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PubMed2005

Additional minocycline pleurodesis after thoracoscopic surgery for primary spontaneous pneumothorax.

RATIONALE: Ipsilateral recurrence rates of spontaneous pneumothorax after video-assisted thoracoscopic surgery are higher than rates after open thoracotomy. OBJECTIVES: This study was conducted to determine whether additional minocycline pleurodesis would be effective in diminishing recurrence after video-assisted thoracoscopic surgery treatment of primary spontaneous pneumothorax. METHODS: Between June 2001 and February 2004, 202 patients with primary spontaneous pneumothorax were treated by conventional or needlescopic video-assisted thoracoscopic surgery. The procedures included resection of blebs and mechanical pleurodesis by scrubbing the parietal pleura. After the operation, patients were randomly assigned to additional minocycline pleurodesis (103 patients) or to observation (99 patients). MAIN RESULTS: Patients in the minocycline group had higher intensity chest pain and required a higher accumulated dose of meperidine. Short-term results showed that the two groups had comparable chest drainage duration, postoperative hospital stay, and complication rates. Patients in the minocycline group demonstrated a trend of decreased rate of prolonged air leaks (1.9 vs. 6.1%, p = 0.100). After a mean follow-up of 29 mo (12-47 mo), recurrent ipsilateral pneumothorax was noted in two patients in the minocycline group and eight patients in the observation group (p = 0.044 by the Kaplan-Meier method and log-rank test). Postoperative long-term residual chest pain and pulmonary function were comparable in both groups. CONCLUSIONS: Although associated with intense immediate chest pain, additional minocycline pleurodesis is a safe and convenient procedure that can reduce the rate of ipsilateral recurrence after thoracoscopic treatment for primary spontaneous pneumothorax.

Adult↗
PubMed1996

A simple way to indicate pulmonary nodules at thoracoscopic wedge resections.

PURPOSE: Small pulmonary subpleural nodules are sometimes difficult to localise at thoracotomy. With the advent of minimal invasive surgery, thoracoscopic resection avoiding anterolateral thoracotomy is an attractive procedure. Since this technique does not allow manual palpation, preoperative indication of lesions is mandatory. A simple and cost-effective system for preoperative CT-guided localisation of small subpleural nodules before thoracoscopic resection is described. MATERIAL AND METHODS: The system consists of a 0.2 mm steel wire 30-40 cm in length and a 0.9-mm biopsy needle. The tip of the wire is bent to a hook, and, guided by CT, it is placed in the vicinity of the lesion. The technique was tested in 8 cases. RESULTS: The procedure was possible to perform in 7 patients. In all instances the wire remained in place when the lung was collapsed during the thoracoscopic procedure. The staple resected part of the lung also contained the lesion when examined extracorporeally. CONCLUSION: This simple and inexpensive system was found to be useful for indication of pulmonary lesions at thoracoscopic wedge resections.

Aged↗
PubMed2006

Thoracoscopic enucleation of a large esophageal leiomyoma using a three thoracic ports technique.

BACKGROUND: Video assisted thoracoscopic resection of an esophageal leiomyoma offers distinct advantages over an open approach. Many papers have described various techniques of thoracoscopic resection. CASE PRESENTATION: We describe a 32-year old man who presented with intermittent dysphagia. Imaging studies showed a large esophageal leiomyoma. He underwent thoracoscopic enucleation using a three thoracic-ports technique. CONCLUSION: Thoracoscopic enucleation can be technically performed using a three thoracic-ports technique.

Journal Article↗
PubMed2003

Robot-assisted thoracoscopic resection of a benign mediastinal neurogenic tumor: technical note.

