https://www.laparoscopyhospital.com/SERV01.HTM<br /><br />Pleural fibroma, also known as solitary fibrous tumor of the pleura (SFTP), is a rare, usually benign mesenchymal tumor arising from the submesothelial layer of the pleura. Although traditionally managed via open thoracotomy, advances in minimally invasive thoracic surgery have enabled thoracoscopic resection as a preferred approach, offering reduced morbidity and quicker recovery.<br /><br />Case Selection and Preoperative Considerations<br /><br />Indications for Thoracoscopic Resection:<br /><br />Well-encapsulated, localized pleural fibroma.<br /><br />Absence of chest wall or diaphragmatic invasion.<br /><br />Tumor size generally 10 cm for optimal thoracoscopic handling.<br /><br />Preoperative Workup:<br /><br />Imaging: Contrast-enhanced CT scan to assess size, location, and vascular supply. MRI can be useful in evaluating soft-tissue characteristics.<br /><br />Biopsy: CT-guided biopsy may be done if malignancy is suspected.<br /><br />Pulmonary Function Tests: To assess lung reserve, especially for larger tumors.<br /><br />Surgical Technique<br /><br />1. Patient Positioning & Anesthesia<br /><br />Lateral decubitus position with single-lung ventilation using double-lumen endotracheal intubation.<br /><br />General anesthesia with controlled ventilation.<br /><br />2. Port Placement<br /><br />Three-port technique:<br /><br />5 mm camera port in the 7th intercostal space, midaxillary line.<br /><br />Two 5 mm working ports in the anterior and posterior axillary lines.<br /><br />Adjustments are made based on tumor location.<br /><br />3. Tumor Dissection<br /><br />Exploration and Localization: Identification of the tumor and assessment of its pedicle.<br /><br />Vascular Control:<br /><br />If a pedunculated tumor, use ligasure or harmonic scalpel for hemostasis.<br /><br />If broad-based, careful blunt and sharp dissection is required to prevent pleural injury.<br /><br />Resection:<br /><br />Small tumors are retrieved directly.<br /><br />Larger tumors require specimen bag retrieval and extension of one port if needed.<br /><br />Conclusion<br /><br />Thoracoscopic removal of pleural fibroma is a safe and effective alternative to open surgery for selected patients. It offers the benefits of reduced postoperative pain, shorter hospital stay, and excellent oncological outcomes. With proper patient selection and advanced thoracoscopic techniques, minimally invasive surgery continues to evolve as the gold standard for benign pleural tumors.
