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PubMed1998

Video-assisted thoracoscopy for pleural disease.

Thoracoscopy has been a valuable modality for the diagnosis and treatment of pleural-based disease for almost 100 years. With the development of video technology and improved instrumentation, video-assisted thoracoscopy is the procedure of choice for effusions of unknown origin, pleural mass biopsy, and free-flowing empyema drainage when conventional techniques fail. Reported success rates have been very good for diagnosis and treatment of both benign and malignant disease, and the morbidity is low.

Adult↗
PubMed1998

Diagnostic thoracoscopy.

Thoracoscopy provides diagnosis of pleural diseases with a high degree of accuracy. Moreover, this procedure allows a careful pleural staging of the disease, in particular for pleural cancer, which is important for the prognosis and therapeutic decision. This article focuses on the technique, indications, and results of medical thoracoscopy.

Biopsy↗
PubMed1998

Therapeutic thoracoscopy.

Thoracoscopy provides a minimally invasive window to the pleural space, lung, and mediastinum. Further advances prompted by improvements of specifically designed endoscopic instruments and procedural techniques are expected. There is no doubt that thoracoscopy has a place among therapeutic procedures in the chest. The time-proven principles of thoracic surgical intervention, particularly in regard to patients with cancer, however, must not be neglected. A beckoning window always offers new opportunities, but the open door of classic surgical techniques should not be ignored.

Endoscopes↗
PubMed2001

[Value of thoracoscopy in purulent pleuresies in children younger than four years].

UNLABELLED: Video-assisted thoracoscopic surgery is widely performed in adults but there are few publications concerning the paediatric population. The objective is to effect optimal adhesiolysis of post-pneumonic loculated empyema with lower morbidity. PATIENTS AND METHODS: Over a 4-year period we used thoracoscopic debridement in five children younger than 4 years of age with loculated thoracic empyema. All patients failed initial treatment, including antibiotics and chest tube drainage. Early sonographic evaluation of the empyema organization guided the most appropriate moment for the intervention. The average duration of tube drainage after thoracoscopy was 4 days (range: 1 to 7 days). RESULTS: All patients made an uneventful postoperative recovery. At a follow-up visit 1 month after discharge, the children were clinically asymptomatic; however, some degree of pleural thickening was still visible on chest X-rays. CONCLUSION: In skilled hands, thoracoscopy is a safe procedure for post-pneumonic empyema in young children, providing a rapid clinical and radiological recovery with a good cosmetic result.

Age Factors↗
PubMed1994

Anesthetic and Physiological Changes During Laparoscopy and Thoracoscopy: The Surgeon's View.

Although physiological changes during laparoscopy and thoracoscopy generally are similar to those seen during standard open procedures, these minimally invasive techniques are accompanied by some unique changes. General, regional, and local anesthesia during laparoscopy and thoracoscopy, and potential complications, are discussed. The physiological responses that are discussed include hemodynamic effects, acid-base and pulmonary effects, and hormonal effects.

Journal Article↗
PubMed1996

Thoracoscopy for Management of Lung Disease (Including Emphysema).

Thoracic applications for thoracoscopy or video-assisted thoracic surgery (VATS) remain many. Wedge resection for lung nodules and lung biopsy remains the most frequently performed VATS procedure. Thoracoscopy has been very valuable as a diagnostic technique for undiagnosed lung nodules and infiltrates. Using VATS for therapeutic resection of metastatic nodules remains controversial with potential adverse consequences. Recently there has been a great deal of interest and enthusiasm for VATS techniques in emphysematous patients. Surgical procedures such as resection of apical blebs and bullae have become standard. However, VATS volume reduction is aimed at a different segment of the emphysema population. The theoretic and potential surgical role in emphysema is discussed. VATS offers decreased pain and shortened hospital stays for many disorders and as such remains a valuable tool for the surgeon.

Journal Article↗
PubMed1999

Successful monitoring of neurogenic mixed evoked potentials elicited by anterior spinal cord stimulation through thoracoscopy during spine surgery.

