and Giampiero Soccorso2
(1)
Department of Paediatric Surgery, Birmingham Children’s Hospital, Birmingham, England, UK
(2)
Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK
Abstract
Posterior mediastinal neurogenic tumors (neuroblastomas, ganglioneuroblastomas, and ganglioneuromas) represent 15–20 % of all neuroblastomas (apical 38 %, cervical 9.5 %, cervicothoracic 9.5 %, midthoracic 38 %, and thoracoabdominal 5 %). In small (<6 cm), mature, stage 1, mid-thoracic lesions, the thoracoscopic approach can result in adequate resection, low complication rate, shorter hospital stay, and long-term disease-free survival.
Keywords
NeuroblastomaThoracoscopic13.1 General Information
Posterior mediastinal neurogenic tumors (neuroblastomas, ganglioneuroblastomas, and ganglioneuromas) represent 15–20 % of all neuroblastomas (apical 38 %, cervical 9.5 %, cervicothoracic 9.5 %, midthoracic 38 %, and thoracoabdominal 5 %). In small (<6 cm), mature, stage 1, mid-thoracic lesions, the thoracoscopic approach can result in adequate resection, low complication rate, shorter hospital stay, and long-term disease-free survival.
13.2 Working Instruments
5-mm Working ports, 10-mm port, and an endocatch bag for specimen extraction
5-mm, 0° laparoscope
5- mm Curved and straight graspers, monopolar hook diathermy
5-mm LigaSure sealing device
5-mm Endoclips
13.3 Positioning, Port Siting, and Ergonomic Considerations
For a midthoracic lesion, the patient is positioned semi-prone on a roll. The surgeon and assistant stand toward the patient’s abdomen. The monitor is positioned opposite the surgeon. The ports should be positioned so that the triangulation occurs in relation to the tumor.
13.4 Relevant Anatomy
The tumor usually lies along the posterior thoracic wall, lateral to the spine. On the left side it tends to be in close proximity to the thoracic aorta (Figs. 13.1 and 13.2). Its blood supply may come from the aorta and intercostal vessels. On the right side the related structures include the oesophagus, thoracic duct, pericardium, and superior mediastinum.
