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PubMed2006

A completely thoracoscopic lobectomy/segmentectomy for primary lung cancer--technique, feasibility, and advantages.

INTRODUCTION: A completely thoracoscopic lobectomy/segmentectomy for primary lung cancer was designed to maximize the benefits of this type of minimally invasive surgery. The technique, feasibility, and advantages of this surgical modality over the conventional procedure were investigated. MATERIALS AND METHODS: Between January 2003 and December 2004, 38 patients underwent a lobectomy (n = 30) or segmentectomy (n = 8) for clinical stage IA primary lung cancer. A resection using a standard thoracotomy (Thoracotomy Group) was performed in 19 patients, and a completely thoracoscopic resection was performed in 10 cases (CTR Group). Conventional video-assisted thoracic surgery with a mini-thoracotomy was performed in 9 cases. RESULTS: All CTR lobectomies or segmentectomies were carried out safely without any major complications. The number of resected mediastinal lymph nodes was similar in both groups. There was a tendency for the hospital stay to be somewhat shorter in the CTR Group. With respect to postoperative pain as evaluated by a visual analogue scale (VAS), the CTR Group showed a significantly lower level of pain in comparison to the Thoracotomy Group ( P = 0.024 on day 2). CONCLUSIONS: We concluded that a complete thoracoscopic lung resection is a safe and technically feasible surgical procedure which enables us to make thoracoscopic lung resections less invasive.

Aged↗
PubMed1998

Thoracoscopic upper thoracic sympathectomy for primary palmar hyperhidrosis--the combined paediatric, adolescents and adult experience.

OBJECTIVE: To present our experience, over the past 4 years, of thoracoscopic upper thoracic sympathectomy in patients with primary palmar hyperhidrosis. DESIGN: Retrospective study. SETTING: University hospital, Israel. SUBJECTS: 402 thoracoscopic upper thoracic sympathectomies in 223 patients over a period of 4 years. INTERVENTIONS: Thoracoscopic ablation of ganglia and severing of the sympathetic chain at the level of T2 and T3. 142 patients underwent bilateral simultaneous sympathectomy, 37 had bilateral non-simultaneous sympathectomy and 44 had unilateral sympathectomy. RESULTS: 220 patients (98.7%) had an uneventful postoperative course and were discharged the following day. Three patients with residual pneumothorax required intercostal drainage and were discharged on the third postoperative day. 219 patients (98.2%) were completely satisfied, having immediate and permanent relief of palmar sweating. Four patients were dissatisfied. CONCLUSION: The thoracoscopic approach to the upper thoracic sympathectomy is at present the procedure of choice. Early operation for severe palmar hyperhidrosis is indicated to save a child many years of frustration and discomfort.

Adolescent↗
PubMed2006

Thoracoscopic repair of esophageal atresia and tracheoesophageal fistula: lessons learned.

OBJECTIVE: Repair of esophageal atresia and tracheoesophageal fistula has traditionally been performed via thoracotomy. This study aims to evaluate the feasibility and pitfalls of the thoracoscopic approach. MATERIALS AND METHODS: Six consecutive patients with type C tracheoesophageal fistulae underwent thoracoscopic repair. The operation was approached through the right chest using a three-trocar technique (two 5-mm and one 3-mm) with the patient placed in a three-quarter prone position. Patient characteristics, operative time, duration of narcotic usage, conversion factors, postoperative complications, and long-term follow-up were recorded. RESULTS: Five of six patients were successfully operated on thoracoscopically. The average operative time was 143 minutes (range, 75-215 minutes) with repair of long-gap defects requiring significantly longer times than short-gap defects (200 vs. 129 minutes, P < 0.05). There were no intraoperative complications. Mean duration of narcotic use was 52 hours (range, 24-72 hours). There were no anastomotic leaks. One patient developed an anastomotic stricture at the third postoperative week, which resolved with two dilations. One patient died on the first postoperative day from respiratory failure. CONCLUSION: Thoracoscopic repair of esophageal atresia and tracheoesophageal fistula is feasible, but is technically challenging. Long-gap defects require more extensive dissection and difficult anastomosis, and are therefore associated with longer operative times. More data are needed for further evaluation of this approach.

