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PubMed1988

[Thoracoscopy in pulmonary histiocytosis X].

We report 4 cases of recurrent multiple pneumothorax in patients with diffuse interstitial lung disease diagnosed as histiocytosis X. These cases demonstrate the dual value of thoracoscopy in that disease: (1) it facilitates the diagnosis by showing the characteristic macroscopic aspect of the lung with multiple blebs and by enabling pulmonary biopsies to be performed; (2) it contributes to the treatment and prevention of pneumothorax by diffuse pleural poudrage. Immediate thoracoscopy should therefore be contemplated in special conditions, such as pulmonary interstitial lung disease with pneumothorax as first presentation.

Adult↗
PubMed1985

[Diagnostic and therapeutic thoracoscopy in 83 cases of chronic pleurisy].

From May 1983 to June 1985 the authors performed a thoracoscopy as a diagnostic and therapeutic objective in 83 patients with chronic recurrent pleurisy; amongst these patients, 69 had know intra or extra thoracic cancer and the other 14 presented with an isolated pleurisy. Eight other patients had pleural carcinomatosis proven by needle biopsy and had pleural talc introduced by thoracoscopy. The examination was performed under local anaesthesia with neuroleptanalgesia; a rigid 7 mm diameter thoracoscope was used; the biopsies were performed uniquely on the parietal pleura using tropical forceps. The outcome was uncomplicated with no deaths nor any serious complications due to the method. The sensitivity of the pleural biopsy was 91.5% or 76 positive biopsies out of 83. 73 biopsies were metastatic and 3 were tuberculous pleurisies. The macroscopic appearance was strongly suggestive of malignancy in 78 patients and appeared inflammatory in 13, of whom 9 cases were positive on biopsy. The authors performed a pleural talcage in every case; a lasting pleural adhesion was obtained in 66 patients but regrettably there were 14 failures, the effusion recurring after removal of the drain. The authors stress the reduced number of incidents of pleural effusion, which confirms the good tolerance of pleural endoscopy.

Adult↗
PubMed1985

[Thoracoscopy in nonspecific spontaneous and iatrogenic pneumothorax].

Thoracoscopy was used in 92 patients. The etiology of pneumothorax was established in 76 patients. In most of them the treatment was effective. Suture of the pleura and lung defect, pleurodesis, pleurectomy, coagulation of tissues were performed under the control of thoracoscope. Thoracoscopy allowed to avoid extensive thoracotomy, to shorten the period of treatment at the hospital.

Catheterization↗
PubMedDate not supplied

[Value of thoracoscopy in the diagnosis of solid tumors extending into the pleural cavity].

Thoracoscopy examinations in 5 cases of solid tumors of the pleura: 1 case of Pancoast's and Tobias' tumors of neoplastic origin, 1 case of asbestosis-induced fibrohyaline plaques, and 2 cases of benign pleural tumors, 1 neurinoma emphasized the diagnostic value of thoracoscopy for tumors of this type. Direct visualization of the lesion is possible, its precise site and extent can be determined, and biopsy samples obtained for pathology under direct visual guidance.

Adult↗
PubMed1981

Thoracoscopy in children.

In the past four and one-half years we have used thoracoscopy as the primary technique for pulmonary biopsy in children. During that interval, over 80 thoracoscopic procedures have been performed with no mortality and minimal morbidity. The ages of the patients have ranged between 2 weeks and 20 years. The procedure is carried out in the general operating room under regional and intravenous anesthesia, avoiding the need for endotracheal intubation. Fourty-two of the procedures have been performed in immunosuppressed patients, attempting to determine the presence of Pneumocystis carinii pneumonia. Twenty-four of the procedures have been performed for the diagnosis of intrathoracic tumors while 15 procedures have been performed for the diagnosis of localized pulmonary infiltrates. The diagnostic accuracy in immunosuppressed patients has been 100 persons and in the tumor patients has been 92 percent. The complications of this technique have been minimal. Four patients developed pneumothoraces which responded to manipulation of the chest tube and 3 patients have had sufficient postoperatoire bleeding to require transfusion, while none have required re-exploration. The technique of thoracoscopy has provided a safe and rapid method of pulmonary diagnosis in this aged patient.

Adolescent↗
PubMedDate not supplied

[Thoracoscopy in 1980. A general review (author's transl)].

