Chest Wall Tumor - Dual Thoracoscopic and Open Approach
INTRODUCTION : Tumoralpathology 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.
MATERIAL AND METHOD : 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.
RESULTS : 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.
CONCLUSION : 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.