Esophageal Atresia↗
PubMed2006

Thoracoscopic resection of foregut duplication cysts.

BACKGROUND: Foregut duplications are rare entities that include both esophageal and bronchogenic cysts. The diagnosis of foregut duplication cyst is made most often from an incidental finding on chest radiograph, or due to respiratory compromise due to mass effect or infection. Treatment consists of complete resection. Recurrences are associated with incomplete resection. Six cases of foregut duplication cysts are presented that were resected thoracoscopically. MATERIALS AND METHODS: From May 1998 to April 2003, six patients underwent thoracoscopy for resection of foregut duplication cyst. One patient required conversion to open thoracotomy due to esophageal perforation. The distribution of cysts was 4 on the left and 2 on the right; all procedures were performed with three or four ports. Single lung ventilation was used in three patients. The masses were removed via a port site after intrathoracic decompression. Chest tubes were placed in all patients, and most were removed within 12 hours. RESULTS: Five of six cases underwent successful thoracoscopic resection. Pathology demonstrated esophageal duplication cyst in three patients and bronchogenic cyst in the other three patients. Average hospital stay was 5.5 days. Complications included aspiration pneumonia and chest tube dislodgment. There were no deaths, and no recurrences. CONCLUSION: Thoracoscopic resection is a safe and effective method of treating foregut duplications. Outcomes have been good with little short-term morbidity and no mortality. Morbidity and cosmesis are improved by avoiding thoracotomy. Thoracoscopic resection should be considered the first-line therapy for these benign masses.

Adolescent↗
PubMed2006

Hand-assisted thoracoscopic repair of a Bochdalek hernia in an adult.

BACKGROUND: Bochdalek hernias are congenital diaphragmatic hernias that are generally asymptomatic and often discovered incidentally. Surgical treatment is indicated once the diagnosis is made. These hernias have traditionally been repaired by open abdominal or thoracic approaches. MATERIALS AND METHODS: A healthy 24-year-old male presented with an 8-month history of shortness of breath. The patient was noted to have a postero-lateral diaphragmatic hernia, with a 4 cm defect in the left hemidiaphragm seen with computed tomography scan. He underwent hand-assisted video-assisted thoracoscopic surgery, in which the herniated omentum was reduced and the defect was repaired primarily and reinforced with Marlex mesh. The patient recovered uneventfully and was discharged home after a short hospitalization. CONCLUSION: Video-assisted thoracoscopic surgery for repair of Bochdalek hernias offers diagnostic as well as therapeutic advantages as it provides an excellent view of the surgical field, is easily executed, results in minimal surgical trauma, and has excellent cosmetic results and rapid recovery. We report a hand-assisted intracorporeal thoracoscopic repair to be a secure and satisfactory adjuvant to achieve the repair and conclude that thoracoscopic repair of the rare Bochdalek hernia is feasible.

Adult↗
PubMed2006

Efficacy of single-dose, multilevel paravertebral nerve blockade for analgesia after thoracoscopic procedures.