STUDY DESIGN: Neurogenic mixed evoked potentials were recorded after thoracoscopic spinal cord stimulation in patients undergoing video-assisted spine surgery. OBJECTIVE: To demonstrate the feasibility and value of thoracoscopic spinal cord monitoring. SUMMARY OF BACKGROUND DATA: Video-assisted thoracic surgery recently has been proposed as a new technique for thoracic spine surgery. It can be used for anterior spinal release of patients with severe spinal deformities and for thoracic hernia removal. METHODS: Five patients undergoing video-assisted thoracic surgery for spinal fusion were studied. Neurogenic mixed evoked potentials were elicited by electrodes seated into intervertebral discs through thoracoscopy and recorded from peripheral nerves of the lower limbs. Moreover, the study included the case of a patient with a thoracic hernia who underwent video-assisted thoracic surgery with combined thoracoscopic neurogenic mixed evoked potential and standard somatosensory evoked potential monitoring. RESULTS: Neurogenic mixed evoked potentials were recorded consistently after spinal cord stimulation in all patients. For the patient with a thoracic hernia, neurogenic mixed evoked potentials suddenly disappeared, whereas somatosensory evoked potentials were not significantly modified, leading to surgery interruption. Neurogenic mixed evoked potentials progressively reappeared after a 30-minute delay. Postoperation examination revealed a Brown-Sequard's syndrome with incomplete right motor deficit. CONCLUSIONS: Neurogenic mixed evoked potentials evoked by anterior stimulation through thoracoscopy are of interest for spinal cord monitoring when posterior electrical stimulation is impossible, and they provide reliable information regarding spinal motor pathways.

Adolescent↗
PubMed2000

Thoracoscopy and talc poudrage in the management of hepatic hydrothorax.

STUDY OBJECTIVE: To determine indications, limitations, morbidity and mortality of surgical thoracoscopy for management of hepatic hydrothorax, a rare, but often recurrent, complication in cirrhotic patients. PATIENTS AND METHODS: From May 1985 through May 1999, 10 men and 8 women, with a mean age of 57.6 years (range, 26 to 76 years), underwent 21 therapeutic thoracoscopies to achieve pleurodesis by application of talc. RESULTS: The procedure was effective in 10 of 21 procedures. There were four recurrences (19. 1%) that were retreated, with only one being successful. In this specific group, we detected high morbidity (57.1%) and mortality (38.9%) during the follow-up period of 3 months. Diaphragmatic defects were localized and closed five times (23.8%). Hospital stay was approximately 15 days (range, 5 to 41 days). CONCLUSION: The procedure appears to be indicated for these fragile patients, especially when medical therapy fails. Immediate efficacy was 47.6%, increasing to 60% with videothoracoscopy and suture of the diaphragmatic defect. However, morbidity and mortality were high.

Adult↗
PubMed1999

[Surgical video-thoracoscopy].

Surgical video thoracoscopy represents a new surgical approach to thoracic disease. Its objective is to limit thoracotomy trauma to the pleural wall and at the same time to eliminate the consequences of post-thoracotomy pain and post-operative respiratory dysfunction. There are certain indications which are already accepted as the gold standard, others still require validation and the inverse that certain interventions will probably be excluded from the domain of video thoracoscopy with acquired experience. The best indications are: the treatment of spontaneous pneumothorax in a young person, lung biopsy, the excision of peripheral parenchymal nodules of uncertain aetiology, the diagnostic approach to mediastinal adenopathy notably nodes which are inferiorly situated and inaccessible to mediastinoscopy or anterior mediastinotomy, the debridement of purulent pleurisy and/or haemothorax, the initial exploration before thoracotomy of a pulmonary tumour accompanied by a pleural effusion which may be minimal or irregularities of the parietal pleura, a thoracic sympathectomy, pleural symphysis for pleural tumour pathology, the pleuropericardial fenestration in cases of double pathology, pleural and pericardial requiring both a diagnostic approach and symphysis.

Humans↗
PubMed2002

[Video-assisted thoracoscopy (VATS) during the last ten years (1992-2001)].

We summarize and analyse the video-assisted thoracoscopies (VATS) performed in our department during the last ten years. In this period 296 patients underwent VATS for diagnosis or therapy. We describe indications, advantages and disadvantages, we also analyse the complications. Video-assisted thoracoscopy is less demanding to the patients than thoracotomy, it reduces the length and cost of inpatient treatment. We recommend extensive use of VATS in suitable patients.

