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PubMed1987

[Prospective comparison of the diagnostic value of cytology and immunocytology in pleural effusion studied by thoracoscopy and biopsy].

Two issues have been elaborated: the value of immunocytochemistry in the diagnosis of pleural effusions, and the reactivity of the investigated antibodies with different classes of cells in pleural effusions. Effusions of unknown origin from 38 patients were investigated using thoracoscopy, pleural biopsies, conventional cytology, and immunocytochemistry. The following antibodies were used: those monoclonal against various leukocyte antigens, macrophage antigens, epithelial membrane antigen (EMA), various cytoskeleton antigens, and melanoma antigens; those polyclonal against CEA and ferritin. All of the techniques used showed 18 patients (48%) as having a tumor-cell negative effusion. A pleural tumor with a malignant effusion showed in 13 patients (34%); in 12 of these immunocytochemistry also revealed tumor cells. Seven patients (18%) had a tumor of the pleura with a tumor-cell negative effusion; in 2 of these immunocytochemistry revealed a tumor-cell positive effusion. There was no difference with regard to the number of NK cells in patients with inflammation of the pleura and negative cytology and patients with tumor of the pleura and malignant effusion (3% vs 4.5%). Tumor cells were mainly stained by EMA, cytokeratin, and CEA. CEA was the only antibody to be tumor-cell specific, while EMA and cytokeratin were expressed by mesothelial cells also. The antibody against ferritin was a significant marker for mesothelial cells.

Antibodies, Monoclonal↗
PubMed1999

Two-stage operation for endobronchial lipoma and lung cancer using bronchoscopy and thoracoscopy in an elderly patient with chronic obstructive pulmonary disease.

We present an 82-year-old man with chronic obstructive pulmonary disease with endobronchial lipoma, obstructing the right lower lobe bronchus, and lung adenocarcinoma in the peripheral lung of the right upper lobe (clinically T1N0M0). The endobronchial lipoma was thus first removed by bronchoscopic snaring forceps and laser therapy, resulting in an improvement of the pulmonary function. One month later, the lung adenocarcinoma was removed using thoracoscopy. The postoperative course was satisfactory, and the patient is now doing well without any tumor recurrence 11 months after surgery. For elderly chronic obstructive pulmonary disease patients with endobronchial lipoma and T1N0M0 lung cancer, a two-stage operation, consisting of bronchoscopic resection followed by a thoracoscopic resection for lung cancer, was found to be a safe and effective method of treatment while maintaining sufficient pulmonary function.

Adenocarcinoma↗
PubMed2002

Thoracoscopy versus thoracotomy: a prospective comparison of trauma and quality of life.

BACKGROUND: Reliable comparisons of thoracoscopy (TCC) and anterolateral thoracotomy (ATT) with regard to trauma and post-operative quality of life are rare. This study was conducted to quantify the results of TCC, which was expected to show an advantage. METHODS: Using a matched-pair design (matching criteria: comparable intracavitary procedure, benign/malignant disease and sex), 22 patients were compared who underwent either TCC or ATT (Wilcoxon matched-pairs signed-ranks test, P<0.05). RESULTS: Incision and operation time were shorter for TCC (TCC 5.3 vs ATT 23.7 cm, P=0.003; TCC 64 vs ATT 87 min, P=0.029). Differences in favor of TCC were detected for interleukin 6 (IL6) (TCC 17.2 vs ATT 105.6 pg/ml, P=0.036) in the immediate postoperative period, C-reactive protein (CRP) (TCC 28.2 vs ATT 86.6 mg/l; P=0.010) on the day 1 after the operation, forced vital capacity (FVC) (TCC 2.5 vs ATT 1.5 l, P=0.0173), elevation of the arm (EA) (TCC 143 vs ATT 109; P=0,026), pain on coughing (CP) (TCC 2.5 vs ATT 6.9 patients; P=0.009) and Spitzer Index (SI) (TCC 9.2 vs ATT 7,1 patients; P=0.009), as well as CP (TCC 1.4 vs ATT 4.4 patients; P=0,005) on day 4 after the operation. Forced expiratory volume in the first second, pain, creatin kinase, blood glucose and neopterin showed no differences. CONCLUSIONS: In terms of surgical trauma and quality of life ICC is superior to ATT in the immediate postoperative period. With the exception of pain and coughing, there were no differences after postoperative day 4.

