Dr. M.M. Zameer
Consultant Pediatric Laparoscopic and Robotic Surgeon
A 11 year old boy presented with chest pain and breathing difficulty. He was evaluated and found to have a large complex solid – cystic anterior mediastinal mass ( 23 * 12 * 15 cm) along bilateral hemithorax. The biopsy was suggestive of extragonadal germ cell tumour. He received 7 cycles of chemotherapy with no reduction in the size of the tumour.
We performed a Clamshell Thoracotomy and excised the tumour at NH. The Clamshell Thoracotomy was made over the 4th ICS. The tumour was involving the whole of the thorax extending from the root of the neck to the diaphragm. Inferiorly it was resting on the lungs and pushing the pericardium inferiorly and laterally. The tumour was decompressed (cystic part) for space for dissection. It was dissected off the surrounding structures. Partial pericardiectomy was done as it was infiltrating the pericardium. This was patched with a bovine pericardium (with the help of CTVS Surgeon). The tumour was resected in toto. Child was extubated on post operative day 1 and discharged in 7 days.
Mediastinal germ cell tumours can be very large and some may not reduce after chemotherapy. Clamshell thoracotomy is a very good approach not just for trauma but also for large tumours for complete resection of the tumour.
In this era of Minimally Invasive Surgery, sometimes BIG INCISIONS are needed.
Also such complex lesions need a team effort. At Narayana Health , Bangalore , we have a dedicated Pediatric Surgery team with the support many other specialities like CTVS , Pediatric Intensivists , Pediatric Anesthesiologists … all under the same roof : making it possible to treat such complex diseases.