Confronting Upside-Down Video-Assisted Thoracic Surgery for Anterior Mediastinal Leiomyoma. (PubMed, Surg Case Rep)
Primary leiomyoma of the anterior mediastinum is extremely rare. Because primary mediastinal leiomyomas have nonspecific imaging features, distinguishing them from other anterior mediastinal tumors is challenging; thus, surgical resection is required for both diagnosis and treatment. Compared with the conventional look-up method, the confronting upside-down VATS technique utilizes higher intercostal access to provide a comprehensive thoracic view while minimizing diaphragmatic interference. The 180-degree rotated assistant monitor allows both surgeon and assistant to share a thoracotomy-like visual field, enhancing intraoperative coordination. In this case, it facilitated a stable operative field and phrenic nerve preservation despite the tumor's proximity without diaphragmatic interference. The confronting upside-down VATS technique may be particularly advantageous for anterior mediastinal tumors located along the phrenic nerve and in close proximity to the diaphragm.