Modified Chamberlain Procedure Is an Alternative Option with or Without VATS Still a Gold Standard Technique: A 10 Years Experience
International Journal of Cardiovascular and Thoracic Surgery
Volume 4, Issue 2, March 2018, Pages: 14-19
Received: May 8, 2018; Accepted: May 31, 2018; Published: Jun. 14, 2018
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Authors
Arun Kumar Haridas, Department of Cardiovascular and Thoracic Surgery, B K Shah Medical College, Vadodara, India
Bharathi Shridhar Bhat, Department of Cardiovascular and Thoracic Surgery, B K Shah Medical College, Vadodara, India
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Abstract
Introduction: Mediastinum is divided in anterior, middle and posterior part. Mediastinum contains heart, lung, thymus, lymph nodes and nerves. A varied spectrum of disease can arise from these organs. It poses a challenge to the clinicians to confirm the diagnosis. A Mediastinal lesion grows beyond the individual division of origin in advanced stages. It is the biopsy and histopathological study that gives us an idea about probable site or organ of origin and nature of the lesion. Diagnostic biopsy approach for such cases would be CT guide FNAC, Mediastinoscopy, Video Assisted Thoracoscopic Surgery, Chamberlain procedure and Thoracotomy. Anterior mediastinotomy known as chamberlain procedure is time tested technique for confirmation of the mediastinal lesions. Objective: To re-evaluate the technique of chamberlain procedure and its modifications to confirm the diagnosis of various lesions found in the mediastinum. Chamberlain procedure and other mediastinoscopic biopsy techniques have been replaced with VATS in most centres. In view of difficulties in gaining VATS instruments as they are expensive and its steep learning curve, we continue to do chamberlain procedure for mediastinal lesions biopsy. Method: We studied 75 patients, presented with various mediastinal mass or lung lesions. Most of these lesions were not identified from another mode of investigations. Chamberlain Procedure adopted to confirm the diagnosis, asses the stage of disease, operability status and to plan the treatment. Conclusion: Chamberlain procedure is still a gold standard over multiple other techniques in diagnosis and confirmation of the mediastinal diseases. It allows accessing any plane and location in the mediastinum. Result: Chamberlain procedure and biopsy can be done for diagnosis and confirmation of all kinds of mediastinal lesions. Compared to VATS, chamberlain procedure results and outcomes are similar.
Keywords
VATS, Chamberlain Procedure, Tuberculosis, Lung Cancer, Sarcoidosis, Thymus
To cite this article
Arun Kumar Haridas, Bharathi Shridhar Bhat, Modified Chamberlain Procedure Is an Alternative Option with or Without VATS Still a Gold Standard Technique: A 10 Years Experience, International Journal of Cardiovascular and Thoracic Surgery. Vol. 4, No. 2, 2018, pp. 14-19. doi: 10.11648/j.ijcts.20180402.11
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Copyright © 2018 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
[1]
Biondi A, Rausei S, Cananzi FC, Zoccali M, D'Ugo S, Persiani R. Surgical anatomy of the anterior mediastinum. Ann Ital Chir. 2007; 78(5):351-3.
[2]
Assaad MW, Pantanowitz L, Otis CN. Diagnostic accuracy of image-guided percutaneous fine needle aspiration biopsy of the mediastinum. Diagn Cytopathol. 2007; 35(11):705-9.
[3]
Olak. J. Parasternal mediastinotomy (Chamberlain procedure). Chest Surg Clin N Am. 1996; 6(1):31-40.
[4]
Korst R. J. Mediastinal Biopsy Techniques. Mediastinal Lesions. Springer, Cham. 2017. pp 5-24 DOI. https://doi.org/10.1007/978-3-319-48379-5_2
[5]
Tetsuro Araki, Mizuki Nishino, Wei Gao, Josee Dupuis, George R, Washko Gary M, et al. Anterior mediastinal masses in the Framingham Heart Study: Prevalence and CT image characteristics. European Journal of Radiology. 2015; 2:26-31.
[6]
Takeda S, Miyoshi S, Akashi A, Ohta M, Minami M, Okumura M, Masaoka A, Matsuda H. Clinical spectrum of primary mediastinal tumors: a comparison of adult and pediatric populations at a single Japanese institution. J Surg Oncol. 2003 May; 83(1):24-30.
[7]
Brett W. Carter, Edith M. Marom, Frank C, Detterbeck. Approaching the Patient with an Anterior Mediastinal Mass: A Guide for Clinicians. J Thorac Oncol. 2014; 9: 102–109.
[8]
Kirschner P. Cerival Mediatinoscopy. Chest Surg Clincs of North America. 1996; 6(1) 1-20.
[9]
Ginsberg, Robert. Extended Cervical Mediatinoscopy. Chest Surg Clincs of North America. 1996; 6(1) 21-30.
[10]
Heikki J, Puhakka. Complications of mediastinoscopy. J Laryng Otol, 1989; 103:312-315.
[11]
Urschel J. Conservative Management (Packing) of Hemorrhage Complicating Mediatinoscopy. Ann Thorac Cardiovasc Surg, 2000; 6(1):9-12.
