Electroevaporative Surgery - A Novel Approach for Giant Thoracic Tumors

Welcome to the final of twelve videos that compose the series "Thoracic Surgical Oncology - Technical Approaches" by Professor Tristan D. Yan. To learn more about the series and see the complete list of videos, click here.

An electroevaporative surgical technique is demonstrated in this video. This is a unique surgical approach that can be used in all major thoracic surgical oncology cases. Generous warm saline solution is injected under gentle pressure between the tumor and the normal tissues with a bulb-syringe. The saline solution has a tendency to be absorbed by adhesions, creating a small amount of separation along the dissection planes. The special tool used to dissect tumor from the surrounding tissues is a 3mm ball-tip electrosurgical hand-piece, which is used at a high voltage. This creates an electrical arc on the blunt ball-tip that contours the dissection plane rather than cutting through the structures beneath. The 3mm ball-tip electrode can be used for dissecting along the extra-pleural surfaces and on the mediastinal structures. The main advantages of the electroevaporative technique include blood-less operative field, minimal risk of vascular injury and precise tumor dissection.

Also presented in this video is the "Coliseum" approach for giant thoracic tumors. Usually, these tumors firmly occupy the entire ipsilateral thoracic cavity (ie. “frozen thorax”), splay the ribs, compress the hemi-diaphragm, and grossly displace the mediastinal structures to the contralateral side. This mass effect is usually profound and causes impedance of venous return, and reduction in cardiac output. A systematic surgical-oncological approach is required in order to achieve complete cytoreduction.

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