The mediastinum is an anatomic description of the central portion of the chest. Mediastinal surgery represents any procedure performed within this area. The mediastinum is surrounded by the breastbone in front, the spine in back, and the lungs on each side (Figure). The types of surgery range from small procedures performed to diagnose disease processes as well as more significant operations necessary to remove larger tumors that grow in this region.
Many types of growths (tumors) occur in the mediastinum. These can range from non-cancerous (benign) to cancerous (malignant). It can sometimes be difficult to distinguish between benign and malignant conditions. Obtaining a piece of the tumor (biopsy) can differentiate between benign and malignant growths and allow appropriate treatment. Some benign and many malignant tumors are best treated by surgical removal (resection) although this varies by the type of tumor. Some tumors are best treated by chemotherapy or radiation therapy and do not require removal. Your surgeon will help guide you in this decision. Some diseases such as Myasthenia Gravis, a disease affecting a patient’s strength and vision, can be treated by removal of the thymus gland which resides in the mediastinum.
Most tumors that grow in the mediastinum should be biopsied or removed. Most biopsies can be performed with minimally invasive techniques and rapid recovery. Almost all patients are candidates for biopsy while candidacy for resection depends on the size of the tumor, its location, relationship with other structures in the chest and a patient’s overall medical condition.
Your surgeon will perform a thorough history and physical exam. Breathing tests are generally performed (pulmonary function tests). Blood tests are drawn that can give clues to the cause of some tumors. Additionally, imaging is performed including but not limited to:
Your surgeon will determine if additional preoperative tests are necessary based on the findings of these studies and your medical history.
A biopsy is the removal of a sample of tissue for examination under the microscope by a pathologist, a physician trained in examining this tissue. The following are biopsy techniques:
Some tumors of the mediastinum require complete removal. Techniques to remove them include:
Some tumors of the mediastinum are amenable to less invasive approaches. This depends on the type, size and location of the tumor. Minimally invasive approaches include:
Video-assisted thoracic surgery (VATS) is a procedure that uses video-assisted technology to minimize trauma and speed recovery. A small camera is inserted between the ribs and two other instrument “ports” utilized to manipulate and remove the tumor.
Robotic Surgery Robotic surgery utilizes robotic technology to minimize surgical trauma. The surgeon works at a console next to the patient in the operating room that provides visualization of the inside of the chest and control of highly responsive robotic arms. Advantages include 3-D technology to visualize and fine robotic dexterity to manipulate and remove tumors. Your surgeon will discuss with you and choose the best approach for your tumor.