[Video-assisted Thoracoscopic Surgery for Mediastinal Tumor and Thoracic Wall Tumor]

"A final conceptual change concerns the appreciation that all major thymoma subtypes can behave in a clinically aggressive fashion and, therefore, should no longer be called benign tumors, irrespective tumor stage. Accordingly, their International Classification of Disease for Oncology( ICD)-O codes now have a /3 suffix, thymomas, for as malignant.1)" This manuscript indicated that almost all mediastinal tumors, which could not be easy to diagnose per-operatively, should be removed. There were two large problems for mediastinal tumors resection with video-assisted thoracoscopic surgery (VATS). First is management or approach for the thymic vein, which have a short distance but large diameter relatively, and individual variation about the position and the number. Some solutions were 1) performance of pre-operative enhanced computed tomograpy( CT) or magnetic resonance imaging( MRI), 2) transcervical approach with Kent retractor, 3) sternal-L shape approach. Second is for the patients, which have thymoma or thymic tumor with myasthenia gravis, to what extent should be removed anterior fatty tissue. For the moment including beneath the innominate vein it should be removed as extent as possible. Liga Sure Impact was useful to remove a large thoracic wall tumor with VATS for resection of thick muscle.