BACKGROUND: Although video-assisted thoracoscopic surgery for pulmonary resection is increasingly chosen over thoracotomy, the optimal analgesia regimen for thoracoscopy is unknown. The purpose of this trial was to compare the efficacy of analgesia from preoperative bupivacaine paravertebral nerve blockade with that from placebo injections. METHODS: Eighty adult patients undergoing unilateral thoracoscopic procedures were enrolled in a prospective, double-blinded, randomized clinical trial of preoperative, multilevel, single-dose paravertebral nerve blockade. Patients received six paravertebral injections with 5 ml of either 0.5% bupivacaine with 0.0005% epinephrine (treated, n = 40) or preservative-free saline (control, n = 40). Cumulative weight-adjusted intraoperative fentanyl and postoperative patient-controlled morphine usage, visual analog pain scores, and spirometry were used to compare efficacy of analgesia between groups. RESULTS: The treated group received significantly less intraoperative fentanyl compared with the control group (P = 0.003) and had a 31% smaller cumulative patient-controlled morphine dose (P = 0.03) in the 6 h after block placement. Within 6 h, treated patients also reported lower maximum pain scores (P = 0.02) and demonstrated less pain score variability (P = 0.01). No statistically significant difference in cumulative morphine usage existed at 12 or 18 h after block placement. No significant difference in spirometry, cortisol levels, or cytokine production was found between treatments. CONCLUSIONS: Single-dose paravertebral nerve blockade with bupivacaine is effective in reducing pain after thoracoscopic surgery, but only during the first 6 h after nerve blockade. Because of the limited duration of effect with currently available local anesthetic agents, the current data suggest that, at present, this technique is not indicated in the setting of thoracoscopic surgery.

Adult↗
PubMed2000

Thoracoscopic removal of intrathoracic neurogenic tumors: a combined Chinese experience.

OBJECTIVE: To review the surgical and clinical results of minimally invasive resection of intrathoracic neurogenic tumors using a video-assisted thoracoscopic technique. SUMMARY BACKGROUND DATA: Thoracoscopy has emerged as a possible means for diagnosing and managing various intrathoracic disorders. Benign intrathoracic tumors often are ideal lesions for resection using a video-assisted technique. The authors report on their combined experience with the thoracoscopic resection of 143 intrathoracic neurogenic tumors. METHODS: Between March 1992 and February 1999, 143 patients with intrathoracic neurogenic tumors were diagnosed and underwent resection using video-assisted thoracoscopic techniques in three teaching centers. Case selection, surgical technique, and clinical results were reviewed. RESULTS: The average age of the patients was 40.8 years; 57.3% were male. Thirty-eight patients (27%) had symptoms attributable to the masses. Seventy-two masses were neurofibromas, 33 were neurilemmomas, 7 were paragangliomas, and 31 were ganglioneuromas. All but seven tumors were located in the posterior mediastinum. The masses were on average 3.5 cm in greatest diameter. The mean surgical time was 40 minutes, and the average hospital stay was 4.1 days. There were no major postoperative complications or recurrences to date. Nine patients reported paresthesias over the chest wall during a mean follow-up of 29 months. CONCLUSIONS: Resection of intrathoracic neurogenic tumors using a thoracoscopic technique based on standard surgical indications would seem to be appropriate. Most of these masses are benign and readily removed. For dumbbell tumors, a combined thoracic and neurosurgical approach is mandatory.

Adult↗
PubMed2001

Laparoscopic and thoracoscopic esophagomyotomy for children with achalasia.

