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Video Presentation - 20
Minimally invasive surgery for congenital thymic cysts in children: a report of 3 cases.
N Dessouky
Cairo University Faculty of Medicine , Pediatric Surgical Division, Cairo University Specialized Pediatric Hospital, Egypt
Background: Congenital thymic cysts are considered extremely rare in children. They account for 3% of all superior mediastinal masses. Approximately 150 cases of cervical thymic cysts have been reported in literature usually as single case reports, 50% of them extend to the mediastinum. With review to the literature, no reports have been documented to use the minimally invasive approach for excision of such lesions in children.
Patients and Methods: Three children presented with congenital thymic cysts were excised with video-assisted thoracoscopic approach. Their ages were 11 months, 2 and 8 years. All of them were males. The cysts were on the right-side in 2 patients. In two cases the cysts were cervico-mediastinal. These were dissected thoracoscopicaly and then excision was completed through a small supraclavicular incision in the neck. In one case, the lesion was purely intra-thoracic with its total excision being achieved via thoracoscopy. The lesions were dissected thoracoscopicaly from the great mediastinal vessels (superior vena cava and right atrium, left common carotid artery…) with excision of the remaining part of the thymic lobe.
Results: Accidental intra-operative opening of the contralateral pleural space resulted in one case that necessitated the insertion of intercostal tube drainage. Histopathological examination of the cysts revealed fibrotic wall with inflammatory cells and foci of cholesterine crystals surrounded by normal thymic tissues with Hassal’s corpuscles. Follow-up of 6-18 months revealed no recurrences.
Conclusions:Thoracoscopy for thymic cyst can be used safely to avoid scars of open surgery with rapid recovery of the patients. It can assist the removal of cervical thymic cysts that extend into the mediastinum, thus eliminating the need for a second thoracotomy incision .