Thoracoscopic Resection of an Intrathoracic Ganglioneuroma Using Carbon Dioxide Insufflation—A Case Report—

Abstract

A 33-year-old asymptomatic man was referred to our hospital because of an abnormal shadow on a chest radiograph at a medical checkup. A chest computed tomography (CT) showed a smooth solid tumor of 11 cm in diameter extending from Th10 to L2, the level of the right renal artery and vein. A contrast-enhanced CT scan showed relatively poor enhancement effect. The tumor showed a homogeneous low signal intensity on T1-weighted magnetic resonance imaging (MRI) and partially high signal intensity on T2-weighted MRI. The patient was preoperatively diagnosed as having a neurogenic tumor and underwent thoracoscopic surgery using carbon dioxide (CO2) insufflation for tumor resection. Before surgery, we evaluated the artery of Adamkiewicz and prepared for possible postoperative chylothorax. The operation was initiated following CO2 insufflation into the thoracic cavity to ensure the surgical field, in a left lateral decubitus with four ports. Intrapleural pressure was maintained at 8 mmHg. A favorable operating field achieved in the posterior mediastinum allowed tumor resection by total thoracoscopic surgery. The operation time was 155 minutes, with minimal blood loss. The definitive histopathological diagnosis was ganglioneuroma. The patient developed right chylothorax on postoperative day two, which was successfully treated with conservative therapy, and on postoperative day 13, the patient was discharged. He has been doing well as of nine months after the operation.