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THE JOURNAL OF CARDIOVASCULAR SURGERY

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The Journal of Cardiovascular Surgery 1999 February;40(1):157-60

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

Thoracoscopic diagnosis and treatment of mediastinal masses. Usefulness of the Two Windows Method

Kaga K., Nishiumi N., Iwasaki M., Inoue H.

From the Department of Surgery Tokai University School of Medicine, Japan


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Back­ground. We ­report on the use­ful­ness of tho­rac­os­copic sur­gery by the Two Win­dows ­Method in med­i­as­tinal dis­eases. ­While the posi­tioning of the two-­window ­skin inci­sions was orig­i­nally ­decided for ­lung ­cancer, but we ­have ­been ­using pre­cisely the ­same ­method to ­biopsy and ­remove med­i­as­tinal ­lesions.
­Methods. Tho­rac­os­copic sur­gery by the Two Win­dows ­Method was per­formed in 40 ­cases in ­which it had ­been impos­sible to ­make a diag­nosis by non­in­va­sive ­methods. ­Access to the ­pleural ­cavity was ­achieved by ­making ­skin inci­sions in two ­places ante­rior and pos­te­rior to the infe­rior ­angle of the ­scapula in the ­fourth inter­costal ­space.
­Results. ­Biopsy was per­formed in 17 of the 40 ­patients to ­make a his­to­log­ical diag­nosis. It was pos­sible to ­make a defin­i­tive his­to­log­ical diag­nosis in all of the ­patients. Com­plete resec­tion of a med­i­as­tinal ­tumor was per­formed in 23 ­patients, and the resec­tion was con­cluded tho­rac­os­cop­i­cally by the Two Win­dows ­Method in 22 of ­these ­patients (95.7%), ­with the ­only excep­tion of one ­patient in ­whom we con­verted to stan­dard thor­a­cotomy ­because of intra­op­er­a­tive ­bleeding. ­There ­were no post­op­er­a­tive com­pli­ca­tions and no per­i­op­er­a­tive ­deaths.
Con­clu­sions. We con­clude ­that the Two Win­dows ­Method is ­also ­useful for the diag­nosis and com­plete resec­tion of med­i­as­tinal dis­eases and ­that ­this is a low-inva­sive and ­safe ­method.

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