Management of hemorrhage during thoracoscopic surgery for anterior mediastinal tumors

Takashi Suda


Recently, thoracoscopic surgery for mediastinal tumors has become a frequent procedure but is generally associated with more difficult management of hemorrhage than open surgery; therefore, extra care is needed for ensuring safety. The criterion for determining whether endoscopic surgery is indicated for an anterior mediastinal tumor is based on whether the tumor can be safely dissected from the left brachiocephalic vein. The range of applications differs depending upon the surgical approach selected. Because it is difficult to clamp this vessel when the patient is in the lateral decubitus position, surgery should be performed with the patient in the supine position, which allows for conversion to median sternotomy regardless of the endoscopic surgery approach being used. In cases in which the anterior mediastinal tumor is suspected to have invaded and in contact with the left brachiocephalic vein, dissection of the tumor from the brachiocephalic vein is required. If thoracoscopic hemostasis is deemed difficult, then swiftly convert to median sternotomy without any hesitation or delay, and safely performing the procedure is of utmost importance. Any minimally invasive surgical procedure must maintain the same or better precision than that in its open surgery counterpart and must consider patient safety.