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PubMed2005

Video-assisted thoracoscopy for diaphragmatic plication: experimental study in a canine model.

BACKGROUND: Plication of a nonfunctional hemidiaphragm usually restores altered ventilatory mechanics. This study compared two techniques in performing diaphragmatic plication: video-assisted thoracoscopy (group A) and thoracotomy (group B). MATERIALS AND METHODS: Twenty dogs with induced paralysis of the right hemidiaphragm were randomly assigned to one of the two groups. Evaluations were performed before and after plication of the respiratory frequency (f) and lung area (LA) of the affected side. Operative time, time to resumption of walking, ingestion of fluids and solid food, pain intensity, and postoperative complications were measured. RESULTS: Group A had less pain after the surgery (P < 0.0001), earlier fluid ingestion (P < 0.05), and earlier resumption of walking (P < 0.019). Four weeks after the procedure, LA was similar in both groups, while a significant decrease in f was recorded in group A (P < 0.02). The remaining evaluated variables showed no differences. CONCLUSION: Both approaches were effective. Pain recorded in the postoperative period was less and recovery was faster in group A. Complications and surgical times were similar. The video-assisted thoracoscopy is a safe and efficient option for performing diaphragmatic plication in dogs.

Animals↗
PubMed1994

Video-assisted thoracoscopy.

Recent advances in video-imaging and minimally invasive surgical instrumentation have expanded the role of thoracoscopy in the diagnosis and treatment of intrathoracic conditions. This prospective study describes the use of video-assisted thoracoscopy (VAT) in 100 consecutive patients. There were 70 males and 30 females with a mean age of 54.6. They underwent 103 VAT procedures with 41 thoracoscopic biopsies of lung, pleural, chest wall and mediastinal abnormalities, 32 for treatment of recurrent or persistent pneumothorax, 18 for thoracoscopic assessment of pulmonary and pleural tumours and 12 for thoracoscopic resection of peripheral lung lesions, chest wall, mediastinal and pleural tumours. Eighty-one patients had VAT procedures alone while the remaining 19 had VAT proceeding to thoracotomy. The mean operating time for VAT alone was 51 min (range 30-135 min). There were no operative deaths. There were 8 significant complications from which patients recovered fully. Patients who underwent VAT alone were shown to have earlier postoperative mobilization, reduction in parenteral analgesic requirement and reduced length of hospital stay compared to patients undergoing additional thoracotomy. A telephone survey of patients on returning home showed that patients undergoing VAT alone returned to full activity earlier than those who had thoracotomy (mean 9.0 vs mean 19.4 days). This study confirms that VAT is a safe and effective procedure in the management of pulmonary, mediastinal and pleural disease and the treatment of persistent and recurrent pneumothorax. Its role in the resection of pulmonary malignancy remains to be defined.

Activities of Daily Living↗
PubMed2004

Cardiopulmonary effects of thoracoscopy in anesthetized normal dogs.

OBJECTIVE: To evaluate the effect of an open-chest condition on oxygen delivery in anesthetized dogs. STUDY DESIGN: Prospective, controlled experimental study. ANIMALS: Eight clinically normal adult Walker Hound dogs weighing 25.6-29.2 kg. METHODS: Eight anesthetized dogs underwent an open-chest operation after the insertion of thoracoscopy cannulae in the lateral chest walls. A Swan Ganz catheter was used to both measure hemodynamic parameters and obtain mixed venous blood samples for blood gas analysis. A dorsal pedal catheter was placed to both measure arterial blood pressure and obtain blood samples for blood gas analysis. Oxygen delivery index and oxygen extraction ratio were calculated. A randomized block anova for repeated measures was used to evaluate the effect of the treatment on hemodynamic and pulmonary parameters. RESULTS: Creation of an open chest did not significantly affect oxygen delivery index (DO(2)I; p = 0.545). It induced a significant decrease in arterial oxygen partial pressure (PaO(2); p = 0.018) and arterial oxygen content (CaO(2); p = 0.025). It induced a significant increase in shunt fraction (p = 0.023), physiologic dead space (p = 0.015), and alveolar-arterial oxygen difference (p = 0.019). Arterial partial pressure of carbon dioxide (PaCO(2); p = 0.766) and arterial hemoglobin oxygen saturation (SaO(2); p = 0.178) were not significantly affected. Diastolic (DPAP; p = 0.050) and mean (MPAP; p = 0.033) pulmonary arterial pressures were significantly increased by opening the chest. Other hemodynamic parameters were not significantly affected. CONCLUSIONS: Opening the thoracic cavity is not detrimental to hemodynamic function and oxygen delivery in normal dogs, although impaired gas exchange does occur. CLINICAL RELEVANCE: Close monitoring of patients is recommended during open-chest thoracoscopy as adverse effects on gas exchange can contribute to hypoxemia.

