Hsu Diana S, Banks Kian C, Velotta Jeffrey B
UCSF East Bay Surgery, Highland Hospital, Oakland, CA, USA.
Department of Surgery, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA.
Mediastinum. 2022 Dec 25;6:32. doi: 10.21037/med-22-20. eCollection 2022.
The traditional approach to mediastinal cyst and mass resection has been open via median sternotomy or thoracotomy. With the advent of minimally invasive techniques, there have been successful cases completed via video-assisted thoracoscopic (VATS) and robot-assisted thoracoscopic surgery (RATS). Although mediastinal cysts are uncommon, they are a significant and relevant topic in the practice of thoracic surgery. Thus, this clinical practice review aims to summarize and highlight some of the key case series and retrospective studies in order to provide insight on each of the approaches. In addition, there is a brief review of other approaches, such as subxiphoid, and the utility of endobronchial ultrasound in the management of mediastinal cysts. In this review, the identified benefits of VATS and RATS lie largely in quality improvement of the patient experience-decreased length of stay (LOS) and pain-without compromising patient outcomes. However, the open approach remains a viable option, particularly for the management of large cysts or as a bail-out option. When surgeons approach with VATS or RATS and encounter bleeding or difficult dissection planes, it is consistent in the literature that conversion to thoracotomy is the safe next step. Our clinical practice is to attempt VATS or RATS approach for mediastinal cysts when possible. The data used for this review relies heavily on case reports and case series, and thus is the main limitation of this clinical practice review.
传统的纵隔囊肿及肿物切除术是通过正中胸骨切开术或开胸术进行的开放性手术。随着微创技术的出现，已经有通过电视辅助胸腔镜手术（VATS）和机器人辅助胸腔镜手术（RATS）成功完成的病例。尽管纵隔囊肿并不常见，但在胸外科实践中却是一个重要且相关的话题。因此，本临床实践综述旨在总结并突出一些关键的病例系列和回顾性研究，以便对每种手术方法提供见解。此外，还简要回顾了其他手术方法，如剑突下手术，以及支气管内超声在纵隔囊肿管理中的应用。在本综述中，VATS和RATS的已确定益处主要在于改善患者体验——缩短住院时间（LOS）和减轻疼痛——而不影响患者预后。然而，开放性手术仍然是一种可行的选择，特别是对于大型囊肿的处理或作为补救措施。当外科医生采用VATS或RATS手术并遇到出血或解剖平面困难时，文献一致认为转为开胸术是安全的下一步。我们的临床实践是尽可能尝试对纵隔囊肿采用VATS或RATS手术方法。本综述所使用的数据严重依赖病例报告和病例系列，因此这是本临床实践综述的主要局限性。