Female↗
PubMed2004

Minimally invasive surgical implantation of left ventricular epicardial leads for ventricular resynchronization using video-assisted thoracoscopy.

BACKGROUND AND OBJECTIVES: Cardiac resynchronization via left ventricular or biventricular pacing is an option for selected patients with ventricular systolic dysfunction and widened QRS complex. Stimulation through a coronary vein is the technique of choice for left ventricular pacing, but this approach results in a failure rate of approximately 8%. We describe our initial experience with minimally invasive surgical implantation of left ventricular epicardial leads using video-assisted thoracoscopy. PATIENTS AND METHOD: A total of 14 patients with congestive heart failure, NYHA functional class 3.2 (0.6) and mean ejection fraction 22.9 (6.8)% were included in this study. Left bundle branch block, QRS complex >140 ms and abnormal septal motion were observed in all cases. Epicardial leads were implanted on the left ventricular free wall under general anesthesia using video-assisted thoracoscopic surgery. RESULTS: Lead implantation was successful in 13 patients. Conversion to a small thoracotomy was necessary in one patient. All patients were extubated in the operating room. None of the patients died during their hospital stay. Follow-up showed reversal of ventricular asynchrony and significant improvement in ejection fraction and functional class. CONCLUSIONS: Minimally invasive surgery for ventricular resynchronization using video-assisted thoracoscopy in selected patients is a safe procedure that makes it possible to choose the best site for lead implantation and provides adequate short- and medium-term stimulation.

Adult↗
PubMed2004

[Pulmonary dirofilariasis resected by video-assisted thoracoscopy; report of a case].

A 35-year-old female was admitted for biopsy of abnormal shadow on chest X-ray. She was operated on for partial wedge resection of the right lower lobe by video-assisted thoracoscopy without complication. Pathological findings in operation showed inflammatory benign tissues and suggested pulmonary dirofilariasis. Serologic examination was negative after operation, however histological diagnosis supported pulmonary dirofilariasis because a pulmonary artery embolism of calcified tissues consisted of non-human cells. There may be many cases due to old infections like this one, so it is important to consider it for diagnosis and perform more positive surgical procedures. We review a case of pulmonary dirofilariasis safely resected by video-assisted thoracoscopy for diagnosis by exclusion.

Adult↗
PubMed2005

[Esophagectomy combined with radical lymphadenectomy by video-thoracoscopy].

OBJECTIVE: To explore the value of video-thoracoscopy in the thoracoscopic mobilization of the thoracic esophagus combined with radical lymphadenectomy. METHODS: Between March 2002 and May 2003, thoracoscopic mobilization of the thoracic esophagus combined with radical lymphadenectomy was attempted in 25 patients (test group) and 22 cases received routine open thoracotomy (control group). Mean age was 55 years (range 34 - 73). The cancers were T(1)-T(3). Dissection of the thoracic esophagus was attempted via a right-sided approach, followed by a laparotomy and a cervical incision. RESULTS: The thoracoscopic procedure was successful in all patients. There was no post-operative death in two groups. Mean node harvest was (7.8 +/- 1.7) nodes for test group and (7.5 +/- 1.3) nodes for control group (P > 0.05). Mean blood lo of the thoracic component was (130 +/- 83) ml for test group and (350 +/- 135) ml for control group (t = 6.83, P < 0.05). Median post-operative stay was (10.9 +/- 2.5) days for test group and (14.6 +/- 1.7) days for control group (t = 5.87, P < 0.05). CONCLUSION: Video-thoracoscopy could potentially provide an oncologically sound means for resecting the thoracic esophagus without the need for a thoracotomy. Radical thoracoscopic mobilization of the esophagus is feasible.

Adult↗
PubMed2005

The utility and timing of surgical intervention for parapneumonic empyema in the era of video-assisted thoracoscopy.