Anesthesia, General↗
PubMed2006

Effect of positive end-expiratory pressure on oxygen delivery during 1-lung ventilation for thoracoscopy in normal dogs.

OBJECTIVE: To evaluate the effect of positive end-expiratory pressure (PEEP) on oxygen delivery (DO(2)) with 1-lung ventilation during thoracoscopy in normal anesthetized dogs. STUDY DESIGN: Prospective, controlled experimental study. ANIMALS: Eight, adult, intact Walker Hound dogs weighing 25.6-29.2 kg. METHODS: Anesthetized dogs had 1-lung ventilation during an open-chest condition. A Swan-Ganz catheter was used to measure pulmonary hemodynamic variables and to obtain mixed venous blood samples for blood gas analysis. A dorsal pedal catheter was used for measurement of systemic arterial pressure and to obtain arterial blood samples for blood gas analysis. Oxygen delivery was calculated and used to assess the effect of 0, 2.5, and 5 cm H(2)O PEEP during 1-lung ventilation on cardiopulmonary function. Each dog was its own control at 0 cm H(2)O PEEP. A randomized block ANOVA for repeated measures was used to evaluate the effect of the treatment on hemodynamic and pulmonary variables. RESULTS: Use of 5 cm H(2)O PEEP induced a significant augmentation in the arterial partial pressure of oxygen (PaO(2)). Shunt fraction (Q(s)/Q(t)), physiologic dead space (V(D)/V(T)), and the alveolar-arterial oxygen difference (P(A-a)O(2)) decreased significantly after 5 cm H(2)O PEEP, compared with 1-lung ventilation without PEEP. Use of 2.5 cm H(2)O PEEP had no significant effect on cardiopulmonary variables. Use of PEEP had no significant effect on arterial oxygen saturation (SaO(2)), DO(2), and hemodynamic variables in normal dogs. CONCLUSIONS: PEEP had no effect on DO(2) in normal dogs undergoing open-chest 1-lung ventilation because it had no adverse effect on hemodynamic variables. CLINICAL RELEVANCE: PEEP in normal dogs during open-chest 1-lung ventilation for thoracoscopy is not detrimental to cardiac output and can be recommended in clinical patients.

Anesthesia, Inhalation↗
PubMed1977

Thoracoscopy in the diagnosis of pleural effusion.

The technique, indications, and complications of diagnostic thoracoscopy are described. Two hundred and eight explorations have been performed in our service in the last seven years. From 137 pleural malignancies we have obtained an unequivocal positive biopsy in 129 (94%) with a minimum number of complications and no mortality. From our experience we conclude that thoracoscopy, when porperly performed, is diagnostic in most pleural conditions.

Biopsy↗
PubMed1983

Thoracoscopy: influence of the procedure on some respiratory and cardiac values.

In eight patients with pleural effusion arterial oxygen and carbon dioxide tensions (PaO2 and PaCO2), pH, respiratory frequency, and cardiac rhythm and frequency were measured before, during, and after thoracoscopy. Four of the patients had a PaO2 below 70 mm Hg (9.3 kPa) before the procedure. During and after the procedure respiratory frequency increased and PaCO2 fell, indicating hyperventilation, while the other indices remained unchanged. It is concluded that respiration and the circulation readily adapt to the changes produced by the pneumothorax and the manipulation during thoracoscopy.

