P-221TRANSCERVICAL AND RETROSTERNAL APPROACH TO LEFT THORACIC CAVITY USING A FLEXIBLE ENDOSCOPE

• Published in: Interactive cardiovascular and thoracic surgery Vol. 17; no. suppl_1; p. S58
• Main Authors: Giol, M., Masmoudi, Hicham, Karsenti, A., Evrard, D., Costea, C., Sylvestre, R., Gounant, V., Debrosse, D., Grunenwald, D., Assouad, J.
• Format: Journal Article
• Language: English
• Published: Oxford University Press 01-07-2013
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivt288.221

Objectives
Mediastinoscopy remains the gold standard for surgical exploration of the mediastinum. Nevertheless, surgical exploration of left mediastinal and left thoracic lymph nodes still remains a surgical challenge due to anatomical difficulties to access left thoracic cavity (vascular and neurological structures). The aim of this anatomical study is first to describe a new left thoracic approach through a single cervical incision and retrosternal dissection using a flexible endoscope as unique instrument, and secondly to evaluate the risk of injuries of adjacent anatomic structures.
Methods
We conducted an experimental work on 12 refrigerated and non-embalmed cadavers. Through a small cervical incision, we dissected, first digitally and then using a mediastinoscope, the retrosternal space to the level of Louis angle. We then opened the left mediastinal pleura. We introduced the flexible endoscope through this pleural window into the left thoracic cavity. To study the distance between the endoscope entry point and the adjacent anatomic structures, we performed a left postero-lateral thoracotomy. We defined and measured three distances between the borders of the endoscope entrance point and the adjacent structures (phrenic nerve and mammary artery).
Results
We did not notice any injury of the phrenic nerve and mammary artery. Mean measured distances between the endoscope entry point, phrenic nerve and mammary artery were: 17.1 mm [02; 40], 39.5 mm [17; 80] and 19.1 mm [10; 40].
Conclusions
Retrosternal approach for left thoracic cavity exploration through a small cervical incision using a flexible endoscope is feasible. Retrosternal area has less anatomic fragile structures and present less potential anatomic lesion during mediastinal approach. The mean distances we calculated show the potential safety of our approach concerning the phrenic nerve and the mammary artery. An experimental protocol on living animals is currently started to confirm these preliminary results
Disclosure
All authors have declared no conflicts of interest.