Thoracoscopy & Mediastinal Tumors😍

Thoracoscopy

Video-Assisted Thoracoscopic Surgery (VATS)

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  • Uses:
    • Resections.
    • Decortication.
    • Biopsies.
      •  
  • Method: 
    • Lung collapsed to create space (using a double lumen endotracheal tube).

Empyema

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  • Pus in the pleural space.

Phases:

Phase
Exudative
Fibrinopurulent
Organized
Characteristics
Thick pus, fever
Thickening of pus + pleura
Thickening of pleura,
lung becomes entrapped
Management (Mx)
Aspiration + antibiotics
Chest tube
(P/D/F = Drainage, Fibrinolytic)
Stripping of pleura/VATS
  • If VATS fails → Decortication may be done.

Thoracoscore

  • not include → COMPLICATION OF SURGERY

Definition

  • Prognostic scoring system
    • Post lung resection
  • Predict mortality and assess risks

9 Key Criteria

Criteria
Description
Age
Older age is associated with higher risk.
Sex
Gender may influence risk assessment.
Performance Status
Evaluates the patient's overall functional capacity.
Dyspnoea
Presence and severity of shortness of breath.
Comorbidities
Presence of additional health conditions
ASA Score
Reflects the patient's physical status.
FEV1
Measures lung function.
DLCO
Assesses gas exchange capability.
Extent of Resection
Type and extent of lung surgery

Mediastinal Tumors

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Anterior (3Ts)

  • Thymoma
    • m/c overall
  • Terrible lymphoma
  • Teratoma

Middle

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  • Cystic lesions
  • Lymphoma
  • Mesenchymal tumors

Posterior

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  • Neurogenic
    • m/c in children

Mediastinal Teratoma:

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  • Imaging:
    • Well-defined mixed density lesions
      • displacing > invading
    • cystic areas
    • calcification
  • Most common mediastinal germ cell tumor.
  • Most common in anterior mediastinum.
  • Mature teratoma associated with Klinefelter's syndrome.
    • Mnemonic: Klinefelter guy has 2 swellings on chest,
      • Gynecomastia
      • Mature teratoma

Thymoma:

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  • Thymoma is the most common neoplasia of the thymus
  • A/w Myasthenia Gravis

Staging

  • (Masaoka Staging for MRI/CT):
      • Stage
      Description
      Rx
      I
      Macroscopically completely encapsulated + No capsular invasion
      Sx
      II
      Invading into surrounding structures + Capsular invasion
      Sx + RT
      III
      Invading neighbouring organs (Pericardium, great vessels, Lungs)
      Sx + RT
      IVA
      Pleural/Pericardial dissemination
      Neochemo + Sx + RT
      IVB
      Lymphatogenous/Hematogenous metastasis
      Neochemo + Sx + RT
      Mnemonic:
    • Thy Moma → My Momma → My God → MG (Myasthenia)
    • Masooka → character → Like “Thy Moma” (Ur momma)

Treatment

  • Thymectomy
    • M/c N injured → Phrenic N