OBJECTIVE: Robotic surgery systems were introduced recently with the objective of enhancing the dexterity and view during procedures that use a videoscope. The first case report of robot-assisted thoracoscopic removal of a benign neurogenic tumor in the thorax is presented. METHODS: A 46-year-old woman presented with a history of paravertebral pain. A chest x-ray revealed a left paravertebral mass. A magnetic resonance imaging scan revealed a well-encapsulated mass that was suspected to be a neuroma at the level of T8-T9, separate from vascular structures, without extension in the foramina, and without a spinal canal component. RESULTS: A left robot-assisted thoracoscopic resection of the tumor was performed. After placement of six trocars, the tumor was carefully dissected and removed through one of the trocar openings. The histopathological findings revealed an ancient schwannoma. CONCLUSION: This case report demonstrates the feasibility of robot-assisted thoracoscopic extirpation of a thoracic neurogenic tumor. Robot-assisted surgery may prove to be of additional value in challenging thoracoscopic surgery, such as the delicate surgical removal of benign neurogenic tumors, because of the support in manipulation and visualization during videoscopic interventions.

Female↗
PubMed1992

Thoracoscopic resection of pulmonary metastases.

OBJECTIVE: To describe the use of thoracoscopic techniques to achieve parenchymal sparing wedge resection of peripheral lung lesions in patients with a history of malignancy, and to describe the morbidity, mortality, and hospital course associated with this approach. DESIGN: Case series. SETTING: University hospital. PARTICIPANTS: Patients with a history of malignancy and lesions on computerized tomography in the outer one third of the lung parenchyma. MAIN OUTCOME MEASUREMENTS: Histologic analysis of resected lung lesions, operative findings, operative time, duration of chest tube drainage and hospital stay, operative morbidity, and mortality. RESULTS: Twenty-one thoracoscopic resections of pulmonary parenchymal lesions were performed on 15 patients. All peripheral lesions identified by computerized tomography were found at thoracoscopy and successfully resected with the Nd:YAG laser (n = 7), an endoscopic stapler (n = 10), or both (n = 4). The mean diameter of the lesions was 0.8 cm (range 0.2 to 1.5 cm). Histologic analysis revealed metastatic disease in 13 patients and benign disease in 2 patients. All resection margins were free of tumor. The mean duration of chest tube drainage and postoperative hospital stay were 1.8 +/- 0.1 and 3.3 +/- 0.1 days, respectively. Mean operative time was 111 min (range 45 to 155 min). One patient who underwent a right thoracoscopic resection developed a transient left vocal cord paresis. There were no other complications and no deaths. CONCLUSION: Thoracoscopy was successful in identifying peripheral lung lesions and allowed for parenchymal sparing resection identical in extent to that performed with open approaches. For select patients with peripheral lung nodules felt to be metastases, thoracoscopic resection may result in reduced morbidity, cost, hospital stay and allow for more rapid institution of therapy for the primary disease.

Adult↗
PubMed1996

A comparative study of thoracoscopic vs open removal of benign neurogenic mediastinal tumors.

STUDY OBJECTIVE: To assess the relative benefit of thoracoscopy vs open thoracotomy in the removal of benign neurogenic, mediastinal tumors (BNMTs). DESIGN: Retrospective comparative study of thoracoscopy and open thoracotomy. SETTING: Patients underwent surgery at the thoracic surgical services of two institutions from 1988 to 1994. Patients who underwent thoracoscopy were operated on more recently, 1992 to 1994. Patients who had thoracotomies underwent resection from 1988 to 1992. PATIENTS: All adult patients undergoing isolated removal of BNMTs at both institutions were included. Eleven patients underwent removal by posterolateral thoracotomy while six patients underwent thoracoscopic removal. INTERVENTIONS: BNMTs were removed by standard posterolateral thoracotomy or by three-hole thoracoscopic techniques with extension of incisions and conversion to an open procedure as necessary. MEASUREMENTS AND RESULTS: Larger tumors were more difficult to remove thoracoscopically. Two cases of transient postoperative ptosis were noted among the patients who underwent thoracoscopy. Operative time was longer in the thoracoscopy group (171 vs 112 min; p<0.05). Postoperative stay was significantly shorter (2.6 vs 4.5 days; p<0.02) and return to work tended to be more rapid (4.3 vs 7.7 weeks; p=0.13) among patients who underwent thoracoscopy. CONCLUSIONS: Thoracoscopic resection of BNMTs can be achieved safely and effectively with more rapid postoperative recovery when compared with an open thoracotomy approach to these mediastinal tumors.

