tumor, 1 reactive lymphadenopathy, 1 tuberculous lymphadenopathy, 1 cystic hygroma, 2 bronchogenic cysts, 2 foregut cysts, 1 thymic cyst, and 1 pleuropericardial cyst. There has been no recurrence of tumor or cyst on follow-up.
Conclusions: Videothoracoscopic excision of mediastinal tumors and cysts can be safely performed using the harmonic scalpel with a low morbidity and mortality.