Adult↗
PubMed1988

Thoracoscopy: assessment of a physician service and comparison of a flexible bronchoscope used as a thoracoscope with a rigid thoracoscope.

The practicality of physicians performing thoracoscopy for diagnostic purposes was assessed in 30 patients with pleural effusions of unknown cause. A rigid thoracoscope was compared with a fibreoptic bronchoscope used as a flexible thoracoscope and the diagnostic adequacy of biopsy specimens obtained with the two instruments assessed. The two instruments were inserted by a physician in the bronchoscopy suite using local anaesthesia. The procedure proved safe, acceptable, and diagnostically effective. The rigid thoracoscope proved a more satisfactory instrument but the fibreoptic bronchoscope, with minor adaptations, may be used for thoracoscopy.

Biopsy↗
PubMedDate not supplied

Does 'idiopathic pleuritis' exist? Natural history of non-specific pleuritis diagnosed after thoracoscopy.

BACKGROUND: Even after a complete work-up including thoracoscopic biopsies, a significant number of patients with pleural exudates are diagnosed with 'non-specific pleuritis', and no specific diagnosis can be made. The natural evolution of these patients is poorly understood. OBJECTIVES: To study the natural evolution of patients with non-specific pleuritis diagnosed after thoracoscopy and to evaluate whether the histological diagnosis of non-specific pleuritis corresponds with the clinical diagnosis of 'idiopathic pleuritis'. METHODS: We retrospectively studied the evolution of 75 patients between 1992 and 2002 (49 men and 26 women), mean (+/- SD) age 63.4 (+/- 13.3) years, who underwent diagnostic thoracoscopy because of an unexplained exudative pleural effusion, and in whom the histological diagnosis of non-specific pleuritis was made. Follow-up data were obtained through medical files and/or telephone contacts with general practitioners. RESULTS: Of these 75 patients, 8.3% eventually developed a malignancy during the follow-up period. In the remaining patients (91.7%), the clinical evolution followed a benign course. Ultimately, a probable cause was established on clinical grounds in 40 patients. True idiopathic pleuritis was finally observed in 25% of patients with the histological diagnosis of non-specific pleuritis. Recurrence of the effusion occurred in 10 out of 60 (16.7%) patients, after a mean period of 26.2 months. CONCLUSIONS: The majority of non-specific pleuritis patients (91.7%) followed a benign course, with a spontaneous resolution of the effusion in 81.8% of cases. In the majority of patients, a probable cause of the pleuritis was identified. True 'idiopathic benign pleuritis' hence occurs in only a minority (25%) of patients.

Biopsy↗
PubMed2004

Medical thoracoscopy: hormone receptor content in pleural metastases due to breast cancer.

Pleural metastases are common in the course of breast cancer, but, to date, the role of oestrogen receptor (OR) and progesterone receptor (PgR) content in metastatic tissue has been poorly evaluated. A series of 50 consecutive patients with a history of breast cancer (median age 64 yrs, range 40-86 yrs), which presented with pleural effusion and therefore underwent medical thoracoscopy, was analysed. Metastatic pleural involvement was histologically confirmed in all patients. The hormone receptor status of the pleural metastases was investigated using the immunohistochemical method in 49 and the biochemical method in 31 cases. The immunohistochemical test was performed using monoclonal antibodies. Biochemical analysis was performed on specimens quick-frozen in liquid nitrogen. OR and PgR were measured with the dextran-coated charcoal assay and Scatchard analysis. Immunohistochemical analysis yielded 29 OR-positive and 25 PgR-positive cases and biochemical analysis yielded 16 OR-positive and four PgR-positive cases, sometimes discrepant to hormone status of the primary breast cancer. Using a semiquantitative immunoreactive score, there was a significant association between receptor positivity and survival, but only for PgR positivity. Immunohistochemical and biochemical detection of hormone receptors (oestrogen and progesterone) in pleural metastases of breast cancer is feasible based on medical thoracoscopy as the method of choice, by which sufficient specimens may be obtained. The receptor status may enable a decision on antihormonal treatment. Whether a positive receptor status in pleural metastatic tissue is associated with a better prognosis remains to be confirmed.