Empyema, a pyogenic or suppurative infection of the pleural space, continues to cause significant morbidity and mortality in patients with pneumonia. The advent of video-assisted thoracoscopy has placed the treatment algorithm of empyema in flux. We retrospectively reviewed all patients who underwent surgical treatment for parapneumonic empyema from January 1, 1999, through December 31, 2003. Data collected included demographic information, preoperative CT scanning/ thoracostomy tube placement, morbidity/mortality, days from admission to surgery, and postoperative length of stay. We compared patients undergoing video-assisted thoracoscopy to those requiring conversion to open thoracotomy and those who had initial open thoracotomy. Morbidity and mortality rates were similar among all groups. Conversion rate to open thoracotomy was 21 per cent. We found patients operated on within 11 days of admission had a shorter postoperative length of stay with similar morbidity and mortality. Our data supports early aggressive surgery treatment for parapneumonic empyema.

Adult↗
PubMed1989

[Thoracoscopy using flexible fiberoptic bronchoscopy--a preliminary report of experimental and clinical studies].

The preliminary experience on thoracoscopy with fiberoptic bronchoscope through a trocar designed by the authors for the purpose of studying its diagnostic implication and safety was reported. Structures in the pleural cavity of 8 dogs, being examined for 16 times, could be clearly perceived and taken for biopsy with exact localization. This technique was also carried out in 5 patients suffering from pleural effusion, mediastinal mass and periphery lung disease of unknown cause. After the examination, diagnosis was made as mesothelioma in 2 cases and non-specific pleurisy, malignant lung tumor with mediastinal lymphatic node metastasis and pulmonary benign tumor in the remaining 3 cases respectively. It was observed that its respiratory and circulatory effects were negligible as there were only transient fever in all the cases and local subcutaneous emphysema in one case with prompt recovery without treatment. Thoracoscopy is a technique easy to operate, safe, less traumatic and gives accurate diagnosis in clinical practice.

Adult↗
PubMed1979

[Thoracoscopy in chronic pleural effusion (author's transl)].

123 patients with chronic pleurisy were investigated by thoracoscopy. The endoscopic biopsy is positive in 16 out of 17 cases of mesothelioma (96%), in 57 out of 72 cases of pleural metastasis (79%), and in 6 cases out of 7 pleural tuberculosis. Begnin pleural asbestosis was confirmed in 5. Endoscopic biopsy is thus more efficient than results obtained with pleural needle biopsy and exudative cytology. Thoracoscopy can be performed without any serious complications, this is not always true with open thoracotomy.

Anesthesia, General↗
PubMed1998

[Rheumatoid nodule diagnosed by thoracoscopy using flexible fiberoptic bronchoscope].

A 51-year-old man had been treated at a nearby hospital since 1993 for rheumatoid arthritis. Right pectoralgia developed in December 1994, and the patient consulted a nearby hospital, which detected right pleural effusion retention was pointed out on chest x-ray films. The patient was referred and admitted to our hospital. Rheumatic pleurisy was suspected because of a high serum rheumatoid factor(RF)level and high RF and high rheumatoid arthritis hemagglutination levels in the pleural effusion. However, due to a high adenosine deaminase level in the pleural effusion tuberculous pleurisy could not be ruled out. After drainage through a trocar catheter, the thoracic cavity was examined by thoracoscopy through the site of catheter insertion. As a result, sporadic bluish white nodular lesions were observed on the pleura. Granuloma formations presenting a palisade arrangement of giant cells were also observed, and pathologically diagnosed as rheumatoid nodules, thus providing the basis for a diagnosis of rheumatic pleurisy. Treatment with an increased dose of prednisolone achieved a rapid remission of the pleural effusion. Our experience underscored the usefulness of thoracoscopy as a means diagnosing of rheumatic pleurisy.

Anti-Inflammatory Agents↗
PubMed2003

Thoracoscopy: a new era for surgical anatomy.

In this new era of minimal access surgery, advances in optics and illumination have established thoracoscopic sympathectomy as a pre-eminent procedure, including a safe and efficient technique for upper limb sympathectomy. The success of thoracoscopy will doubtless ensure that a greater number of these procedures will be carried out and will put some of the daunting technical challenges posed by traditional open surgical procedures to rest. The thoracoscopic era affords the surgical anatomist a new challenge: to move the teaching of living anatomy to a higher level.

Anatomy↗