Examining the literature and their own experience, the authors reviewed the methods, the complications and indications of modern thoracoscopy. They considered the rigid cold light thoracoscope with diathermo-coagulation. The authors stressed the importance of the macroscopic appearance of the pleural cavity, and the need to take numerous biopsies. Several types of anesthesia can be used, although the authors prefer general anesthesia for the comfort of both the patient and the doctor. Complications are very rare, the main ones being hemorrhage, pulmonary perforation and contamination of the puncture route with cancer cells. The first two can be avoided by good technique and diathermo-coagulation. The latter can be prevented by systematic radiotherapy of the puncture route, in mesothelioma patients. Amongst the numerous indications mentioned, three are important: the etiological diagnosis of chronic effusion, where cancer is a major fear. In these cases, the authors get 97% of positive results. Spontaneous pneumothorax is also a good indication: thoracoscopy allows a useful separation of patients, into those who need surgical treatment, or those in whom local adhesion of the pleura with talcum powder would be effective. Finally, pulmonary biopsy via the thoracoscope is a reliable and effective technique in a large number of indications.

Anesthesia↗
PubMed1981

[Indications, technics and results of thoracoscopy].

Indications, materials, technique and contraindications of diagnostic thoracoscopy are described. Examination of 67 thoracoscopies carried out in the past four years shows the technique studied to be the best available diagnostic tool in the field of pleural and peripheral lung diseases: neoplasia, pleuritis and bullous disease. Whether done under narcosis or local anaesthetic, the examination proved to be well tolerated, given the minimum, temporary damage caused to respiratory function. Complications were few and not lethal. A final diagnosis was achieved in the majority of cases. There were a number of false negatives in circumscribed neoplasia localised at points that could not be reached by the instrument, and in cases complicated by pleural adhesions, which prevent correct examination.

Humans↗
PubMed1981

[Current indications for thoracoscopy].

Thoracoscopy is performed at best with a rigid apparatus and a cold light source using a single or double site of entry into the chest. Biopsy under direct vision requires a double-spoon biopsy forceps that can be connected to diathermy to insure haemostasis and prevent any air leak age. Some authors prefer a local anaesthesia but a light general anaesthesia with or without intubation allows a safe and painless examination. Numerous biopsies can be obtained for subsequent examinations, like light or electron microscopy, immunofluorescence, bacteriology and mineral studies as well as search for hormonal receptors sites on tumours. Complications are rare and fatalities exceptional (4 cases in a review of the literature covering 3.384 cases. 2 of which occurred in a small series of 150 cases). In chronic pleurisies secondary to cancer, a diagnosis was made in 92% of cases. In suspected pleural mesothelioma, thoracoscopy allows both diagnosis and staging. In pleural tuberculosis, a diagnosis is obtained in 93% of cases. Talc pleurodesis in the treatment of chronic recurrent malignant pleural effusions is successful in 80%. In the treatment of spontaneous pneumothorax with a mean follow up of 10 years, only 6.6% recurred after talc poudrage, and functional sequelae were minimal; no talcomas induced mesotheliomas were seen in a review of 151 cases. Thoracoscopic lung biopsy has an 87 to 94% success rate depending on series, and is thus comparable to surgical biopsy with a markedly smaller morbidity and mortality. It should thus be used more widely by pneumologists.

Biopsy↗
PubMed1981

Thoracoscopy in the diagnosis of malignant mesothelioma.

Among 325 patients (95 women and 230 men) admitted to hospital for pleural effusion, 28 cases of malignant mesothelioma were found. In 22 of the 28 patients thoracoscopy was used to determine the course of the effusions. Thoracoscopy revealed the correct diagnosis in 19 of the 22 patients and thus gave far better results than cytological examination or hyaluronic acid determination on the pleural fluid.

Asbestos↗
PubMed1981

[The thoracic surgeon and thoracoscopy (author's transl)].

In the light of the results of thoracoscopy, the surgeon has a tendency to readily adopt the procedure and rather than criticising it, to tend on the contrary to "push" it even more. He would like to see if even more audacious in order to go to the maximum of its possibilities. Its extension to certain revisions after surgery is desirable (e.g. removal of clots). Nevertheless, in order to even further widen its indications and to take known risks, it would seem to be preferable to perform thoracoscopy in surgical surroundings, being aware of the possible need for subsequent surgery in case of complications. The patient and physician should be warned of the latter.

