Ann Thorac Surg 1998;66:192
© 1998 The Society of Thoracic Surgeons
Original articles: general thoracic
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DR FREDERICK L. GROVER (Denver, CO): Do you advocate draining mediastinal cysts or do you try to excise them? If you excise them, how difficult is it to do using a thoracoscopic technique?
DR DEMMY: I think that in all but two of the cysts, controlled drainage facilitated the process of their dissection and removal through the ports. Benign cysts are usually thin walled and rupture easily. Generally one is careful to drain them without spilling too much of the cyst’s contents. Two were excised without opening them.
DR DANIEL L. MILLER (Rochester, MN): In regard to the bronchogenic cysts, I think it is very important to remove the entire cyst. We are currently reviewing our cases of recurrent bronchogenic cysts at the Mayo Clinic. There are a moderate number of cysts that had been opened previously and drained only with recurrence developing years later. We had 1 patient who was 35 years out from her first operation in whom a recurrent bronchogenic cyst developed because at the first operation the cyst was not removed completely. I think before we dive into thoracoscopic removal of these bronchogenic cysts, it is very important that we remember the principles of surgical resection to remove the entire cyst, because if you do not remove the entire lining of the cyst, it has the potential to come back at a later date.
DR DEMMY: I agree. I think the principle behind all these video-assisted techniques is that you should be able to accomplish what you were doing in an open procedure. The patient whose cyst recurred in this series had one fourth of the cyst left attached to the descending thoracic aorta, and its lining was cauterized. I am not sure whether the cyst would have been dissected free with an open procedure. It was the opinion of the surgeon that it may have been approached the same way in an open procedure.
For the patient with a bronchogenic cyst wall containing a coronary bypass graft, I was reluctant to cauterize the cyst lining there. In general, however, one should try to ablate the epithelial lining as best one can.
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