The document outlines the surgical approach to resect mediastinal tumors based on their anatomical location within the mediastinum, which is divided into superior and inferior sections, with the latter further partitioned into anterior, middle, and posterior regions. It details the contents of each mediastinal section and the various surgical techniques employed, including median sternotomy, thoracotomy, and robotic-assisted methods. The use of video-assisted thoracoscopic surgery (vats) and robotic-assisted thoracic surgery (rats) is increasingly common, particularly for anterior mediastinal tumors like thymomas.

1. The Mediastinum
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2. The surgical approach when mediastinal tumours require
resection depends on the anatomical location of the
tumour .

3. Surgical anatomy
● The mediastinum is a broad central
partition that separates the two laterally
placed pleural cavities.
● It extends from the sternum to the bodies
of the vertebrae; from the superior
thoracic aperture to the diaphragm.

4. Division of mediastinum
A transverse plane extending from the sternal
angle to the intervertebral disc between vertebrae
thoracic 4 and 5 spaces separates the mediastinum
into the superior mediastinum and inferior
mediastinum.
• Inferior mediastinum is further partitioned into the
anterior, middle, and posterior mediastinum by
the pericardial sac.

5. Contents
● Anterior mediastinum: It contains the thymus, internal mammary
arteries, lymph nodes, connective tissue and fat.
● Middle mediastinum: It contains the pericardium, heart, great
vessels,airway and oesophagus.
● Posterior mediastinum: contains the proximal intercostal
neurovascular bundles,the spinal ganglia, the sympathetic chain,
lymphatic tissue,and connective tissue.

6. Mediastinal Masses

8. ● Various surgical procedures to approach structures in the
mediastinum are performed, usually as diagnostic procedures.
● The surgical approach when mediastinal tumours require
resection depends on the anatomical location of the tumour .

9. ● median sternotomy for anterior mediastinal pathology,
● thoracotomy or VATS for posterior mediastinal pathology
● transcervical (neck incisions) for superior mediastinal pathology.
● The middle mediastinum can usually be approached through thoracotomy
or VATS.
● Increasingly, a robotic or RATS approach is used, particularly for anterior
mediastinal tumours such as thymomas.

10. Video-assisted thoracoscopic
surgery (VATS)

11. Robotic-assisted thoracic surgery
(RATS)