Uniportal VATS Resection of a Large Posterior Mediastinal Bronchogenic Cyst

Bronchogenic cysts are congenital foregut malformations that commonly arise within the mediastinum. Surgical resection is recommended due to risks of infection, compression of adjacent structures, and potential complications. Minimally invasive thoracoscopic approaches have become the preferred method for resection.

This video demonstrates the uniportal video-assisted thoracoscopic surgical (VATS) resection of a large posterior mediastinal bronchogenic cyst.

Case Description

A 28-year-old male was incidentally found to have a posterior mediastinal mass on imaging. Chest computed tomography (CT) revealed a well-circumscribed cystic lesion located in the right posterior mediastinum, adjacent to the right lower lobe bronchus and inferior pulmonary vein. Magnetic resonance imaging (MRI) confirmed the cystic nature of the lesion.

Operative Technique

The patient was positioned in the left lateral decubitus position under general anesthesia with single-lung ventilation. A 2 cm incision was made at the right fifth intercostal space along the anterior axillary line, and a uniportal thoracoscopic approach was established.

Thoracoscopic exploration revealed a large cystic lesion in the posterior mediastinum. The inferior pulmonary ligament was divided, and the right lower lobe was mobilized superiorly to improve exposure.

Initial dissection was performed along the anterior and lateral aspects of the cyst. The lesion was densely adherent to the basal segment of the right lower lobe and pericardial surface. Controlled cyst decompression was performed to reduce the cyst volume and facilitate further dissection.

Following decompression, careful dissection was carried out to separate the cyst from surrounding structures, including the inferior pulmonary vein. A feeding vessel encountered during posterior dissection was clipped. Complete mobilization of the cyst was achieved with limited pericardiectomy where dense adhesions were present.

Finally, a tissue patch was applied over the lung surface to reduce the risk of postoperative air leak.

Conclusion

Controlled cyst decompression is a useful technique in the management of large mediastinal cysts during uniportal VATS surgery, improving exposure and facilitating safe dissection around critical mediastinal structures.

This video submission is from the 2026 CTSNet Instructional Video Competition. Stay tuned to CTSNet.org and the CTSNet YouTube channel in the coming weeks to watch all entries from the competition, including the winning videos.  

References

1. Takeda S, Miyoshi S, Minami M, et al. Clinical spectrum of mediastinal cysts. Chest. 2003;124:125–132.
2. Coselli JS, de Ipolyi P, Bloss RS. Bronchogenic cysts: a review of adult cases. Ann Thorac Surg. 1987;43:219–224.
3. Rocco G. Uniportal thoracoscopic surgery. J Thorac Dis. 2016.

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