[Diagnosis and treatment of pleuro-pericardial cysts. Role of videosurgery]. / Diagnosi e trattamento delle cisti pleuro-pericardiche. Ruolo della videochirurgia.

BACKGROUND: The pericardial cysts are benign "tumors" of the antero-inferior mediastinum, most often asymptomatic, which diagnosis is radiologic and incidental. When cysts are symptomatic and/or diagnosis is difficult, any resort to invasive diagnostic examinations and surgical ablation is suitable. METHODS: From January 1993 to January 1994 five patients with pericardial cyst have been treated. Three patients were symptomatic: two suffering from cardiac arrhythmia and one had cough with dyspnea. In three cases the lesion had a typical location and typical radiological patterns, and diagnosis was made by chest X-ray, confirmed by computed tomography (CT). In one case chest X-ray and CT didn't allow a sure diagnosis (differential diagnosis with Morgagni's diaphragmatic hernia), and in another case all examinations suggested a relapsing pleural effusion. RESULTS: All patients underwent ablation of the cyst by VATS; no complications were observed and patients left the hospital, on average, after 2 days (range 1-3). CONCLUSIONS: VATS, thanks to its low invasiveness, may be considered the method of choice for the diagnosis of atypical lesions and/or treatment of symptomatic cysts.

Endothoracic sonography with color Doppler availability during video assisted thoracic surgery (videothoracoscopic operative staging with ultrasound color Doppler) for lung cancer staging.

BACKGROUND: The preoperative staging of lung cancer can be problematical when we attempt to evaluate T factor (T2-T3 versus T4) and N factor (N0 versus N1-N2). In some cases, radiology tests (CT scan, magnetic resonance imaging) cannot entirely dispel the possibility that the mediastinal structures have been infiltrated. N factor is evaluated mainly by dimensional criteria. However, mediastinoscopy and mediastinotomy do not allow the full exploration of all mediastinal mode stations. METHOD: Starting in 1995, we submitted 10 consecutive patients to videothoracoscopic operative staging with ultrasound color Doppler (VOS-USCD). In five cases, preoperative staging showed possible infiltration of the pulmonary artery (T4). In nine cases, we found involvement of the mediastinal nodes, seven patients were N2, and two were N3. Videothoracoscopy was performed under general anesthesia using a double-lumen endotracheal tube. The videothoracoscope and sonographic probe were inserted via three thoracoports placed in the axillary triangle. RESULTS: Following the results of VOS-USCD, the staging and subsequently the therapeutic program were modified in seven of 10 cases (70%). CONCLUSIONS: Our preliminary experience indicates that VOS-USCD should be applied to the diagnosis of patients in stage IIIA (N2) and that it is particularly valuable for patients in stage IIIB.