Mediastinum

Myasthenia Gravis

Myasthenia Gravis is an autoimmune neuromuscular disease leading to fluctuating muscle weakness and fatigability. People with myasthenia gravis may feel the weakness of the arms and legs, and can also have double vision and difficulty speaking or swallowing due to the weakness of the facial muscles. It generally is seen in young ladies. The removal of the Thymus gland helps over 85% of Myasthenia Gravis Patients.

Our team performed Indias first VATS (key-hole) Thymectomy in the year 2000 at AIIMS and also Indias first Robotic Thymectomy at AIIMS in the year 2008. We performed the First Robotic Thymectomy at Sir Ganga Ram Hospital on 16th March 2012 and now, offer these services routinely at Medanta Hospital.

Thymoma

Thymoma is a tumor originating from the thymus gland. It is an uncommon tumor, best known for its association with Myasthenia Gravis. Thymoma is found in 15% of patients with myasthenia gravis. Once diagnosed, the best treatment for thymomas is complete surgical removal. Our team has Indias largest experience in the removal of Thymomas by Robotic Surgery, VATS, or Open surgery (depending upon the tumor size and invasion of surrounding organs).

We have also developed a unique expertise of excising thymomas which involve the superior vena cava. The same is reconstructed with an artificial graft. We are the only center in the country performing this procedure and we have long-term survivors even in these very advanced tumors.

Cysts

Mediastinal cysts are relatively common in infants and children. Although cysts of the mediastinum are often asymptomatic, once diagnosed, they should be excised completely otherwise they tend to grow over a period o time and create complications. When symptomatic, they cause chest pain, cough, breathing problems, bloody cough or bloody vomiting, and difficulty swallowing. We routinely remove these by VATS/Robotic method.

Posterior Mediastinal Tumour

Posterior Mediastinal tumors are benign or cancerous growths that form in the back area of the chest that separates the lungs. This area, called the posterior mediastinum, is surrounded by the spine in back and the lungs on each side. These tumors can develop at any age although 30-50years is the commonest affected age group. Many a times, they produce no symptom and are incidentally detected on a chest X-ray done for some other reason including, routine medical check-up.

Sometimes, they may cause cough, shortness of breath, chest pain or unexplained weight loss. The diagnosis is confirmed by a CT Scan of the chest. Complete surgical removal is the treatment, best done by VATS/Robotic method which has been our speciality for over a decade.

Mediastinal Lymph Nodes (glands)

Mediastinal Lymph nodes are glands in the middle of the chest. They are quite common in our country, seen at all age from young to elderly. The commonest cause is tuberculosis, however, Lymphoma (a form of cancer of glands), Sarcoidosis, Fungal infection, spread of Tumor from other organs and numerous other causes may be responsible for the enlarged glands. Patients can present with symptoms ranging from fever, weight-loss, weakness, cough, breathlessness to blood in sputum or difficulty in swallowing. Diagnosis is suspected on chest X-ray and confirmed by CT Scan. However, CT Scan can only tell about the location and the size of the gland. The exact cause of enlargement of the gland can only be known by a biopsy of the gland. Although it is a common practise in our country to start these patients on anti-tubercular treatment, in todays era of evidence based medicine, it is preferable to get tissue diagnosis and then start the treatment. Tissue is also required in tuberculosis cases when the disease does not respond adequately to the treatment and resistant tuberculosis is suspected. In such cases, tissue is taken and sent for culture and sensitivity, to be able to start the patient confidently on second line anti-tubercular drugs (which are expensive and toxic).

We can provide an adequate size piece of mediastinal gland by key-hole procedure i.e. Cervical Mediastinoscopy (done through a small incision in the neck) or Thoracoscopy (done through a small incision in the chest), depending on the location of the enlarged gland. These procedures are safe and provide a large piece of tissue, adequate enough for sending for diagnosis as well as culture and other tests.