BACKGROUND: Minimally invasive esophagomyotomy, consisting of a laparoscopic or thoracoscopic approach, has become a preferred surgical treatment for adults with achalasia. This multicenter study reports on the clinical status of children who have undergone minimally invasive esophagomyotomy for achalasia. METHODS: Symptomatology for achalasia was assessed in 22 pediatric patients who underwent minimally invasive esophagomyotomy for achalasia between 1995 and 2000. All patients were evaluated for duration of hospitalization, postoperative resumption of feeds, postoperative complications, and symptomatic relief. Participants were assigned pre-and postoperative symptom severity scores ranging from 0 (no symptoms) to 3 (severe). RESULTS: The median age of the 10 females and 12 males at time of surgery was 11.3 years +/- 3.4 (standard deviation). Transabdominal laparoscopic esophagomyotomy with fundoplication was performed in 18 patients, and thoracoscopic esophagomyotomy without fundoplication was performed in 4. Two patients required conversion from transabdominal laparoscopic esophagomyotomy to open esophagomyotomy because of intraoperative esophageal perforation. The mean duration of postsurgical follow-up was 17 +/- 16 (standard deviation) months (range, 1-54 months). Mean duration of hospitalization (days +/- standard error or mean) was less for transabdominal laparoscopic esophagomyotomy than for converted open esophagomyotomy (2.7 +/- 0.3 vs. 9.0 +/- 3.0 days; P < 0.05) or for thoracoscopic esophagomyotomy (4.8 +/- 1.7 days; P = not significant). Mean time to resumption of soft feedings (days +/- standard error or mean) occurred sooner after transabdominal laparoscopic esophagomyotomy than after converted open esophagomyotomy (2.0 +/- 0.2 vs. 5.5 +/- 0.5 days; P < 0.001) or after thoracoscopic esophagomyotomy (4.0 +/- 1.3 days; P = not significant). Patients experienced significant pre-to postoperative improvement in mean severity score with regard to dysphagia (2.6 vs. 0.4; P < 0.001) and regurgitation (1.7 vs. 0.2; P < 0.001). CONCLUSIONS: Minimally invasive esophagomyotomy can provide excellent symptomatic relief from dysphagia and regurgitation for children with achalasia.

Adolescent↗
PubMed1999

Predicting the need for thoracoscopic evacuation of residual traumatic hemothorax: chest radiograph is insufficient.

BACKGROUND: The early removal of large residual posttraumatic hemothorax by videothoracoscopy is increasingly used to avoid the late sequelae of trapped lung and empyema. Plain chest radiography (CXR) is the tool most frequently used to select such cases for operation. Our recent experience has demonstrated that what appears to be a large retained hemothorax on CXR may turn out to be intrapulmonary or extrapleural conditions not amenable to thoracoscopic removal. Our objective was to evaluate the accuracy of CXR in detecting significant residual hemothorax and compare its clinical value to thoracic computed tomography (CT) when used to select patients for thoracoscopic evacuation. METHODS: All patients requiring tube thoracostomy for traumatic hemothorax were prospectively evaluated during a 22-month period (n = 703). Patients who, on the second day after admission, demonstrated opacification on CXR involving more than the costophrenic angle were evaluated by thoracic computed tomography for the presence of undrained fluid. Second-day CXR (CXR2) results were compared with the CT findings. Incorrect interpretation was defined as a difference of more than 300 mL between the two readings. All CXR2 and CT results were reviewed in the same fashion by a radiologist blinded to the surgeon's interpretations. Data on injury mechanism, hemodynamic status, laboratory values, interventions, and outcome were collected prospectively. RESULTS: Fifty-eight patients had clinically significant opacifications on CXR2. The surgeon's and radiologist's CXR2 interpretations were incorrect in 48 and 47% of the cases, respectively. The CT interpretations by the two specialists were in agreement in 97% of the cases. Management that would have been instituted on the basis of CXR2 findings was changed in 18 cases (31%). Twelve patients (21%) required early thoracoscopic evacuation of undrained collections. There was good correlation between the CT estimation and the thoracoscopically retrieved amount of blood. CONCLUSION: Although CXR is useful as a screening tool, it cannot be used to reliably select patients for surgical evacuation of retained traumatic hemothorax. Decision-making should be based on thoracic CT findings.

Adult↗
PubMed1996

Thoracic vertebrectomy and reconstruction using a microsurgical thoracoscopic approach.