Adult↗
PubMed1997

Thoracoscopic wedge resection of blebs under local anesthesia with sedation for treatment of a spontaneous pneumothorax.

We performed thoracoscopic wedge resections of blebs with a stapling device under local anesthesia with sedation in 34 consecutive patients who presented with spontaneous pneumothoraces. The indications for surgery included the absence of parietal pleural adhesions and knowledge of the precise bleb location prior to the procedure. Prior to surgery, 0.5% lidocaine was administered into the pleural space, and IV butorphanol tartrate and diazepam were administered to reduce pain and anxiety during the procedure. In our series, the thoracoscopic procedure resulted in favorable outcomes in all but two patients. There was no evidence of hemodynamic instability or arterial blood gas abnormalities encountered during the procedure. Minor postoperative complications were seen in only three patients (two with air leakage and one with transient atelectasis). One patient had a recurrence of his spontaneous pneumothorax 3 months following the procedure. Therefore, the overall success rate was 91%. We compared the results of this therapeutic modality (group 1) with those of 38 patients who underwent the procedure under general anesthesia (group 2) during the same period. The length of hospital stay was shorter in group 1 than in group 2 (4.5 +/- 1.3 vs 5.8 +/- 1.1 days; p < 0.01). Thoracoscopic wedge resections under local anesthesia are safe and offer the benefit of shorter hospital stays. We believe that this thoracoscopic technique will further simplify the surgical treatment of pneumothoraces without incremental risks.

Adolescent↗
PubMed2004

Effects of additional minocycline pleurodesis after thoracoscopic procedures for primary spontaneous pneumothorax.

STUDY OBJECTIVE: To evaluate the safety and efficacy of additional minocycline pleurodesis after thoracoscopic treatment of primary spontaneous pneumothorax. DESIGN: Retrospective comparative study with a historical control. SETTING: Thoracic surgical division of a university-affiliated tertiary medical center. PATIENTS AND METHODS: Between April 1994 and April 2001, 313 consecutive patients (minocycline group) with primary spontaneous pneumothorax were treated by video-assisted thoracoscopic surgery. The procedures included resection of the blebs and mechanical pleurodesis by scrubbing the parietal pleura. After operation, minocycline hydrochloride, 7 mg/kg, was instilled into the pleural space through a thoracostomy tube. The control group consisted of 51 consecutive patients who underwent the same thoracoscopic procedures alone for primary spontaneous pneumothorax between January 1992 and April 1994. RESULTS: There was no significant difference between the two groups in terms of demographic data, operative findings, and operation time. Chest pain was a common complaint after minocycline pleurodesis, but the total doses of requested analgesics were comparable in both groups. The rate of prolonged air leaks was significantly lower in the minocycline group (7.0% vs 17.6%, p = 0.025). Patients treated with minocycline had shorter periods of postoperative chest drainage and hospitalization. The ipsilateral recurrence rate was also significantly lower in these patients (2.9% vs 9.8%, p = 0.033). CONCLUSIONS: Minocycline pleurodesis is a safe and convenient procedure that may improve the outcome and reduce the rate of recurrence after thoracoscopic treatment for primary spontaneous pneumothorax. A randomized control study may be needed to confirm the findings.

Adolescent↗
PubMed2006

Video assisted thoracoscopic surgery at the Queen Elizabeth Hospital Barbados.

Video assisted thoracoscopic surgery (VATS) is now an established technique for diagnostic and therapeutic intervention in patients with thoracic pathology at the Queen Elizabeth Hospital (QEH). This article reviews the experience with 50 patients over the period May 1996 to February 2003, looking at various factors and outcomes in an attempt to ascertain the viability of this procedure at this institution. It serves as a follow-up article to the publication of the initial experience in 1999 (1). There were 24 males and 26 females included in the study. Video assisted thoracoscopic surgery was used for diagnosis in 27 cases (54%), therapeutic indication in 17 cases (34%) and as both a diagnostic and therapeutic modality in six cases (12%). In 92% of cases, the operations were completed thoracoscopically with a conversion rate of 8%. The morbidity and mortality rates were 18% and 2% respectively. Video assisted thoracoscopic surgery is an effective tool for the treatment and investigation of selected thoracic pathology at the QEH with complications and mortality rates comparable to other institutions (2, 3).

