New operative approach for large mediastinal teratoma in children--complete median sternotomy with lateral incision.

Experience on a large mediastinal teratoma which almost occupied one side of the entire thoracic cavity is reported. The first patient was operated on by standard thoracotomy incision and considerable difficulty was encountered in dissecting the tumour because of a narrow space between the large tumour and the rigid thoracic cage. The second and the third patients were operated on by complete median sternotomy with lateral incision (a T-shaped incision) and no difficulty was encountered. This new approach allows all aspects of the large tumour to be reached under direct vision. Dissecting the median side of the tumour which might adhere to the important mediastinal structures would be carried out with minimum risk. No respiratory and circulatory impairment by compression of the healthy lung and mediastinum by the tumour would result from placing the patient in supine position by this approach.