A video-assisted thoracoscopic microsurgical approach was developed in the laboratory and subsequently used clinically to resect abnormalities of the thoracic vertebrae, to decompress the thoracic spinal cord, and to reconstruct the thoracic vertebral bodies. This report describes the development of the clinical operative techniques for microsurgical thoracoscopic vertebrectomy, neural decompression, and spinal reconstruction. This minimally incisional approach was clinically used in 17 patients to treat vertebral osteomyelitis, tumors, and compression fractures. Microsurgical thoracoscopic techniques were performed using several narrow, flexible, working portals placed in small incisions in the intercostal spaces. Access to the thoracic spine was achieved through the pleural cavity after temporary deflation of one lung using a double-lumen endotracheal tube. The parietal pleura, segmental vessels, and rib heads were dissected off the surfaces of the involved vertebrae to expose the region of interest. Long narrow spine dissection tools were used to perform the spinal decommpression and reconstruction. This technique achieved the same amount of spinal dissection as that achieved with conventional open spinal procedures and used microsurgical visualization techniques. The small incisions with reduced soft tissue dissection may reduce postoperative pain, shorten the length of hospitalization, and have cosmetic and functional advantages. Thoracoscopic vertebrectomies and reconstruction of the spine were technically feasilble procedures that were performed with excellent clinical results. This minimally incisional technique provides a viable alternative to thoracotomy or to posterolateral approaches for thoracic vertebrectomy and vertebral body reconstruction.

Adult↗
PubMed2002

Thoracoscopic techniques for the treatment of scoliosis: early results in procedure development.

OBJECTIVE: The goal of this study was to determine the effectiveness of an endoscopic option for anterior approaches to the thoracolumbar spine for scoliosis treatment. Fifty patients with 24 to 45 months of follow-up data were retrospectively studied. Techniques for endoscopic treatment of spinal disorders have been under development since 1993. The benefits of thoracoscopic surgery for the treatment of spinal deformities have been documented as improved observation of the spine, enhanced access to the extremes of the curve, decreased operative times and blood losses, shorter hospital stays and recuperative periods, and decreased overall costs. After more than 150 endoscopic procedures for the treatment of these spinal deformities had been performed, the next step was to develop a thoracoscopic technique for instrumentation, correction, and fusion for the treatment of primary thoracic scoliosis. Our goal has been to develop a safe, reproducible, and effective endoscopic technique for the treatment of scoliosis that can provide equal or better outcomes, compared with formal open surgical techniques. METHODS: Between October 1996 and October 1998, 50 patients with a diagnosis of primary thoracic scoliosis were selected to undergo thoracoscopic instrumentation, correction, and fusion. Postoperatively, patients were assessed with respect to restoration of spinal alignment, axial derotation, pain management, and incidence of complications. RESULTS: Endoscopic instrumentation was successfully performed for all patients. Curve correction averaged 50.2%, improving to 68.6% in the last 10 cases. Patients with hypokyphosis averaged 20.7 degrees of correction. The preoperative axial rotation (as measured with a scoliometer) averaged 16 degrees, which was corrected to 5 degrees. Postoperative pain was less, and patients could discontinue the use of all pain medications by 1 to 3 weeks, compared with patients who underwent formal open procedures, who required pain medication for 6 to 12 weeks. The hospital stays averaged 2.9 days. Our initial complication rate was high, which could be attributed to the development of a new technique. Keys to successful fusions include total discectomy, complete endplate removal, and the use of autogenous bone graft. CONCLUSION: Although these techniques are still in early development, the initial results for our thoracoscopic techniques are promising. With experience, surgical times are decreasing and fusion and curve correction rates are improving. With further evolution, patients should realize shortened hospitalizations, decreased rehabilitation times, and decreased levels of postoperative pain. This is a technically demanding procedure that requires demonstrated skills in endoscopic discectomy and fusion.

Adolescent↗
PubMed2005

Video-assisted thoracoscopic surgery: the Cincinnati experience.

