Uniportal video-assisted thoracoscopic surgery in the prone position for esophageal bronchogenic cyst

Abstract

Esophageal bronchogenic cysts are very rare. A bronchogenic cyst is a congenital malformation resulting from abnormal sprouting of primitive bronchi because of a foregut bronchopulmonary malformation. An 18-year-old patient with a cystic tumor in the left posterior mediastinum was identified. The mediastinal tumor was removed by uniportal video-assisted thoracoscopic surgery. The operation was performed in the prone position through a single 4-cm incision on the lateral scapular line in the left ninth intercostal space. After tumor resection, the dissected esophageal muscle and mediastinal pleura were sutured with two continuous barbed sutures. The operation took 80 min. A biopsy confirmed the diagnosis of esophageal bronchial cyst. Diet was started on the evening of the operation. The chest tube was removed on the 1st postoperative day, and the patient was discharged without any problems on the 2nd postoperative day.

Keywords: esophageal bronchogenic cyst; prone position; uniport; video-assisted thoracic surgery.

Figure 1

Radiographs of an 18-year-old man. (a) Simple radiograph shows a tumor in the left lower paravertebral area (arrow head). (b, c) A contrast-enhanced computed tomography scan. A 60 × 36 mm well-defined lobulated cystic mass in the left posterior mediastinum, abutting the esophagus.

Figure 2

Operative findings. (a) Cystic tumor covered by mediastinal pleura located posterior mediastinum. (b) Distal half of the tumor was buried in muscular layer of esophagus. Left vagus nerve was placed beside the lower part of the tumor. (c) Continuous suturing of the esophageal muscular layer and periesophageal tissue using a barbed suture (V-Loc™ 90, Medtronic). (d) A 24 Fr drainage tube is inserted through 4-cm single port.

Figure 3

A computed tomography scan at 2 years 7 months after surgery. There was no evidence of tumor recurrence.