Polyostotic rib fibrous dysplasia resected by video-assisted thoracoscopic surgery with preservation of the overlying periosteum

Abstract

Video-assisted thoracoscopic rib resection has rarely been reported, but a relatively simple procedure that uses readily available instruments can prove to be feasible. [1][2][3] A conventional approach would involve an incision greater than the length of the mass itself. Such an approach would require significant resection of the chest wall musculature and could lead to significant postoperative morbidity and decrease in quality of life. Multiple rib tumors would require an even more extensive incision and may require multiple incisions to facilitate exposure and removal. We report the removal of 2 expansile bone tumors by video-assisted thoracoscopic surgery while preserving the periosteum to allow for bone formation. To the best of our knowledge, no such attempts at preserving the periosteum during a rib resection via video-assisted thoracoscopy have been done. CLINICAL SUMMARYAn 18-year-old male patient with Down syndrome was admitted to the urology department of Hanyang University Guri Hospital with a testicular artery rupture after a bicycle accident. The patient underwent an emergency operation for the bleeding. After a thorough inquiry, the patient reported having chest pain over his left chest wall for 3 months. The patient did not have precocious puberty or cafe ´-au-lait spots. A routine chest x-ray showed cortical thickening in the patient's ribs. Computed tomography scans of his chest showed multiple bone tumors of the fourth, sixth, seventh, and eighth ribs (Figure 1). The sixth and seventh ribs were expansile; thus, for diagnostic reasons and to rule out possible malignancy, he was referred to the general thoracic department and an operation by minimally invasive surgery was scheduled.General anesthesia was done with double-lumen ventilation, and the patient was placed in the right down 30-degree semilateral position with his right arm tucked beside the pillow. Three ports were used: a 3-mm port at the third intercostal space, a 15-mm port at the areola margin, and a 5-mm

Subxiphoid uniportal video‐assisted thoracoscopic surgery: A cosmetically superior approach to submammary rib tumor resection

“…A conventional approach to rib tumor resection would involve an incision greater than the length of the mass itself. Such an approach would require significant resection of the chest wall musculature and could lead to substantial postoperative morbidity and decreased quality of life . Following the widespread popularity and common use of video‐thoracoscopy in almost all types of surgical approaches ranging from complex anatomical lung resections to pleural biopsies, some surgeons have performed chest wall and rib resection by video‐assisted thoracoscope through the lateral chest approach.…”

“…Such an approach would require significant resection of the chest wall musculature and could lead to substantial postoperative morbidity and decreased quality of life. 4 Following the widespread popularity and common use of video-thoracoscopy in almost all types of surgical approaches ranging from complex anatomical lung resections to pleural biopsies, some surgeons 6 have performed chest wall and rib resection by video-assisted thoracoscope through the lateral chest approach. The lateral chest approach is a minimally invasive approach that offers several potential advantages over traditional open techniques, including decreased surgical morbidity to the chest wall musculature, decreased blood loss, and more precise localization of the ribs.…”

“…With the development of medical devices and the promotion of minimally invasive concepts, thoracoscopic surgery has been gradually applied to the treatment of various thoracic diseases such as lung cancer, 1 esophageal cancer, 2,3 and rib tumors. 4 Although thoracoscopic surgery has been used for rib tumor resection during the past decade, previous reports describe single-port or multiport thoracoscopic surgery through the lateral chest wall. The present report describes a case of subxiphoid uniportal video-assisted thoracoscopic surgery (VATS) for left sixth rib tumor resection.…”

Minimally invasive rib resection with preservation of periosteum using 1-port video-assisted thoracoscopic surgery

“…The advantages of thoracoscopic methods have been previously reported. 3 These advantages include a smaller incision, no muscle damage, and no dead space issues, which can lead to complications. Other advantages include a more rapid recovery to daily life and a shorter hospital stay.…”

Thoracoscopic Management of Fibrous Dysplasia: First Experience in Turkey

“…Asymptomatic and mild symptomatic patients should be observed. Surgical intervention is indicated in presence or suspicion of malignancy, ineffective conservative therapy and improve the skeletal deformity Despite the widespread use of thoracoscopy in thoracic surgery, thoracoscopic management of FD has been reported rarely 5,6 . We believe that video-assisted thoracoscopic surgery is easly applied in these tumours and this technique will be main procedure for the surgical management of fibrous dysplasia of ribs in next years.…”