Description

Introduction Pleural fibroma, also known as solitary fibrous tumor of the pleura (SFTP), is a rare mesenchymal neoplasm originating from the pleural tissue. These tumors can be either benign or malignant and often remain asymptomatic until they reach a significant size, at which point they may cause respiratory symptoms, chest pain, or other complications due to compression of adjacent structures. Traditional surgical management involves open thoracotomy, which can be associated with significant morbidity and longer recovery times. However, with advances in minimally invasive surgery, thoracoscopic resection has emerged as a preferred approach for selected cases. This article explores the role of video-assisted thoracoscopic surgery (VATS) in the resection of pleural fibromas, highlighting its benefits, technical considerations, and patient outcomes. Understanding Pleural Fibroma Pleural fibromas arise from submesothelial fibroblastic tissue and are generally slow-growing tumors. Although most cases are benign, a subset of these tumors exhibits aggressive behavior and can metastasize. Diagnosis is typically made through imaging modalities such as chest X-rays, CT scans, and MRI, with biopsy confirmation where necessary. The clinical presentation varies depending on the tumor size and location. While small tumors may be incidental findings, larger ones can cause dyspnea, chest discomfort, and even paraneoplastic syndromes such as hypoglycemia due to tumor secretion of insulin-like growth factors. Surgical resection remains the definitive treatment for symptomatic or enlarging pleural fibromas. Advantages of Thoracoscopic Resection The advent of minimally invasive thoracic surgery has revolutionized the management of pleural tumors. Compared to traditional open thoracotomy, VATS offers several advantages, including: 1. Reduced Surgical Trauma – Small incisions and avoidance of rib spreading minimize tissue damage. 2. Less Postoperative Pain – Patients experience reduced pain due to limited muscle and nerve disruption. 3. Shorter Hospital Stay – Most patients recover faster and are discharged earlier than those undergoing open surgery. 4. Lower Complication Rates – Reduced risk of infection, bleeding, and respiratory complications. 5. Improved Cosmetic Outcomes – Minimal scarring enhances patient satisfaction. 6. Faster Recovery and Return to Daily Activities – Patients can resume normal activities more quickly. Surgical Technique: Video-Assisted Thoracoscopic Surgery (VATS) Thoracoscopic resection of pleural fibroma follows a well-defined surgical protocol. Preoperative Evaluation Before surgery, a comprehensive evaluation is necessary, including: - Imaging Studies: High-resolution CT or MRI to assess tumor size, location, and vascular supply. - Pulmonary Function Tests: To determine baseline respiratory status. - Biopsy (if indicated): For histopathological confirmation of the tumor. Surgical Procedure 1. Patient Positioning: The patient is placed in a lateral decubitus position to allow optimal access to the pleural cavity. 2. Port Placement: Typically, 2-3 small incisions (5–12 mm) are made for the insertion of the thoracoscope and surgical instruments. 3. Thoracoscopic Exploration: The pleural cavity is inspected to confirm tumor location and assess any adhesions. 4. Tumor Resection: The tumor is carefully dissected from the pleural surface using electrocautery or an ultrasonic scalpel. Attention is given to preserving vital structures, including major vessels and lung tissue. 5. Specimen Retrieval: The tumor is enclosed in an endoscopic retrieval bag and extracted through one of the port sites to prevent contamination. 6. Hemostasis and Closure: Careful hemostasis is ensured before closing the incisions, and a chest drain may be placed if needed. Postoperative Care and Outcomes Following VATS, patients are monitored for respiratory function and potential complications such as pneumothorax or bleeding. Most patients can be discharged within 1-3 days, with follow-up imaging scheduled to assess for recurrence. Studies have shown that VATS resection for pleural fibroma results in excellent oncological outcomes, with lower recurrence rates in completely excised tumors. Conclusion Minimally invasive thoracoscopic resection is a safe and effective approach for managing pleural fibromas. This technique significantly reduces morbidity associated with traditional thoracotomy while offering comparable or superior oncological outcomes. As surgical technology and expertise continue to evolve, VATS is expected to become the standard approach for the resection of benign and select malignant pleural tumors. Further research and long-term follow-up studies will continue to refine patient selection criteria and improve surgical outcomes.