Thoracoscopic surgery combined with a supraclavicular approach for removing superior mediastinal tumor

Abstract

This report introduces our new technique of thoracoscopic surgery combined with a supraclavicular approach for removing superior mediastinal tumor. A 68-year-old woman noticed a tumor palpable in the left supraclavicular fossa. The patient had no pain around the neck and shoulder. A radio-opaque shadow 6 cm in diameter was detected in her left apical lung field on chest roentgenogram. Chest CT and MRI showed that the tumor was located in the superior mediastinum, extending up to the thoracic inlet, and there was no invasion of the surroundings. At first, a thoracoscopic examination was performed to assess the possibility of the excision. After dissecting the tumor from the mediastinal tissue and the first costovertebrae as far as possible by thoracoscopic surgery, a supraclavicular approach was used to enter the thoracic cavity. Complete resection of the tumor was successfully performed by thoracoscopic surgery combined with a supraclavicular approach. The tumor was removed in a plastic bag through the supraclavicular defect. Postoperative histopathology revealed that the tumor was a benign neurogenic one. A satisfactory follow-up of 5 postoperative days was observed without any complications, and the patient was discharged. The procedure was safe, easy, and minimally invasive to perform. Moreover, the supraclavicular approach could be used to add trocar port if needed.

The Cervical Anterior Approach for the Resection of Superior Posterior Neurogenic Tumor: A Case Report

“…The approaches have included (1) supraclavicular approach, 1) (2) cervico-transsternal approach, 2) (3) thoracoscopic surgery (VATS), 3) and (4) VATS combined with the supraclavicular approach. 4) The approach taken is dictated by tumor location with each one having advantages and disadvantages. For instance, tumors bordering the trunk of the brachial plexus or nerve root are best suited for the supraclavicular approach.…”

“…VATS itself is minimally invasive and has a superior cosmetic result. 4) In orthopedics, a manubrium splitting approach has been employed for fixation of vertebra of the cervicothoracic junction. 5) We modified this approach and developed an approach which we have called the cervical anterior approach.…”

Clinical Reasoning: An unusual lung mass causing focal weakness

“…In fact, 25%-45% of extracranial schwannomas arise from nerves in the head and neck, with 65% arising from the face region and 35% from the neck. 2 The most common locations include the vagus, hypoglossal, and lingual nerves; sympathetic trunk; cervical plexus; and brachial plexus. 1,3 Extracranial schwannoma are generally solitary benign lesions, which grow insidiously and rarely undergo malignant transformation.…”

Navigating the thoracic inlet in children

“…A number of approaches to the inlet have been described, predominantly in the adult literature, but there is no unanimity with regard to the ideal approach [1][2][3][4][5][6][7]. We could identify only two previous reports in the literature of approaching the inlet in children with tumours [7,8].…”