• Bronchogenic cyst (BC)
• open surgery
• thoracotomy
• video-assisted thoracoscopic surgery (VATS)

• Learning curve
• Mediastinal mass
• Robot-assisted thoracoscopic surgery
• Thoracoscopy

• Humans
• Retrospective Studies
• Learning Curve
• Robotics
• Robotic Surgical Procedures/methods
• Thoracic Surgery, Video-Assisted/methods

• Ear, nose and throat/otolaryngology
• Paediatrics

• Female
• Humans
• Child
• Child, Preschool
• Bronchogenic Cyst/diagnostic imaging
• Bronchogenic Cyst/surgery
• Neck/diagnostic imaging
• Neck/pathology
• Branchioma/diagnosis
• Magnetic Resonance Imaging
• Diagnosis, Differential
• Precancerous Conditions/pathology
• Uterine Cervical Neoplasms/pathology

• Bronchogenic cyst
• Case report
• Mediastinal cyst
• Minimally invasive surgery
• VATS

• Bronchopulmonary Dysplasia
• Cardiothoracic surgery
• Pneumomediastinum

• Mediastinal cyst
• minimally invasive approach
• open approach

The effectiveness of robotic-assisted thoracoscopic surgery (RATS) for mediastinal masses has not been fully evaluated. This study aimed to compare the perioperative outcomes between RATS and video-assisted thoracoscopic surgery (VATS) for mediastinal masses, and then explore which group of people would benefit more from RATS.

This retrospective study compared the perioperative outcomes of patients with mediastinal masses who underwent RATS and VATS from September 2018 to December 2021. Subgroup analysis were performed according to body mass index (BMI) ranges.

A total of 212 patients with mediastinal masses (106 RATS cases and 106 VATS cases) were included. Compared with the VATS group, the RATS group had a significantly reduced incidence of overall postoperative complications (5.7% vs. 14.2%, p = 0.039), complications of grade II or less (3.8% vs. 12.3%, p = 0.023), and pneumonia (2.8% vs. 9.4%, p = 0.045). Hospitalization costs were significantly higher in the RATS group (¥ 49350.0 vs. ¥ 32551.9, p < 0.001). There was no significant difference in operation duration, intraoperative estimated blood loss, postoperative chest tube drainage volume, NRS pain score, day of chest tube removal, complications of grade III or more, or in-hospital mortality rate (p > 0.05). Subgroup analysis indicated that the incidence of overall postoperative complications (3.1% vs. 15.2%, p = 0.017), complications of grade II or less (1.5% vs. 12.1%, p = 0.033) and postoperative length of stay (4 days vs. 4.5 days, p = 0.046) were significantly reduced in the RATS group for overweight and obese patients (BMI ≥ 24 kg/m²), while these differences became insignificant in the BMI < 24 kg/m² subgroup.

RATS could reduce the incidence of postoperative complications, shorten the postoperative length of stay and might be a more cost-effective surgical treatment for overweight and obese patients with mediastinal masses.

• National Key Research and Development Program
• Natural Science Foundation of Shandong Province
• Taishan Scholar Program of Shandong Province

Mediastinal bronchogenic cysts and pericardial defects are both rare. It is extremely rare that both occur simultaneously. To the best of our knowledge, this is the first case of a coexistent bronchogenic cyst and pericardial defect reported in China. We performed a literature review and found a relationship between bronchogenic cysts and pericardial defects, which further revealed the correlation between the bronchus and pericardium during embryonic development.

A 14-year-old boy attended a local hospital for ankylosing spondylitis. Chest radiography showed an enhanced circular-density shadow near the left mediastinum. The patient had no chest symptoms and the physical examination was normal. Because of the mediastinal occupation, the patient visited our department of chest surgery for further treatment. During surgery, a left pericardial defect was observed. The bronchogenic cyst was removed by thoracoscopic surgery, but the pericardial defect remained untreated, and a satisfactory outcome was achieved after the operation. The patient was diagnosed with a mediastinal tumor. The pathological diagnosis of the tumor was a bronchogenic cyst.

This case further reveals the correlation between the bronchus and pericardium during embryonic development.

• Bronchogenic cyst
• Pericardial defect
• Mediastinal mass
• Embryonic development
• Literature review
• Case report

Background: Our aim in this study was to compare the results of video-assisted thoracoscopic surgery with those of open surgery regarding efficacy, morbidity, and long-term recurrence of bronchogenic cysts in light of the literature.

Methods: This study comprises the data of 51 patients whose pathological diagnosis revealed bronchogenic cyst after surgical excision between January 2010 and December 2016. There were two groups according to the type of resection: video-assisted thoracoscopic surgery (VATS) and thoracotomy.

Results: Of the patients included in the study, 25 (49%) were male and 26 (51%) were female. Their average age was 41.7 ± 14.1 years. While 14 patients (27.5%) were asymptomatic in the preoperative period, 37 patients (72.5%) had symptoms. The Charlson Comorbidity Index was 0 in 35 patients (68.6%) and 1 and above in 16 patients (31.4%). While 22 (43.1%) patients underwent cyst excision via VATS, 29 (56.9%) patients underwent thoracotomy. The average length of hospital stay was 1.77 ± 0.68 days for patients who had VATS, whereas it was 3.82 ± 3.3 days for patients who had thoracotomy (p <0.001).

Conclusion: VATS procedure is a safe method in the surgical treatment of bronchogenic cysts, with less hospitalization and similar recurrence rates.

• VATS
• bronchogenic cyst
• mediastinal lesions

Congenital lung malformation is an umbrella term and consist of various kind of parenchymal and mediastinal pathologies. Surgical resection is often required for diagnosis and curative treatment.