Adult↗
PubMed2004

Recombinant human bone morphogenetic protein-2 enhances anterior spinal fusion in a thoracoscopically instrumented animal model.

BACKGROUND: Thoracoscopically assisted anterior spinal arthrodesis and instrumentation is being used more widely to treat idiopathic scoliosis. However, harvesting autologous bone increases operative time and morbidity. The purpose of this study was to compare autologous iliac crest and rib graft with recombinant human bone morphogenetic protein-2 (rhBMP-2) in thoracoscopically assisted anterior spinal arthrodesis and instrumentation in an animal model. METHODS: Twenty-two pigs underwent thoracoscopically assisted anterior spinal arthrodesis. Each animal had five contiguous thoracic discectomies followed by anterior instrumentation. The animals were randomly assigned to five treatment groups. Group I consisted of control animals that received no graft material; group II, animals treated with autologous rib graft; group III, animals treated with autologous iliac crest graft; group IV, animals treated with an rhBMP-2-composite sponge (collagen-hydroxyapatite-tricalcium phosphate carrier); and group V, animals treated with a composite sponge carrier alone. The animals were killed four months after the procedure, and the spines were harvested. The fusion mass was assessed with use of axial and sagittal computed tomography scans. The spines were tested biomechanically with incremental loads applied in the frontal and axial planes to achieve bending moments of up to 6.0 N-m. Angular motion at each segment was recorded with use of a three-dimensional motion analysis system. Histomorphometric analysis of each undecalcified disc segment was also performed. RESULTS: The fusion grades, according to computed tomography analysis with use of a 4-point grading system in which scores of 3 and 4 indicated a solid fusion, were 0.6 point for group I, 2.1 points for group II, 2.3 points for group III, 3.8 points for group IV, and 0.4 point for group V. Group IV (the rhBMP-2-treated animals) had a higher grade than all of the other groups. Group II (rib graft) and group III (iliac crest) had similar grades, and both were greater than group I (the untreated controls) and group V (composite sponge alone) (p < 0.05). In axial rotation, lateral bending, and flexion-extension, the spines in group IV were stiffer than those in the four other groups (p < 0.05); the spines in groups II and III were similar, and the spines in both of those groups were stiffer than those in groups I and V (the control groups). Histologic analysis demonstrated that the total new-bone area, expressed as a percentage of the total disc space area, was 23.2% in group I, 37.1% in group II, 37.2% in group III, 48.5% in group IV, and 5.9% in group V. Group IV had significantly greater bone formation than all of the other groups (p < 0.001). The animals treated with rib graft (group II) and iliac crest (group III) had a similar amount of bone formation, and it was greater than that in both control groups (p < 0.001). CONCLUSIONS: The rhBMP-2 significantly increased the prevalence and quality of the spinal fusion after thoracoscopically assisted anterior arthrodesis and instrumentation in an animal model compared with that in the other treatment groups and in the controls.

Animals↗
PubMed2003

Thoracoscopic limited T-3 sympathicotomy for primary hyperhidrosis: prevention for compensatory hyperhidrosis.

OBJECT: Compensatory hyperhidrosis is a major and troublesome complication of thoracoscopic sympathectomy for primary hyperhidrosis. The incidence of compensatory hyperhidrosis has been reported to be as high as 50 to 97% in the patients who underwent sympathetic ganglia resection. In this study the authors evaluate the role of thoracoscopic T-3 sympathicotomy for primary hyperhidrosis and the prevention of compensatory hyperhidrosis. METHODS: Thoracoscopic T-3 sympathicotomy was performed in 27 patients with either isolated palmar hyperhidrosis (24 cases) or that in combination with axillary hyperhidrosis (three cases) during a 3-year period. In the cases of combined palmar/axillary hyperhidrosis, the T-4 sympathetic ganglion also was coagulated. The mean follow-up period was 19.7 months. Surgery-related results were determined on the basis of complications, compensatory hyperhidrosis, and patient-related satisfaction. In the immediate postoperative period all 24 patients with palmar hyperhidrosis reported complete alleviation of their symptoms. One patient with palmar/axillary hyperhidrosis in whom axillary hyperhidrosis did not completely resolve underwent a repeated T-4 sympathicotomy 1 month after the initial surgery. Another patient suffered mild compensatory hyperhidrosis of the trunk 1 month postoperatively. The long-term satisfaction rate in all 27 patients was high. One patient required placement of a chest tube to treat pneumothorax. Other complications such as Homer syndrome, intercostal neuralgia, gustatory hyperhidrosis, and pulmonary edema were not observed. CONCLUSIONS: Thoracoscopic limited T-3 sympathicotomy is an effective method to treat primary hyperhidrosis, its rate of compensatory hyperhidrosis is low, and its rate of long-term patient satisfaction is high.