Adult↗
PubMed1995

Thoracoscopy and video-assisted thoracic surgery in the treatment of lung cancer.

The contemporary surgical repertoire for the evaluation and treatment of patients with lung cancer includes the bronchoscope, mediastinoscope, thoracoscope, and standard surgical instrumentation. The recent advances in video optics and the development of endoscopic instruments have significantly expanded the surgical options for patients with lung cancer. Thoracoscopy, or the more inclusive term of video-assisted thoracic surgery (VATS), has been characterized as "minimally invasive" surgery. Thoracoscopy and VATS have decreased operative trauma and facilitated surgical staging prior to neoadjuvant therapy. An ancillary benefit to diminished surgical morbidity is shorter hospital stays with a concomitant reduction in costs to the patient and health-care system. These advantages make VATS ideal for elderly patients or patients with significant comorbidity.

Humans↗
PubMed2003

Minithoracoscopy: a less invasive approach to thoracoscopy.

STUDY OBJECTIVES: To evaluate minithoracoscopy using 3-mm instrumentation for diagnosis of pleural effusions. In the initial phase of the study, minithoracoscopy was used only for small loculated effusions not accessible with standard-sized endoscopes. Indication was later extended to larger nonloculated effusions that could have been examined using conventional thoracoscopy. PATIENTS: A total of 30 patients were studied, including 12 patients with nonloculated effusions of undetermined etiology, 17 patients with loculated effusions, and 1 patient with bilateral effusion. TECHNIQUE: The double-entry site technique was used with placement of two trocars, ie, one for the telescope and one for the biopsy forceps or accessory instruments. All procedures were performed under local anesthesia with mild sedation (midazolam). RESULTS: Minithorascopy provided high diagnostic yield (93.4%). Visualization using minithoracoscopy instrumentation was equal to that obtained using conventional thoracoscopy instrumentation. Tolerance and cosmetic results were good. CONCLUSIONS: Minithoracoscopy is safe and effective for routine diagnostic applications.

Adult↗
PubMed1990

Successful closure of chronic BPF by thoracoscopy after failure of endoscopic fibrin glue application and thoracoplasty.

We report a case of chronic debilitating BPF following right upper lobe resection. Despite several endobronchial applications of fibrin glue, we could not close it. Since the patient was extremely debilitated by symptoms due to the BPF, a thoracoplasty was attempted but was not successful. Finally, the BPF was definitely closed by instillation of talc into the pleura through thoracoscopy. To our knowledge, this is the first reported case of chemical closure of a recalcitrant BPF by the route of thoracoscopy. It also shows the failure of endoscopic fibrin glue application in such a condition.

Bronchial Fistula↗
PubMed2001

Equine thoracoscopy: normal anatomy and surgical technique.

Six normal, healthy horses age 3-10 years underwent left and right thoracoscopic examination using a rigid telescope. A minimum of 30 days was allowed between procedures. Horses were restrained in stocks and sedated with a continuous detomidine infusion. After surgical preparation of the hemithorax elected for surgery, and administration of local or regional anaesthesia of the surgery sites, thoracoscopy was completed during two 15 min pneumothorax periods. During the procedures, the thoracic structures were viewed using a 57 cm, 10 mm diameter, 30 degrees rigid telescope connected to a digital camcorder to allow computer capture of digital images. The telescope was inserted into the thoracic cavity via 3 different intercostal spaces. The 8th, 10th and 12th intercostal spaces were randomly selected and used among horses. The exploration of each hemithorax started from the dorsal-caudal quadrant continued toward the cranial thorax and was completed by observing the diaphragmatic and caudal pulmonary region. Collapsed lung, aorta, oesophagus and diaphragm were viewed readily in either hemithorax. On exploration of the right hemithorax, the azygos vein, thoracic duct and pulmonary veins were also identified. Horses tolerated thoracoscopy well. Signs of discomfort, such as increased respiratory rate, coughing and decreased level of sedation, were associated with lung collapse in one horse, with pneumothorax on 2 occasions, and when the thorax was approached through the 8th intercostal space. Surgery performed via the 8th intercostal space was hindered by the rigidity of the 8th and 9th ribs, and by the presence of a greater musculature, which did not allow easy cranial and caudal movements of the telescope.