[12]
Park JB. Management of major hemorrhage during mediastinoscopy, J Thorac Cardiovasc Surg 2003: 126; 726-31.
[13]
Shimizu J, Kamesui T, Moriya M, Murata S, Nakanishi I, Sasaki M, Minato H. Four cases of invasive anterior mediastinal tumors definitively diagnosed by the chamberlain procedure. Ann Thorac Cardiovasc Surg. 2014; 20 Suppl: 434-40. Doi: 10.5761/atcs.cr.12.02185.
[14]
McNeill TM, Chamberlain JM. Diagnostic anterior mediastinotomy. Ann. Thorac. Surg. 1966; 2:532.
[15]
Powers CN, Silverman JF, Geisinger KR, Frable WJ. Fine-needle aspiration biopsy of the mediastinum. A multi-institutional analysis. Am J Clin Pathol. 1996; 105(2):168-73.
[16]
Krishna S Vyas, Daniel L Davenport, Victor A, Ferraris, Saha, Mediastinoscopy: Trends and Practice Patterns in the United StatesSouth Med J. 2013 Oct; 106(10): 539–544.
[17]
Federico Tacconi, Paola Rogliani, Benedetto Cristino, Francesco Gilardi, Leonardo Palombi, Eugenio Pompeo. Minimalist video-assisted thoracic surgery biopsy of mediastinal tumors. J Thorac Dis. 2016; 8(12): 3704–3710. doi:10.21037/jtd.2016.06.33
[18]
Zakkar M, Hunt I. Complication rates in mediastinoscopy and training: video versus conventional mediastinoscopy. Ann Thorac Surg. 2012; 94:337.
[19]
Demmy, Todd L et al. Multicenter VATS experience with mediastinal tumorsThe Annals of Thoracic Surgery. 1998; 66(1):187–192.
[20]
Molin LJ, Steinberg JB, Lanza LA. VATS increases costs in patients undergoing lung biopsy for interstitial lung disease. Ann Thorac Surg. 1994 Dec; 58(6):1595-8.
[21]
Landreneau RJ, Dowling RD, Castillo WM, Ferson PF. Thoracoscopic resection of an anterior mediastinal tumor. Ann Thorac Surg. 1992; 54: 142–144.
[22]
Sugarbaker DJ. Thoracoscopy in the management of anterior mediastinal masses. Ann Thorac Surg. 1993; 56: 653–656.
[23]
Zakkar M, Tan C, Hunt I. Is video mediastinoscopy a safer and more effective procedure than conventional mediastinoscopy? Interact Cardiovasc Thorac Surg. 2012; 14:81–84.
[24]
Sameer A, Hirji Scott S, Balderson, Mark F, Berry, Thomas A, D’Amico. Troubleshooting thoracoscopic anterior mediastinal surgery: lessons learned from thoracoscopic lobectomy. Ann Cardiothorac Surg. 2015; 4(6): 545–549. doi: 10.3978/j.issn.2225-319X.2015.07.04.20.
[25]
Nechala P, Graham AJ, McFadden SD, Grondin SC, Gelfand G. Retrospective analysis of the clinical performance of anterior mediastinotomy. Ann Thorac Surg. 2006; 82(6):2004-9.
[26]
Alireza Sharifian Attar, Reza Jalaeian Taghaddomi, Reza Bagheri. Anesthetic Management of Patients With Anterior Mediastinal Masses Undergoing Chamberlain Procedure (Anterior Mediastinotomy). Iran Red Crescent Med J. 2013; 15(4): 373–374. doi:10.5812/ircmj.2120
[27]
Vincenzo Ambrogi, Tommaso Claudio Mineo. VATS biopsy for undetermined interstitial lung disease under non-general anesthesia: comparison between uniportal approach under intercostal block vs. three-ports in epidural anesthesia. J Thorac Dis. 2014 Jul; 6(7): 888–895. doi: 10.3978/j.issn.2072-1439.2014.07.06
[28]
Jiao X, Magistrelli P, Goldstraw P. The value of cervical mediastinoscopy combined with anterior mediastinotomy in the peroperative evaluation of bronchogenic carcinoma of the left upper lobe. Eur J Cardiothorac Surg. 1997; 11(3):450-4.
[29]
Salas Valverde S, Gamboa Y, Vega S, Barrantes M, Gonzalez M, Zamora JB. Diagnosis of anterior mediastinal mass lesions using the Chamberlain procedure in children. Pediatr Surg Int. 2008; 24(8):935-7. doi: 10.1007/s00383-008-2179-8.19
[30]
Rami Porta R. Surgical exploration of the mediastinum by mediastinoscopy, parasternal mediastinotomy and remediastinoscopy: indications, technique and complications. Ann Ital Chir. 1999; 70(6):867-72.
[31]
Fernadez A, Campos JR, Filomeno LT, Jatene FB. Mediastinoscopy: technical aspects and current indications. Rev Hosp Clin Fac Med Sao Paulo. 1994; 49(4):164-7.
[32]
Hashim SW, Baue AE, Geha AS. The role of mediastinoscopy and mediastinotomy in lung cancer. Clin Chest Med. 1982; 3(2):353-9.
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