CPT® Code 32662

An excision of a mediastinal cyst, tumor, or mass is performed through a surgical technique known as thoracoscopy, which is also commonly referred to as video-assisted thoracoscopic surgery (VATS). This minimally invasive procedure allows surgeons to access the thoracic cavity using small incisions, which reduces recovery time and minimizes postoperative pain compared to traditional open surgery. During the procedure, the patient is positioned in a lateral decubitus position, which facilitates access to the thoracic structures. The surgeon inserts three or more trocars, which are specialized instruments that allow for the introduction of the thoracoscope and other surgical tools, depending on the specific location of the lesion being addressed. To enhance visualization of the surgical field, a pneumothorax is intentionally created, allowing the lung to collapse slightly and providing a clearer view of the mediastinal structures. Once the thoracoscope is in place, the surgeon evaluates the cyst, tumor, or mass, assessing its location and its relationship to surrounding anatomical structures. The pleura, which is the membrane surrounding the lungs, is incised over the lesion to gain access. If the procedure involves a cyst, the surgeon will open the cystic cavities, aspirate any fluid, and decompress the cyst before performing a complete excision of the cyst wall using blunt dissection and traction techniques. In cases where small remnants of the cyst wall are left attached to vital structures, the mucosal lining of the cyst may be cauterized to reduce the risk of recurrence. For solid tumors, the mass is carefully dissected away from surrounding tissues, and the chest incision may be widened to facilitate the removal of the tumor, which is then placed in an extracting bag to prevent contamination of the chest cavity with tumor cells. Following the excision, a chest tube is typically placed to allow for drainage, the trocars are removed, and the incisions are closed to complete the procedure.