Animals↗
PubMed1996

Unusual indications for thoracoscopy.

Thoracoscopy has been utilized in a number of patients with unusual or difficult problems which were not resolved with standard thoracic techniques. These problems have been grouped in: infectious, tumour, iatrogenic and others. Personal experience and a survey of the literature on the subject show that thoracoscopy may be an ideal approach in many cases.

Endoscopy↗
PubMed1999

[Video thoracoscopy and video-assisted thoracic surgery. An analysis of 303 consecutive cases].

OBJECTIVES: To present our experience in video thoracoscopy and video-assisted thoracic surgery from November of 1991 until November of 1997. PATIENTS AND METHODS: 303 endoscopic thoracic surgery procedures (210 males and 93 females with a mean age of 42.2 years) with the following indications: 151 spontaneous pneumothorax, 51 pulmonary biopsies, 50 pulmonary nodules, 15 mediastinal tumors, 13 pleuroparietal tumors, 8 pericardial windows and 15 thoracic sympathectomies. RESULTS: Mean postoperative stay was of 5.5 days. The thoracotomy conversion was necessary in 32 cases (10.9%). The morbimortality has been: one parietal recidive of a tumor in the way of one of the trocars and one death of a patient to who was accomplished a pulmonary biopsy by diffuse pneumopathy. CONCLUSIONS: The video thoracoscopy and thoracic surgery are effective and sure technical options for diagnosis and treatment of various thoracic affections.

Adolescent↗
PubMed2001

[A case of pleural effusion in a patient with malignant lymphoma diagnosed by thoracoscopy with local anesthesia].

A 47-year-old woman was admitted for examination of massive right pleural effusion on chest radiography, together with chief complaints of dry cough and body weight loss. Exudative effusion was aspirated by thoracentesis, revealing many lymphocytes and a high level of adenosine deaminase. Thoracoscopy with local anesthesia was performed. Elevated white lesions and miliary nodules were observed, and these lesions were examined by thoracoscopic biopsy, leading to a diagnosis of malignant lymphoma. Treatment with chemotherapy (THP-COP) resulted in partial remission. Thoracoscopy with local anesthesia in cases of pleural effusion with malignant lymphoma can be a safe and useful procedure for diagnosis.

Anesthesia, Local↗
PubMed2001

[Clinical utility and safety of diagnostic thoracoscopy].

The increasing use of thoracoscopy performed under local anesthesia has made contributions to the diagnosis of pleural disease with effusion. During the past 7 years, we have performed 100 such thoracoscopy procedures using a flexible fiberoptic bronchoscope. On the basis of our clinical findings, we are able to discuss the utility and safety of this procedure. The causes of pleural effusion were carcinomatous pleurisy in 72 cases, tuberculosis pleurisy in 15 cases, infection without tuberculosis in 4 cases, malignant pleural mesothelioma in 8 cases and one case of asbestosis. The success rate of thoracoscopic pleural biopsies were 97% for carcinomatous pleurisy, 100% for malignant pleural mesothelioma and 86% for tuberculosis pleurisy. This procedure was performed with no serious effect on blood pressure, oxygen saturation, monitored ECG or BGA data, and with no serious complications. Therefore, we concluded that this method is very useful for the diagnosis of pleural effusions and has few complications.

Adult↗