and Ovidiu Burlacu1
Surgery Clinic, Timisoara Municipal Hospital, Timisoara, Timis, Romania
Tumoral pathology of the chest wall is more common nowadays, even in
young patients. Chest wall tumors usually requires extended surgery to
acheieve oncological margins. In some cases the position of the tumoral
formation makes it difficult to approach using classic tecniques and to
acheive oncological margins, thus complementary thoracoscopic approach
may be needed.
We present the case of a 16 year old patient admitted in our clinic
after a sport accident. Incidentally the chest xray identified a
tumoral formation of the left 2nd rib. The CT scan revealed that the
formation was limited only to the second rib, with osteolisis.
We decided to use both thoracoscopic and open approach. We created a
port using the 4th intercostal space mid axillary line, and visualized
the tumor; using the cautery we delimitated the resection area. Using
the dissector we established the uitility incision site.
We then performed a 3 inch incision for the open approach and we
started the endoscopic dissection of the tumoral formation. After the
dissection was complete we proceeded with the rib resection using the
utility incision and resected the tumor.
Chest wall reconstruction was performed using separated interlaced
"spider web" stiches. One chest drain was placed.
The postoperative outcome was good, with no complications. The
resection was within oncologic margins. Hospital stay was 4 days, with
one day ICU care, with minimal analgetic treatment.
Source : http://erj.ersjournals.com/content/44/Suppl_58/P3267
Dual approach was very useful for the resection, the magnification
helped us to establish the macroscopic margins for the tumoral
formation. The use of endoscopic dissection has the advantage of a
minimal resection incision and minimal bleeding.
Image : http://ctsurgerypatients.org