Laparoscopic resection of a lower posterior mediastinal tumor: feasibility of using a transdiaphragmatic approach.

INTRODUCTION Either video-assisted thoracoscopic surgery (VATS) or a thoracotomy is usually performed for a resection of posterior mediastinal tumors. We used a laparoscopic approach to resect a lower posterior mediastinal tumor mimicking a right adrenal tumor that had been identified by a preoperative computed tomography (CT) scan, because this approach is less invasive than VATS or a thoracotomy, regarding the potential to cause damage to the respiratory organs. TECHNICAL CONSIDERATIONS A preoperative CT scan showed a paraspinal mass measuring 5.5 cm in diameter at the level of the 11th thoracic vertebra and gallbladder stones. A laparoscopic transdiaphragmatic excision of this lower posterior mediastinal tumor was attempted and accomplished safely. First, we used the usual laparoscopic transperitoneal approach. Thereafter, we accessed the lower posterior mediastinum by splitting the crural fibers of the diaphragm. The tumor was completely resected without damaging the pleura. We also simultaneously performed a laparoscopic cholecystectomy for gallbladder stones. The operating time was 229 minutes (mediastinal tumorectomy 164 minutes, cholecystectomy 65 minutes) and the bleeding volume was 100 mL. The postoperative course was uneventful. The pathological findings of the specimen demonstrated schwannoma. CONCLUSIONS We found the laparoscopic approach to the lower posterior mediastinum by splitting the diaphragm to be a feasible and less invasive method than either VATS or a thoracotomy. This surgical modality can thus be performed on selected lower posterior mediastinal tumors.