[Thoracic Surgery Thoracoscopic Surgery] 4K Ultra HD Thoracoscopic Mediastinal Tumor Resection

The mediastinum is an organ between the left and right mediastinal pleura. It is a general term for structures and connective tissues. The mediastinum is in the sagittal plane, located slightly to the left of the center of the chest cavity, narrow at the top and wide at the bottom, short in front and long in the back. The anterior boundary of the mediastinum is the sternum, the posterior boundary is the spine, the two sides are the mediastinal pleura, the upper boundary is the entrance of the thorax, and the lower boundary is the diaphragm. Under normal circumstances, the position of the mediastinum is relatively fixed.

The mediastinum is not an organ, but an anatomical area. The mediastinum contains the heart and the large blood vessels entering and exiting the heart, the esophagus, the trachea, the thymus, the nerves and lymphatic tissues, etc. Due to abnormal congenital development and the formation of acquired cysts or tumors, it becomes a mediastinal tumor.

The four-division method is usually used to divide the upper and lower mediastinum into the plane of the sternal angle and the lower edge of the fourth thoracic vertebra; the lower mediastinum is divided into the anterior mediastinum, the middle mediastinum and the posterior mediastinum by the anterior and posterior walls of the pericardium.

Anterior mediastinum

Upper mediastinum to diaphragm and sternum to pericardium

Posterior mediastinum

All tissues behind pericardium

Middle mediastinum

All tissues from anterior mediastinum to posterior mediastinum

Clinical manifestations

1. The manifestations of mediastinal tumors vary from asymptomatic to symptoms related to invasion and compression and systemic symptoms

2. Symptoms are related to tumor size, location, growth direction and speed, texture, nature, etc.

3. Benign tumors grow slowly, symptoms appear late and are mild

4. Malignant tumors have a high degree of erosion, progress rapidly, and symptoms appear earlier

5. Common symptoms include chest pain, chest tightness, cough, and symptoms that irritate or compress the respiratory system, nervous system, cerebral blood vessels, and esophagus

6. Specific symptoms related to the nature of the tumor

Anesthesia method and position

Anesthesia method: General anesthesia with double-lumen endotracheal intubation

Surgical position: Cooperate with the anesthesiologist and the surgeon to place the patient in a 90° lateral position on the healthy side, raise the upper limb on the affected side and fix it on the armrest, put a chest pad under the chest, bend the upper leg slightly and straighten the lower leg, put a cushion between the legs, fix the pelvis, put a head circle under the head, and shake the operating table into a folding knife position to open the intercostal space.

Surgical steps

Anterior mediastinal tumor: Make a small incision at the junction of the 5th and 6th intercostal spaces and the mid-axillary line on the left or right side as the entrance for the thoracoscopic operation.

Middle mediastinal tumor: Take the junction of the mid-axillary line and the 6th and 7th intercostal spaces as the observation hole, and the junction of the anterior axillary line and the 4th intercostal space and the junction of the posterior axillary line and the 6th intercostal space as two operation holes.

Posterior mediastinal tumor: Take the junction of the 5th and 6th intercostal spaces on the anterior axillary line as the observation hole, and adjust the operation hole appropriately according to the location of the tumor.

Postoperative care

1. Supine position.

After general anesthesia, patients who are not awake should lie flat without pillows, with their heads tilted to one side. After waking up and blood pressure is stable, they should take a semi-recumbent position, which is conducive to breathing and chest drainage.

2. Respiratory care.

Oxygen inhalation; guide patients to consciously control breathing techniques to promote lung expansion and increase lung ventilation; dilute sputum and follow the doctor's instructions for treatment.

3. Pain care

Distract the patient's attention; take a comfortable supine position to reduce stimulation; use analgesics as prescribed by the doctor when necessary.

4. Improve the body's resistance

Supplement nutrition, eat more light and easily digestible foods that are high in protein, high in calories, and rich in vitamins, improve immunity, and promote wound healing; encourage early bed activities.

5. Catheter care: keep the tube closed and drainage unobstructed. Strictly follow aseptic operation, observe and record the color, volume and properties of the drainage fluid, and prevent active bleeding (100-200ml per hour).