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82nd Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

01.06. - 05.06.2011, Freiburg

Trans-oral endoscopic mediastinal surgery: first clinical application

Meeting Abstract

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  • corresponding author presenting/speaker Thomas Wilhelm - Dept. Otolaryngology, Head/Neck & Facial Plastic Surgery, HELIOS Klinikum Borna, Borna, Germany
  • author Wolfram Klemm - Dept. Thoracic Surgery, Evangelische Lungenklinik Berlin, Berlin, Germany
  • author André Nemat - Dept Thoracic Surgery & Thoracic Endoscopy, HELIOS Klinikum Wuppertal, Wuppertal, Germany

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. 82nd Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. Freiburg, 01.-05.06.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11hno10

doi: 10.3205/11hno10, urn:nbn:de:0183-11hno105

Published: August 3, 2011

© 2011 Wilhelm et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Introduction: The trans-oral endoscopic approach for surgical procedures within the middle mediastinum was developed and evaluated during anatomical and animal studies. It represented an endoscopic approach without any other skin incisions.

Methods: After approval by the responsible ethical committee this approach was applied for the first time in a 47 years old man after getting extensive informed consent. There was a history of 7 months of arthalgia, retrosternal fullness and respiratory dependend pain of the right hemithorax with temporarily fever. On CT scans no relevant informations due to the genesis were obtained and mediastinal lymph nodes were detected. Therefore a sarcoidosis in an early stage or a lymphoma has to be considered. An extensive bronchological diagnosic battery including bronchoalveolar lavage yielded no results regarding the origin of the lymphadenopathy.

Results: Via a sublingual as well as two bi-vestibulr incisions the middle mediastinum could be reached after passage of the thyroid isthmus without any problems. Lymph nodes were dissected and removed from the lower paratracheal area (station 4) on the right side as well as from the subcarinal area (station 7). Postoperative x-ray showed a small pneumothorax at the level of the lower lobe on the right side, which was no longer detected in the bronchoscopic control. There were no other intra- or postoperative complications noted. Histologically a non-specific lymphadenopathy was found. Two day after the operation the patient left the hospital.

Conclusion: In this patient the trans-oral endoscopic mediastinal surgery could have been applied successfully for the first time ever and therefore a new and innovative approach for this kind of surgery was established. A prospective study on this approach is ongoing.