Search PubMed⌕ Search

Biomedical subjects

D Gossot

Publications and source records attributed to D Gossot.

At least 55 records · Page 3Linked to original sources
PubMed1996

Mediastinoscopy vs thoracoscopy for mediastinal biopsy. Results of a prospective nonrandomized study.

OBJECTIVE: To assess the results and the morbidity of thoracoscopy compared with conventional mediastinoscopy for the approach of mediastinal solid masses and lymph nodes, we have performed a prospective study about the respective yields, complication rates, and the length of hospital stay for patients. MATERIAL AND METHODS: We have included 114 patients in the study. The criteria of inclusion were the accessibility of the lymph nodes and/or mass to cervical mediastinoscopy through CT scan view. There were 2 groups: 52 patients underwent a mediastinoscopy (group M) and 62 underwent a thoracoscopy (group T). RESULTS: There were 3 failures in group M (5.7%) and 5 failures in group T (8.1%) (not significant; NS). In group M, the three procedures were converted to anterior mediastinotomy (two cases) and to thoracoscopy (one case). In group T, the five procedures were converted to anterior mediastinotomy (two cases), mediastinoscopy (two cases), and thoracotomy (one case). The diagnostic yield was 94.3% in group M and 91.9% in group T (NS). After conversion, a diagnosis was reached in all patients in group M (100%) and in all but 1 patient in group T (98.3%) (NS). There was no intraoperative complication in group M, while 2 complications occurred in group T (3.2%) (p < 0.05). The overall morbidity was zero in group M and 4.8% in group T (p < 0.05). CONCLUSION: The diagnostic yield of mediastinoscopy is comparable to thoracoscopy. Complication rate and hospital stay of patients undergoing mediastinoscopy are significantly inferior. Thoracoscopy should be indicated only for lesions that are not within the reach of the mediastinoscope or when multiple biopsy specimens are necessary.

Biopsy↗
PubMed1995

[Selective endoscopic sympathectomy for palmar hyperhidrosis].

OBJECTIVES: Thoracic sympathectomy is the radical and usually definite treatment of palmar hyperhidrosis. Improvement of surgical endoscopy techniques makes it possible to perform the procedure through thoracoscopy, thus minimizing operative trauma and sequellae. However, thoracic sympathectomies give rise to a high rate of compensatory sweating which is the most important adverse effect of the technique. METHODS: We developed a technique of selective sympathectomy which only divides the rami communicanti from the first to the fourth thoracic ganglion. We performed 90 thoracic sympathectomies in 46 patients. They were performed in a truncal manner in 32 patients while it was selective in the last 14 patients. RESULTS: The success rate was 97.5% (2 failures). After reoperation of these 2 failures, the success rate was 100%. The global rate of compensatory sweating was 47.5%. In the 14 last patients who underwent a selective sympathectomy, only one complained of compensatory sweating. CONCLUSION: Endoscopic sympathectomy is an effective means of treating palmar hyperhidrosis. Rigorous technique should help reduce the risk of compensatory sweating.

Adult↗
PubMed1995

Can the morbidity of esophagectomy be reduced by the thoracoscopic approach?

Esophagectomies have a high morbidity rate, mainly related to pulmonary complications. The aim of this work was to assess whether the thoracoscopic approach could reduce this morbidity. We have made a prospective study of the results of 29 attempts of esophagectomy using a right thoracoscopic approach. There were 20 males and 9 females having an average age of 47. The indication was a squamous cell carcinoma in 22 patients, an adenocarcinoma in 1 patient, a melanoma in 1 patient, and a caustic stenosis in 5. The whole esophagus was mobilized thoracoscopically and the esophagectomy was completed through the abdomen. The reconstruction was achieved using a gastric pull-through and a cervical anastomosis. There were five failures for the following reasons: unresectable carcinoma (one case), large tumor making a thoracoscopic dissection unsafe (two cases), and incomplete lung collapse making the exposure of the posterior mediastinum difficult (two cases). The average time of the thoracoscopic procedure was 135 min. The postoperative course was uneventful in all but five patients who had a pulmonary complication: atelectasis (three cases), right purulent pleural effusion (one case), acute respiratory disease syndrome (one case). The latter complication was lethal. Four out of five respiratory complications occurred in patients for whom the dissection was considered difficult. Among the other complications, there were five anastomotic leakages and three cases of laryngeal nerve palsy. The mortality rate was 3.8%. These initial results do not show a real benefit of the thoracoscopic approach for esophageal dissection, especially with respect to difficult esophagectomies. Further evaluation of the technique is needed.