Hemorrhage↗
PubMed1994

[Palliative treatment of malignant effusions by thoracoscopy under video-assistance: morbidity and survival].

Survival after surgical palliation of patients with malignant pleural effusions is expected to be of several months. From a group of 75 patients operated by video-assisted thoracic surgery (VATS) from September 1991 through March 1993, twenty-two of 38 patients with malignant disease underwent palliative surgery and operative morbidity and length of survival were studied. Palliation consisted in 20 talc pleurodesis and 2 pericardial windows for malignant effusions. In the 16 other patients with malignancy, video-thoracoscopy was done for diagnostic purposes. Thirty-day operative mortality was 13.6% (3/22) and the rate of operative morbidity was 31.8% (7/22). The follow-up was complete for all patients with a mean length of 5 months (+/- sd 4 months). During the follow-up period, 14 of 19 (74%) patients, alive 30 days after the procedure, were deceased at a mean of 3.4 +/- 4 months (6 patients < 3 months) after the operation. In all, 9 of 22 patients (40%) survived less than 3 months (median survival 4 months). Operative morbidity and mortality of video-thoracoscopy are high in the palliative group and only 60% of patients survived more than 3 months. More stringent criteria for selection of patients for palliative endosurgery should be defined.

Adult↗
PubMed1994

[The diagnostic and therapeutic potentials of thoracoscopy in thoracic surgery].

Within a decade, the authors performed 484 thoracoscopies in patients with spontaneous pneumothorax, open and closed thoracic trauma, pleuritis, pleural empyema. High diagnostic possibilities of the method permitted to choose a rational therapeutic tactics. In 228 cases, different endothoracic interventions under the guidance of a thoracoscope were performed. With the use of thoracoscopy, diathermocoagulation, laser and ultrasound irradiation were performed, medical glue was introduced. This permitted in most cases to eliminate intrapleural injuries and achieve stable smoothing of a lung.

Diagnosis, Differential↗
PubMed1995

[Closure of patent ductus arteriosus by video-thoracoscopy in 45 children].

For over 20 years, different methods of interventional catheterisation have partially replaced surgical closure of patent ductus arteriosus (PDA). The authors report the results of a new operative technique, video-thoracoscopy, derived from endoscopic surgery. Under general anaesthesia and after tracheal intubation, two trocarts of 5 mm diameter are introduced into the thorax for the passage of the instruments required for dissection and closure of the PDA. Two hooks are also introduced to retract the lung and dissect the ductal region. Two 9 mm titanium clips are positioned under videoscopic control. Forty-five children underwent this procedure between February 1992 and July 1994. The average age at the time of operation was 13.8 months (range: 3 to 32 months) with an average weight of 14.5 kg (range: 2 to 48 kg) including 10 (22%) with a body weight of less than 6 kg. The surgical indications were haemodynamic in 27% of cases (large shunts with pulmonary hypertension) and prophylactic against endocarditis in 73% of cases. There were no operative fatalities. The immediate complications included: chylothorax (1 case) and left recurrent nerve paralysis (2 cases). A residual shunt was observed in 3 of the 45 cases (6%). In one of these cases, a supplementary clip was effective in suppressing the residual shunt. In the other 2 cases, the residual shunt was respected after a second failure of clipping the duct in one of the cases. The final closure rate was 95.6%. Closure of PDA by video-thoracoscopy is a rapid and safe technique.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

[Role of clinical thoracoscopy in the diagnosis and treatment of pleuropulmonary cancer].

Pleuro-pulmonary cancer has a place of choice in medical thoracoscopy. From the diagnostic point of view, this technique, performed under local anesthesia leads to the diagnosis of neoplastic effusion in most cases in the shortest possible time. It improves therapeutic efficacy and especially demonstrates as resectable tumours which could have been declared inoperable. For pleurodesis, pleural talc insufflation under thoracoscopy seems to be the best available technique. Complications are rare with a well-trained operator, as long as he keeps in mind the contraindications of this technique which should be taught to future pneumologists.

Anesthesia, Local↗
PubMed1995

Laparoscopy and thoracoscopy in evaluation of abdominal trauma.