Video-assisted thoracoscopic surgery is an alternative to open thoracotomy. We analyzed our experience during a consecutive series of 100 patients who had this procedure and who were available for study at 3-year followup. Video-assisted thoracoscopic surgery was done on patients with the following diagnoses: idiopathic scoliosis (n = 49), neuromuscular spinal deformity (n = 15), Scheuermann kyphosis (n = 15), congenital and infantile scoliosis (n = 5), neurofibromatosis (n = 5), Marfan (n = 1), postradiation scoliosis (n = 1), and repair of pseudoarthrosis (n = 1). Four patients had excision of the first rib to treat thoracic outlet syndrome. One patient had excision of an intrathoracic neurofibroma and one a benign rib tumor. One had anterior arthrodesis after fracture-dislocation of the thoracic spine and another had anterior fusion for vertebral osteomyelitis. The average operative time for the thoracoscopic anterior release with discectomy and arthrodesis was 253 minutes. The average number of discs excised was 8. Final postoperative scoliosis and kyphosis corrections were 68% and 90%, respectively. Complications related to thoracoscopy occurred in eight patients. Video-assisted thoracoscopic surgery provides a safe and effective alternative to open thoracotomy in the treatment of thoracic pediatric spinal deformities.

Adolescent↗
PubMed2004

Results of thoracoscopic instrumented fusion versus conventional posterior instrumented fusion in adolescent idiopathic scoliosis undergoing selective thoracic fusion.

STUDY DESIGN: Retrospective review of 31 consecutive female patients with adolescent idiopathic scoliosis undergoing selective thoracic fusion. OBJECTIVE: To compare safety and efficacy of two techniques in treating adolescent idiopathic scoliosis undergoing selective thoracic fusion. SUMMARY OF BACKGROUND DATA: There is paucity in the literature comparing posterior versus thoracoscopic instrumented fusion in scoliosis. METHODS: Nineteen patients (group 1) underwent posterior instrumented fusion. Twelve patients (group 2) had thoracoscopic anterior instrumented fusion. All patients had a minimum of 25 months of follow-up observation. RESULTS: Both groups were similar in terms of age at menarche and surgery. Preoperative Cobb angles in the coronal (erect and bending) and sagittal planes did not differ between the two groups. Group 1 patients had higher estimated blood loss (P = 0.006). Operative time (P < 0.001) and intensive care unit stay (P = 0.01) were longer in group 2 patients. There was no difference in parenteral analgesia requirement. There were no complications in group 1. Complications in group 2 included lobar collapse (1) and scapula winging (1). Improvement in scoliosis among group 1 patients averaged 77 (1 week), 72 (6 months), and 67% (most recent follow-up review). In group 2 patients, mean improvement in scoliosis was 66 (1 week), 62 (6 months), and 62% (most recent follow-up review). The differences between the two groups in terms of scoliosis improvement were not significant. Thoracic kyphosis (T2-T12) did not increase significantly with thoracoscopic versus posterior instrumentation. No significant change in lumbar lordosis (T12-S1) was noted with either procedure. CONCLUSIONS: The efficacy of thoracoscopic surgery was similar to standard posterior procedures. Advantages included lower intraoperative blood loss. The longer operative time and intensive care unit stay were attributed to the steep learning curve of this technique.

Adolescent↗
PubMed2005

Prospective evaluation of 50 consecutive scoliosis patients surgically treated with thoracoscopic anterior instrumentation.