Adolescent↗
PubMedDate not supplied

Recurrence after thoracoscopic surgery for spontaneous pneumothorax.

AIM: The purpose of this study was to examine the cause and risk of recurrence after thoracoscopic surgery for spontaneous pneumothorax. METHODS: A total of 204 patients under 60 years of age who underwent axillary thoracotomy and 139 patients who underwent thoracoscopic surgery were compared. In addition, among the patients who underwent thoracoscopic surgery, recurrent and non recurrent cases were reviewed and compared. RESULTS: Postoperative recurrence rate was significantly higher among the thoracoscopic surgery group. There were some significant differences between the recurrent and non recurrent cases in the Brinkman index, the duration from the onset of pneumothorax to the initial consultation, and the number of patients who had past history of pneumothorax. The recurrence rate was higher in patients with an air leak in the chest drainage tube before operation than in patients without an air leak. CONCLUSIONS: Appropriate training under supervision of experienced surgeons is necessary for minimizing complications and procedure failures. A history of heavy smoking or an air leak in the chest drainage tube before surgery may be an index of recurrence after surgery.

Adult↗
PubMed1999

[Changes in acid-base equilibrium, ventilation parameters and immunologic reactions in thoracoscopic operations].

In the thoracoscopic operations it is usually necessary to deflate completely the ipsilateral lung. The aim of this study was to determine changes of blood gases and alterations of immune response mediators during thoracoscopic surgery with one-lung ventilation OLV. In the study 38 patients were included undergoing thoracoscopic or video-assisted thoracic surgery. Arterial blood gases, respiratory parameters, heart rate, blood pressure were determined before one-lung ventilation, at the peak of operation and after finishing OLV. The circulatory cytokines IL-1 beta, IL-2, IL-6, IL-8, TNF-alpha, and reactive oxygen species (ROS) were measured before and after operation, 3 h, 24 h and 48 h after operation. The obtained variables were statistically evaluated. One-lung ventilation caused a significant increase of PaCO2 (from 4.69 +/- 0.67 to 5.91 +/- 0.87 kPa) which was accompanied by an adequate decrease of pH (7.455 +/- 0.033-7.368 +/- 0.037) and a number of patients developed respiratory acidosis (34%). There were no significant changes in levels of the investigated cytokines, only a mild increase of IL-6, IL-8 and TNF during first 24 h after operation was observed. The activity of ROS was highest at the end of the operation, but did not differ significantly from the start, but then decreased significantly for a period of 24 h. The authors conclude that the observed increase of carbon dioxide levels and decrease of pH had no impact on the fate of the patients. Thoracoscopic or VATS procedures were a minimal load for patients causing no significant changes of proinflammatory cytokines. The operations did not significantly elevate the activity of ROS.

Acid-Base Equilibrium↗
PubMed1999

[Thoracoscopic splanchnicectomy for intractable pancreatic pain].

Intractable pain is the most distressing symptom in nonresectable pancreatic carcinoma and in chronic pancreatitis. Recently, thoracoscopic splanchnicectomy has been advocated as a minimally invasive method of pain control in these patients. Between May 1995 and April 1998, 24 patients with nonresectable pancreatic cancer and 4 with chronic pancreatitis, underwent 43 thoracoscopic splanchnicectomies. All suffered from intractable pain, were opiate-dependent and unable to perform normal daily activities. Unilateral left splanchnicectomy was done in 13 and bilateral in 15. All procedures were completed thoracoscopically. Operative time ranged from 25 to 60 min and mean hospital stay was 3 days. Median pain intensity was reduced by 50% in 24 and no further narcotics or analgesics were required. We found thoracoscopic splanchnicectomy a safe and effective procedure for intractable pancreatic pain.