The role of laparoscopy and thoracoscopy as diagnostic modalities in blunt and penetrating abdominal trauma was studied in 35 hemodynamically stable patients who otherwise would have undergone exploratory laparotomy because of equivocal diagnostic findings. Minimally invasive laparoscopic techniques (single 5 millimeter port) and minimal abdominal insufflation (8-10 millimeters mercury) were used with general anesthesia. Both laparoscopy and thoracoscopy appear to be safe (no complications), highly sensitive (100%), specific (88%), and accurate (91%) tools for determining the presence of surgically significant abdominal pathology and the need for therapeutic laparotomy. The appropriate application of these techniques, possibly under local anesthesia, offers potential cost savings.

Abdominal Injuries↗
PubMed1995

Thoracoscopy for spontaneous pneumothorax 2.10 version with bleb stapling and pleurectomy.

A series of 25 Thoracoscopy procedures were performed for spontaneous pneumothorax over the past 2 1/2 years. The indications for the procedure were recurrent pneumothorax or choice of patient for definitive care. The procedure developed over the period of 2 1/2 years, and the procedure included a thoracoscopy, stapling of apical blebs, and apical pleurectomy. The complication rate was 3% and limited to local wound problems. There was one recurrent pneumothorax in a patient who did not have the pleurectomy as a part of the procedure. This was early on in the experience, when it was felt that pleural abrasion would be adequate. Since that time, a formal apical pleurectomy has been done with each of these procedures. No further recurrences have been noted over the 2 1/2 year period of time. The procedure includes one port at the anterior axillary line, fifth intercostal space, one port in the axilla, third intercostal space, and one port in the midclavicular line, fourth intercostal space. A 30 degree and angled scope is sometimes used for better visualization. The Endo GIA (US Surgical or equivalent Ethicon stapler) is used to staple the blebs, and the pleurectomy is done through the two non-video ports.

Adolescent↗
PubMed1995

Outpatient thoracoscopy: a case report and discussion.

Thoracoscopy has long been recognized as having significant diagnostic and therapeutic value. We present a new, less invasive method of obtaining good biopsy specimens of pleural based lesions using a single incision and on an outpatient basis. JW, who has a history of Hodgkin's Lymphoma, presents with a suspicious pleural mass adjacent to the AP window and not amenable to percutaneous biopsy. She was admitted to the ambulatory surgery unit and underwent video thoracoscopic biopsy of the lesion through a single 12 mm incision. Surgery time was 25 minutes, and frozen section revealed Hodgkin's lymphoma. No chest tube was inserted, and post-op chest film revealed a small pneumothorax that resolved in 4 hours. The patient was ready for discharge at that time. The technique we used involved placing a standard 10 mm trocar and scope in the midaxillary line with the patient in the lateral decubitus position. Once the scope is in, the trocar is pulled back so that a mediastinal biopsy forcep can be placed alongside the camera through the same hole. The biopsy is taken, and irrigation and cautery instruments can then also be placed and used in a similar manner. Before removing the camera, a prolene pursestring suture is placed around the incision. While the anesthesiologist inflates the lung, the camera is slowly removed, watching all lobes inflate. The pursestring is then tied and the patient awakened. We have performed seven of the above procedures thus far with good results. We feel the following are essential in patient selection for outpatient thoracoscopy: 1) The lesion to be biopsied is pleural based.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Thoracoscopy in pleural mesothelioma].

19 patients suspected pleural mesothelioma were performed thoracoscopy. The overall diagnostic rate was 94.7% (18/19 cases). The macroscopic findings of 18 cases presented solitary, well circumscribed, smooth, rounded masses in 2 localized cases and multiple, clear, yellowish-white and "grape-like" granulations or malignant pleural thickening in 16 diffuse cases. Biopsy was taken in 18 cases under direct vision. The histological diagnosis showed 2 benign fibromatous mesothelioma and 16 malignant mesothelioma. Pleural mesothelioma was easily misdiagnosed as primary lung cancer, tuberculous pleurisy and metastatic pleural tumor. The diagnostic accuracy by cytological study of pleural effusions and needle biopsy of pleura both were low. Thoracoscopy is currently a suitable diagnostic method for pleural mesothelioma. The resection was considered as a proper treatment of choice for localized pleural mesothelioma. We recommend that thoracoscopic talc poudrage followed by chemotherapy on diffuse malignant mesothelioma with pleural effusion could be used to improve the survival rate and to prevent the recurrent effusion.

Adult↗