STUDY DESIGN: Prospective, consecutive, single-surgeon case series of patients treated for scoliosis with thoracoscopic anterior spinal instrumentation. BACKGROUND: A thoracoscopic approach for insertion of anterior instrumentation has been developed in the past 10 years, which obviates many of the disadvantages of the open anterior thoracic approach. The morbidity associated with a thoracoscopy is limited because of the minimal skin and chest wall dissection required with this method. PURPOSE: The purpose of this evaluation is to report a single surgeon's experience with an initial series of 50 patients. The goal is to report the outcomes with regards to the radiographic findings, pulmonary function, and the SRS Outcomes Instrument, as well as a review of the perioperative data and complications. METHODS: The primary author's initial 50 thoracoscopic anterior spinal instrumentation patients were consecutively collected. Data collection included demographics, such as age, gender, and diagnosis. Data regarding the surgical procedure included the operative time, intraoperative estimated blood loss, as well as the number of levels instrumented anteriorly. In the perioperative hospital period, data were collected with regard to the length of the hospital stay, the number of days in the ICU, the number of days of ventilator support, and the number of days after surgery when conversion from IV to PO pain medication occurred. Radiographic data were obtained systematically on each patient and measured by authors other than the surgeon. The SRS 22 and/or 24 Outcomes Questionnaire and pulmonary function tests were administered to patients at similar intervals. RESULTS: The series consisted of 44 females and 6 males with a mean age of 14 years (range, 9-48 years). Forty-five of the 50 patients were available for clinical and radiographic evaluation at greater than or equal to 2 years after surgery. The average length of follow-up for these 45 patients was 33 months (range, 2-5 years). The mean operative time for the procedure was 350 +/- 50 minutes and ranged from 265 to 528 minutes. The estimated intraoperative blood loss averaged 431 +/- 273 mL (range, 75-1,400 mL). Normalizing the operative time and estimated blood loss based on the number of levels treated resulted in an average operative time per level of 48 +/- 6 minutes per level and an estimated intraoperative blood loss per level of 60 +/- 37 mL per level. The preoperative thoracic Cobb averaged 53 degrees +/- 9 degrees (range, 40 degrees-80 degrees). At most recent follow-up (> or = 2 years), the thoracic Cobb averaged 24 degrees +/- 7 degrees. Implant failure occurred in 3 cases. CONCLUSION: Thoracoscopic anterior instrumentation for adolescent idiopathic scoliosis is a viable surgical option. The outcomes of this consecutive series of patients is comparable to prior open and endoscopic series presented in the literature. The technical challenges of this operation are evident in the learning curve effect, which has been demonstrated.

Adolescent↗
PubMed2005

Image-guided thoracoscopic spinal surgery: a merging of 2 technologies.

STUDY DESIGN: Retrospective clinical and intraoperative navigational data review. OBJECTIVE: To evaluate quantitatively the application of frameless stereotactic image guidance in thoracoscopic discectomy procedures. SUMMARY OF BACKGROUND DATA: Thoracoscopic spinal surgery has technical and anatomic challenges that result in difficult orientation with a 2-dimensional imaging procedure in a complex 3-dimensional structure. METHODS: There were 16 patients who underwent image-guided thoracoscopic discectomy procedures that combine these 2 technologies. Accuracy was determined by the registration (calculated) error and actual navigation (intraoperative) error. The clinical outcomes and complications were reviewed. RESULTS: Accuracy determined by registration (calculated) and navigation (intraoperative) was 1.7 and 1.2 mm, respectively. The additional time required for the image guidance portion of the procedure was countered by the efficiency of the remaining procedure. Clinical outcomes and complication were comparable with previous experience. CONCLUSIONS: Image-guided thoracoscopic spinal surgery can provide 3-dimensional orientation to a 2-dimensional imaging procedure that ultimately improves accuracy, efficiency, and safety. Future developments in combining guidance technology with standard surgical procedures will likely continue.

Adult↗
PubMed1998

Thoracoscopic radiofrequency ablation of the myocardium.

Radiofrequency (RF) catheter ablation has been used for the treatment of ventricular tachycardia (VT), however, in some patients VT might result from subepicardial macroreentry that could be successfully terminated by epicardial approach. This study examined the feasibility of thoracoscopic RF ablation of myocardium from epicardium using a custom made electrode. In five mongrel dogs, the thoracoscope was introduced through the 7th intercostal space. A 500-KHz continuous wave RF energy was connected to a custom made multiple electrode probe. Under thoracoscopic guidance, the heart was exposed and the RF probe was introduced. RF ablation was performed on the nonvascular ventricular wall of the beating heart. The left ventricular free wall and right ventricular outflow tract were satisfactorily visualized and ablated. The total dose of RF energy ranged from 50 to 500 J, and the estimated volume of ablated lesions ranged from 41.0-799 mm3. There were significant correlations between the RF discharge output and the irradiated lesion volume (P < 0.01), and the depth of the lesions (P < 0.01). Grossly, after RF ablation the ventricular myocardium demonstrated a circular, well-demarcated area of thermal injury. Volume and depth of the lesion depended upon the total dose of delivered RF energy. Thoracoscopic RF ablation appears to be a minimally invasive and useful method for creating irradiated myocardial lesions from epicardial surface. This method could be technically feasible for the treatment of Vts for which endocardial RF ablation is ineffective.