Adenocarcinoma↗
PubMed1995

Laser guidance system for CT-guided procedures.

In a phantom and in 37 patients, a simple laser guidance system for computed tomography (CT)-guided procedures used the software program of the CT scanner and a laser beam mounted on the CT gantry without need for additional software or components. The skin entry point and angulation of the target path were determined. Then the system projected the desired needle path (including compound angulation), allowing accurate needle placement in all cases, even in small lesions.

Adult↗
PubMed1995

[Effects of intraperitoneal insufflation on hematogenous seeding of abdominal infections. Preliminary results of an experimental study in rats].

Most laparoscopic procedures require the creation of a pneumoperitoneum. In order to evaluate the potential hazards of bacteriemia related to insufflation, we conducted a study in the rat. Two groups of 20 Wistar rats were used for this study. Peritonitis was induced by opening the terminal ileum. Twenty-four hours later, 20 rats were insufflated at a mean pressure of 6 mm Hg (Group I). After one hour of insufflation, an hemoculture was performed via direct intracardiac puncture and in the other group of 20 non-insufflated rats (Group NI). Five of the 18 hemoculture were positive in the Gr. I (27.7%) and 6 out of 20 in the Gr. NI (30%) (chi 2 = 0.238 p = 0.62 non significant difference). These results suggest that insufflation does not facilitate hematogenous dissemination of bacteria from intraperitoneal sepsis in this animal model.

Animals↗
PubMed1995

[Can a reduction of morbidity of esophagectomy be expected with the thoracoscopic approach?].

OBJECTIVE: Oesophagectomies have a high morbidity rate, mainly related to pulmonary complications. The aim of this work was to assess whether the thoracoscopic approach could reduce this morbidity. PATIENTS AND METHODS: We conducted a prospective study of the results of 26 attempts of esophagectomy using a right thoracoscopic approach. There were 17 males and 9 females having an average age of 47. The indication was a squamous cell carcinoma in 19 patients, an adenocarcinoma in 1 patient, a melanoma in 1 patient and a caustic stenosis in 5. The whole oesophagus was mobilized thoracoscopically, and the eosophagectomy was completed through the abdomen. The reconstruction was achieved using a gastric pull-through and a cervical anastomosis. RESULTS: There were 5 failures for the following reasons: unresectable carcinoma (1 case), large tumour making a thoracoscopic dissection unsafe (1 case) and incomplete lung collapse making the exposure of the posterior mediastinum difficult (2 cases). The average time of the thoracoscopic procedure was 135 min. The post-operative course was uneventful in all but 5 patients who had a pulmonary complication: atelectasis (3 cases), right purulent pleural effusion (1 case), acute respiratory distress syndrome (1 case). The latter complication was lethal. Four out of 5 respiratory complications occurred in patients for whom the dissection was considered as difficult. Among the other complications, there were 5 anastomotic leakages and 3 laryngeal nerve palsy. The mortality rate was 3.8%. CONCLUSION: These initial results do not show a real benefit of the thoracoscopic approach for eosophageal dissection, especially for difficult oesophagectomies. Further evaluation of the technique is needed.

Burns, Chemical↗
PubMed1995

[The diagnostic value of thoracoscopy in solid masses of the mediastinum].

Despite the accuracy of percutaneous biopsy of mediastinal masses under CT scan or sonographic control, there is still a need for surgical biopsy either because of difficult location or because of insufficiency of the percutaneous biopsy, especially for those of the tumors requiring an immunological classification. The thoracoscopic approach of mediastinal masses is an alternative to the usual surgical biopsies performed through thoracotomy, sternotomy or anterior mediastinotomy. The procedure is performed under general anaesthesia and one-lung ventilation. In a series of 44 cases, an histological diagnosis was obtained in 41 cases (93.1%). There was one haemorrhagic complication requiring thoracotomy (2.3%). The mean post-operative duration of stay was 3.2 days. We conclude that thoracoscopy is the method of choice in case of failure or contraindication of percutaneous biopsy. There is still a role for mediastinoscopy for laterotracheal lymph nodes.

Adult↗
PubMed1995

[Laparoscopic splenectomy revisited].