Adult↗
PubMed2001

[Fluoroscopy-assisted thoracoscopic surgery after computed tomography-guided bronchoscopic barium marking: a minimally invasive treatment for small peripheral early adenocarcinoma of the lung].

We developed a marking technique and subsequent thoracoscopic wedge resection as a diagnostic procedure for small peripheral lung nodule and a treatment for small peripheral early lung cancer. Fluoroscopy-assisted thoracoscopic surgery after computed tomography-guided bronchoscopic barium marking. Through CT-guided bronchoscopy, barium marking is done at just central to the target lesion. Thoracoscopic surgery is performed some days later. The barium marking was grasped in the forceps and resected by endostaplers under both intraoperative fluoroscopic and thoracoscopic guidance. All the lesions could be resected with enough surgical margin. This minimally invasive surgery is indicated for small peripheral in situ adenocarcinoma of the lung.

Adenocarcinoma↗
PubMed2002

Technical aids to performing thoracoscopic robotically-assisted internal mammary artery harvesting.

OBJECTIVE: This report outlines the procedures and technical aids used for performing thoracoscopic internal mammary artery (IMA) harvesting in a series of 308 patients. METHODS: As a part of atraumatic coronary artery bypass (ACAB) operations, thoracoscopic IMA harvests (294 left, 14 right, and 12 bilateral) were performed in 308 consecutive patients. Single-lung ventilation and carbon dioxide insufflation were employed in all cases to facilitate exposure and dissection. A voice-activated robotic arm controlled the camera view, and harvesting was accomplished with the electrocautery on a low setting. RESULTS: Harvest time decreased from a mean of 58.4 minutes in the first fifty procedures to 29.4 minutes in the last fifty procedures. There were no significant complications as a result of this technique, and no patients required a conversion to sternotomy as a result of IMA injury. CONCLUSIONS: Thoracoscopic internal mammary artery harvesting is an essential basic skill for cardiac surgeons interested in performing minimally invasive and atraumatic coronary bypass procedures. Thoracoscopic IMA harvesting can be successfully performed with the use of the technical aids and procedures outlined in this report.

Humans↗
PubMed2002

Radical thoracoscopic lobectomy with lymphadenectomy in a cadaver model.

OBJECTIVE: Because the standard thoracoscopic lobectomy in bronchial carcinoma is often criticized for assumed incomplete lymph-node dissection and oncologic radicality, thoracoscopic lymphadenectomy (TL) was investigated as one step of a scientific investigation for developing a method of complete thoracoscopic resection of bronchial carcinoma. DESIGN: A cadaver model (n = 13) was used to investigate the technique of thoracoscopic radical hilar lobectomy and mediastinal lymphadenectomy. INTERVENTION: TL followed by a large anterolateral exploratory thoracotomy to evaluate the safety and radicality of TL. RESULTS: The mean (and standard deviation) number of lymph nodes resected was 15.6 (4.3). On follow-up exploration, no residual tissue was found at the hilar stump or residual lymph nodes. No other intrathoracic lesions were found. CONCLUSIONS: TL with radical hilar and mediastinal lymphadenectomy by the described tehcnique can be accomplished according to current oncologic regulations.

Cadaver↗
PubMed1999

Thoracoscopic sympathectomy: indications and complications.

In 1942,Hughes performed the first thoracoscopic removal of sympathetic ganglia. Two years later Goetz and Marr reported on cases that had undergone thoracoscopic sympathectomy. In the 1950s, Kux performed more than 1,400 thoracoscopic sympathectomies and vagotomies. Interest in thoracoscopic sympathectomy increased in the 1980s and now it is the treatment of choice for severe axillary and palmar hyperhidrosis.

Journal Article↗