Animals↗
PubMed1998

Dynamic aortomyoplasty: clinical experience and thoracoscopic surgery feasibility study.

BACKGROUND: Surgical procedures using the latissimus dorsi (LD) muscle to assist chronic heart failure inflict major trauma on severely sick patients. A less invasive approach may prove beneficial. The aim of this article is to review our clinical and experimental approaches of dynamic aortomyoplasty (AMP) and emphasize the necessity to reorient surgical technique towards new directions and a less invasive thoracoscopic approach. MATERIALS AND METHODS: A clinical pilot study on dynamic descending AMP started in June 1995 and included four patients. Two of them could benefit from LD counterpulsation, surviving 6 months and 18 months. Following this clinical experience, we investigated, on an animal model, minimally invasive thoracoscopic surgery for this procedure. Twelve goats underwent endoscopic LD harvest and video-assisted aortic wrap, and were studied after surgical recovery from an anatomical and functional standpoint. RESULTS: Clinical AMP using open techniques provided extraaortic counterpulsation in NYHA Class IV patients contraindicated for other surgical therapies. However, surgical technique and strategy needed improvements for optimal cardiac assistance and better patient outcome. Minimally invasive thoracoscopic surgery was feasible and reproducible in goats, achieving improved anatomy and physiology as compared to the open technique in humans. When appropriate the wrapping technique and stimulation protocol were used, an optimal counterpulsation was demonstrated. We concluded that thoracoscopic AMP may provide a minimally invasive approach to cardiac assistance and thus, a new surgical option for patients presenting with chronic heart failure.

Animals↗
PubMed1995

Initial experience of video assisted thoracoscopic pneumonectomy.

BACKGROUND: Preliminary experience of video assisted thoracoscopic pneumonectomy in six patients with bronchogenic carcinoma is described. METHODS: Four left and two right pneumonectomies were performed under video thoracoscopic imaging. Thoracoscopic instruments were passed through two separate stab incisions on the lateral chest wall and a separate 6 cm submammary incision was also created to allow further access for instrumentation and removal of the resected lung. In this initial experience resection was restricted to patients with bronchogenic carcinomas of less than 6 cm in diameter who had no involvement of the mediastinum. RESULTS: There were no operative deaths and no complications attributable to the technique. One patient developed postoperative atrial fibrillation and a small sacral sore and one patient was readmitted with abdominal pain and pyrexia which settled following exclusion of post pneumonectomy empyema. The remaining four patients made a rapid uncomplicated postoperative recovery with less pain and discomfort than that normally associated with a standard posterolateral thoracotomy. Postoperatively the mean (SD) patient controlled morphine consumption was 1.36 (1.90) mg per hour in the first 36 hours compared with the unit mean for open thoracotomy of 1.73 (1.68) mg per hour. The mean linear visual analogue pain score was 15.4 (15.6) in the first 24 hours compared with the unit mean for open thoracotomy of 34.5 (8.5). CONCLUSIONS: Video assisted thoracoscopic pneumonectomy can be performed safely in patients who have stage I and stage II bronchogenic carcinomas, up to 6 cm in diameter, with no mediastinal involvement on mediastinoscopy and thoracic computed tomographic assessment. This technique may result in less postoperative pain and discomfort and should allow a quicker return to normal activities.

Aged↗