Mediastinal Surgery
Tumours of the mediastinum include thymomas, bronchonenic cysts, oesophageal duplications cysts, schwannomas, paragangliomas, and can often be removed using the surgical robot.
Diagnosis
The main type of tumours inside the chest are those in the anterior mediastinum which include thymomas (click here), and lung tumours (click here). More rare types include those in the posterior mediasinum (behind the heart) and can include bronchonenic cysts, oesophageal duplications cysts, schwannomas, and paragangliomas. There are also tumours of the ribcage which can be benign or malignant. Dr Bassin performs a high volume of complex robotic surgery to remove mediastinal tumours with the DaVinci Xi robot and receives patients from around Australia. The diagnosis of these tumours is made with CT scans or MRI, and often a needle biopsy is required which is performed under local anaesthetic. As assement of suitability for robotic surgery can be obtained after Dr Bassin has reviewed the CT or MRI.
Robotic surgery avoids the need for a thoracotomy.
What is involved?
Mediastinal tumors can often be removed using robotic surgery, depending on their size and location. Dr. Bassin employs the advanced Da Vinci Xi surgical robot for these procedures. The process involves making up to four small incisions, each 7 mm in diameter, between the ribs on one side of the chest. The lung on that side is temporarily deflated, allowing the robotic instruments to precisely remove the cyst or tumor. This robotic technique provides a highly detailed view of the chest and minimises the risk of injury to critical structures, such as the phrenic nerve, which controls the diaphragm and is essential for breathing. The surgery typically lasts between 1 and 3 hours, with most patients being discharged within 2 days.
In cases where robotic surgery is not feasible due to the tumor’s size or location, a thoracotomy may be required. This method involves making an incision between the ribs to gain access to the mediastinum. While thoracotomy offers excellent exposure, it is associated with increased pain, blood loss, inflammation, and a longer recovery time.
Dr. Bassin is a highly experienced robotic cardiothoracic surgeon and successfully performs robotic removal of mediastinal masses in the majority of cases.
Duplication Cyst
Oesophageal and bronchogenic duplication cysts are congenital malformations where there is an abnormal branching off the gastrointesintal or airways. These blind ended sacs are filled with secretions and can enlarge or become infected. They often are found incidentially on a CT scan performed for other reasons, but can only present with symptoms of infection or enlargement pushing on other structures in the chest. The treatment usually involves complete removal of the cyst with the entire lining to reduce the chance of it recurring. Most duplication cysts can be removed robotically with four very small incisions (7 mm) in between the ribs and patient can often be discharged within a day or two.
Paraganglioma
These tumours arise from the sympathetic chain of the nervous system. Their characteristics include a very eloborate blood supply, and the ability to secrete hormones into the blood stream which can result in very high blood pressures. The diagnosis is made based on a CT scan as well as a a PET scan (dotatate). Hormone levels are measured in the blood stream and referral to a specialist Endocrinologist to assist the management of the complex tumours both before and following surgery.
Schwannoma
A schwannoma is relatively benign tumour of a nerve and can grow quite large. It is a tumour of the Schwann cells, with provide nerve with insulation, in a similar manner to plastic insulation of a electrice wire. Within the chest schwannomas can grow for any nerve, but commonly from the intercostal or vagus nerves. In some cases, a schwannoma can grow from a nerve just as it exits the spinal cord.
The presumptive diagonsis is made based on CT and MRI scans, and a conclusive diagonsis can only be confirmed once this tumour has been resected and viewed by a pathologist under a microscope. In most cases schwannoms within the chest cavity can be removed robotically four very small incisions in between the ribs and patient can often be discharged within a day or two.
If there is any concern of a tumour arising from the spinal cord, Dr Bassin will perform the surgery in conjuction with an expert spinal surgeon. (VIDEO HERE).
What is the recovery like?
After mediastinal surgery, patients typically spend one night in the intensive care unit for monitoring and are then moved to the general ward the next morning. During the procedure, drainage tubes are placed between the ribs to remove any air and blood, and these are usually removed within 12-24 hours. Our team of nurses and physiotherapists will focus on mobilisation and breathing exercises to help restore normal lung function. Additionally, our pain management specialists will create a personalised pain relief plan to facilitate a swift recovery and discharge. For robotic operations, the average hospital stay is about 2 days. In cases requiring a thoracotomy, the stay is generally 5-7 days.
When can I drive?
Patients can generally drive 1 week following a robotic surgery and 2 weeks if a thoracotomy is required. Dr Bassin will give you individualised advice on return to driving and work.
What are the benefits and risks of this procedure?
The primary benefit of removing a mediastinal tumor or cyst is to address masses that may be cancerous or have the potential to become malignant. While many mediastinal masses are slow-growing and benign, their exact nature is often unknown until they are surgically removed and examined by a pathologist.
Surgical risks include infection, bleeding, a small risk of mortality, persistent pain, and potential damage to surrounding structures such as the heart, major blood vessels, lungs, and critical nerves (like the phrenic and recurrent laryngeal nerves). In robotic surgery, there is a small risk that the procedure may need to be converted to an open approach (thoracotomy) due to challenges with visualisation, scar tissue, or significant bleeding. The robotic approach offers several advantages, including minimised trauma, reduced bleeding, less pain, and a quicker recovery.