We present a new technique for laparoscopic splenectomy which allows manual control of endoscopic dissection. After induction of pneumoperitoneum and insertion of an endoscope to check the absence of any contraindications, an incision is made for insertion of the hand and forearm. An airtight system allowing insertion of the hand while maintaining the pneumoperitoneum is fixed around the incision. A second port is inserted in the left flank. The procedure is then performed with laparoscopic instruments while the left hand allows for spleen mobilisation and easier exposure of the structures to be dissected and divided. Eight patients with a mean age of 51.3 years have been operated on for Idiopathic Thrombocytopenia. The average duration of the procedure was 90 min (80-130 min). No postoperative complication occurred. The mean duration of stay was 3.8 days (3-7 days). These results of this technique are encouraging. The procedure is quicker and safer than an exclusive laparoscopic approach. The incision allows removal of the intact spleen. Other applications of this system can be envisaged.

Adult↗
PubMed1994

[Thoracoscopic approach of pericardial effusion].

We report the technique of pericardial approach through the thoracoscope. This approach has several advantages. Extensive pericardial fenestration can be performed as well as pericardoscopy whenever indicated and additional biopsies such as mediastinal or lung parenchyma biopsies. Among the 12 patients operated on, the procedure was possible in all but one case. When there is no contraindication to selective tracheal intubation or lateral positioning, the thoracoscopic approach is the method of choice. In other cases, the subxiphoid approach remains indicated.

Acute Disease↗
PubMed1994

The hook-wire technique for localization of pulmonary nodules during thoracoscopic resection.

The main problem related to the thoracoscopic resection of lung nodules is the difficulty in locating the target nodule. Among the several methods proposed, one of the most efficient is the preoperative placement of a localization wire into the nodule while it is under computed tomography scan control. After our initial series of 22 thoracoscopic resections of lung nodules without preoperative localization, we have used the hook-wire technique in 21 patients. In our initial series, we had four failures while we have had only one in the hook-wire series. Only two minor complications related to the wire localization technique occurred: a poorly tolerated pneumothorax and an intrapulmonary hemorrhage. There was no postoperative complication. The mean duration of postoperative stay was 1 to 6 days. We conclude that the preoperative localization of lung nodules using a hook wire is a safe and accurate method before thoracoscopic resection in selected patients.

Humans↗
PubMed1994

[Video-assisted pneumonectomies: lessons learned from an experimental study on an animal model].

In order to test the feasibility of video-assisted pneumonectomy, we conducted an experimental study in an animal model. We performed 12 attempts of video-assisted pneumonectomy (7 on the right side and 5 on the left side) in pigs with an average weight of 43.5 kg. We used a combined technique of conventional and endoscopic dissection. A complication-free pneumonectomy was possible in 7 animals. Among the remaining 5 animals, 6 vascular injuries occurred, one of which was lethal. Two other animals died during the procedure for unknown reasons. We conclude that: 1) the vascular risk of video-assisted pneumonectomy appears to be prohibitive; 2) the value of animal models for vats feasibility studies is questionable because of the major differences in anatomical conditions.

Animals↗
PubMed1994

[Thoracoscopic resection of a voluminous dermoid cyst of the mediastinum, using a 3-dimensional imaging system].

A case of a young patient who was operated on of a large dermoid cyst of the anterior mediastinum is reported. During this procedure, a new three-dimensional imaging system was used. This case-report confirms the usefulness of thoracoscopy for benign mediastinal tumors removal and points out the benefit of three-dimensional endoscopy for dissection of tumors having complex anatomical connections.

Adult↗
PubMed1994

Thoracoscopic ultrasonic localisation of lung nodules: initial results of an in-vitro and in-vivo study.

The main problem in thoracoscopic resection of lung nodules is the difficulty in localising the target. In the following we describe the use of an ultrasonographic, deflectable linear array probe of 7.5 MHz which was first tested during an in-vitro study. This study has provided useful information with respect to the US inspection of normal parenchyma and lung nodules. Initial results in clinical use in 14 patients demonstrate some limitations linked to the difficulty in manoeuvering the probe and to the remaining air in the parenchyma. However, endoscopic US is an interesting additional tool during thoracoscopic exploration of the lung.

Equipment Design↗
PubMed1994

[Thoracic surgery: progression to surgical endoscopy].

Surgical thoracoscopy is in its first stage of development. However indications are expanding rapidly. This work is a review of the conditions of surgical endoscopy of the chest, the equipment currently available and the main indications. Some of these indications are already accepted. For other indications, further evaluation is needed. Many experimental works as well as clinical studies are required in order to make progress.

Humans↗