We aimed to review our experience in surgical treatment for congenital lung disease and present the role of minimally invasive surgery.

Surgical resections performed for benign lesions of the lung and mediastinum between January 2009 and May 2019 were retrospectively analyzed. Patients who were found to have congenital lung malformation as a result of pathological examination were included in our study. Distribution characteristics of the patients according to congenital lung malformation subtypes, differences in surgical approach and postoperative results were investigated.

A total of 94 patients who underwent surgical resection and were diagnosed with the bronchogenic cyst, sequestration, bronchial atresia, congenital cystic adenomatoid malformation (CCAM), or enteric cyst as a result of pathological examination were included the study. There were no significant differences between pathological subtypes in the postoperative length of hospital stay and drainage duration however, perioperative complication rate was higher in the sequestration group. In addition, in the first three days postoperatively, the mean pain score was found to be lower in the VATS group compared to thoracotomy.

Congenital lung malformations consist of a heterogeneous group of diseases and the surgical treatment in these patients can range from a simple cyst excision to pneumonectomy. Video-assisted thoracoscopic surgery should be considered as the first choice in the surgical treatment of these patients in experienced centers.

• Congenital lung malformation
• Large tumors
• Minimally invasive surgery
• VATS
• lung cancer
• thoracotomy
• video-assisted thoracoscopic surgery

In this study we aimed to assess the clinical outcomes of performing video‐assisted thoracic surgery (VATS) to treat primary mediastinal cysts (PMCs) and investigate the clinical factors which increase the difficulties associated with VATS.

The medical records of all consecutive PMC patients, who underwent surgical resection from April 2001 to July 2016, were reviewed and 282 patients were included. Clinical characteristics, imaging features, and surgical outcomes were analyzed. Follow‐up data were successfully obtained from 230 PMC patients by telephone or outpatient clinic annually. The latest follow‐up was July 2019.

VATS was performed in 278 patients and four patients were converted into thoracotomy. The mean operation time and intraoperative bleeding were 102.4 ± 40.9 minutes (range 25–360 minutes) and 52.4 ± 75.1 mL (range 5–600 mL), respectively. The intra‐ and postoperative complication rates were 2.8 and 5.7%, respectively. Seven patients with bronchogenic cysts showed severe cyst adhesion to vital mediastinal structures and thus had incomplete resection. Multivariable logistic analysis revealed that a maximal cyst diameter greater than 5 cm was significantly associated with increased risks of operation time extension (OR = 2.106; 95% CI: 1.147–3.865, P = 0.016) and intraoperative blood loss increase (OR = 4.428; 95% CI: 1.243–16.489, P = 0.022). A total of 230 patients had follow‐up data. The median follow‐up time was 70 months (range, 36–210 months). No local recurrence was observed.

Surgical resection by VATS may be recommended for PMC management as a primary therapeutic strategy. Cysts with a maximum diameter greater than 5 cm or cysts adjacent to vital mediastinal structures can increase the surgical difficulties.

• Significant findings of the study

A diameter >5 cm and adhesions significantly increased the risk of operation time extension together with increased blood loss.

• What this study adds

Cysts with a diameter >5 cm or those adjacent to vital mediastinal structures increased the potential for surgical difficulties.

• Bronchogenic cyst
• primary mediastinal cyst
• thymic cyst
• video-assisted thoracic surgery (VATS)

• Adolescent
• Adult
• Aged
• Asymptomatic Diseases
• Bronchogenic Cyst/diagnosis
• Bronchogenic Cyst/surgery
• Child
• Child, Preschool
• Female
• Humans
• Infant
• Intraoperative Complications/epidemiology
• Male
• Middle Aged
• Postoperative Complications/epidemiology
• Retrospective Studies
• Treatment Outcome
• Young Adult

• Mediastinum
• mediastinal mass
• robot-assisted thoracoscopic surgery

Video-assisted thoracic surgery (VATS) for mediastinal cysts has been used with increasing frequency. Both single-port VATS and three-port VATS procedures are used for mediastinal cystectomy. Few studies have been published to compare three-port VATS and single-port VATS procedures in mediastinal cystectomy.

Forty-five patients with mediastinal cysts who underwent single-port procedures (n = 23) or three-port procedures (n = 22) in our department from January 2016 to July 2018 were retrospectively analysed. The perioperative conditions and pathological findings were analysed.

The single-port group showed shorter operation times [45 (35–60) vs 55 (45–80) min, p = 0.013], less retention time of the thoracic drainage tube [27(24–48) vs 48(48–70) p < 0.001)], shorter postoperative hospital stays [5(4–6) vs 7(5–7), p = 0.011] and less costs [2.0)1.2–2.5) vs 2.5(1.9–3.5), p = 0.032] than those of the three-port group. No difference was found in case conversions to open procedures (p > 0.99) or second operations (p > 0.99). Logistic regression analysis showed that the surgical method (p = 0.426) and surgeon experience (p = 0.719) were not independent prognostic factors for the success of surgery.

The single-port VATS procedure was not inferior to the three-port VATS procedure for mediastinal cystectomy. The single-port VATS procedure is a feasible choice for mediastinal cystectomy.

• Mediastinal cystectomy
• Single-port
• VATS

• Adolescent
• Adult
• Aged
• Bronchogenic Cyst/surgery
• Child
• Child, Preschool
• Female
• Humans
• Logistic Models
• Male
• Mediastinal Diseases/surgery
• Middle Aged
• Operative Time
• Retrospective Studies
• Thoracic Surgery, Video-Assisted/adverse effects
• Young Adult

• Cyst
• mediastinum
• thoracoscopy
• thoracotomy

• Bronchogenic cyst
• mediastinitis
• video-assisted thoracoscopic surgery (VATS)