Female↗
PubMed2004

Optimizing the surgical management of lung nodules in children with osteosarcoma: thoracoscopy for biopsies, thoracotomy for resections.

BACKGROUND: The goal of this study was to assess the role of thoracoscopy (TS) and thoracotomy (TT) in the management of lung nodules in children with osteosarcoma. METHODS: Charts of 16 osteosarcoma patients undergoing surgery for lung nodules were retrospectively analyzed for a correlation between nodule localization at CT scan, findings at surgery, and pathology. RESULTS: Fourteen TSs were performed in 10 children, eight of which were converted: two for technical problems, and six for inconsistency between CT scan and intraoperative findings. In three converted cases, TT allowed detection of more nodules than CT scan and/or TS. Eight TTs were performed as primary intention in seven children, in one as secondary surgery after a previous TS. In three cases, TT detected more nodules than CT scan. Overall, TT detected more nodules than CT scan in seven of 16 cases (sensitivity, 56.2%), six of whom had a predicted bilateral involvement. Neoplastic tissue was present in lung samples of all but three patients (86.4%). CONCLUSIONS: Lung nodules in osteosarcoma patients are usually metastases. CT scan is unreliable in detecting all the nodules, especially in the case of predicted bilateral involvement. If excision of all metastases is considered the goal of surgery, a TT approach should be chosen in patients with more than one thoracic nodule.

Adolescent↗
PubMed2006

Analysis of hard thoracic herniated discs: review of 18 cases operated by thoracoscopy.

The authors retrospectively reviewed a series of 18 hard thoracic herniated discs (HTHD) operated by thoracoscopy. Isolated cases of HTHD have been reported in the literature, but no series describing these lesions has been published. Seventy-two percent of the herniated discs were situated between T8 and T12. Fifty-six percent of the patients had radiographic sequelae of Scheuermann's disease. Postoperatively, 83% had neurological improvement. In seven cases (39%), a plane separating the herniated disc and the dura mater was found surgically. In 11 patients, no separating plane was found during surgery. The lesion was intradural in three patients (17%) and adherent to the dura mater in eight (44%). Among these 11 patients, surgery was complicated by a dural tear in the first seven that led to a high risk of cerebrospinal fluid fistula: four of these seven patients had required surgical revision. In the last four, the zone of adhesion of the HTHD to the dura mater was preserved, successfully preventing dural tear.

Adult↗
PubMed2006

Complete extirpation of a bronchogenic cyst causing recurrent laryngeal nerve palsy by thoracoscopy: report of a case.

We excised a bronchogenic cyst causing recurrent laryngeal nerve palsy using thoracoscopic surgery. A 28-year-old woman presented after the sudden onset of hoarseness, and laryngoscopic examination showed left vocal cord palsy. Computed tomography and magnetic resonance imaging showed a cystic mass, 4 cm in diameter, in the aortopulmonary window. Thoracoscopic examination revealed that the mass was adhered to the recurrent laryngeal nerve below the aortic arch. We extirpated the cyst via thoracoscopy without any injury to the nerves or major blood vessels. This case illustrates the benefits of thoracoscopic surgery for providing good visualization of the perineural structures and as a safe surgical treatment for a cystic mass in the aortopulmonary window.

Adult↗
PubMed1989

Nd:YAG laser pleurodesis through thoracoscopy: new curative therapy in spontaneous pneumothorax.

From January 1986 to May 1987, 14 patients with spontaneous pneumothorax were treated in our department with a new endoscopic method using neodymium:yttrium-aluminum-garnet laser photocoagulation through thoracoscopy. The 10 male and 4 female patients ranged in age from 14 to 59 years (mean age, 29 years). In all patients, the procedure was performed under general anesthesia. The thoracoscope was introduced through a 1- to 1.5-cm incision in the anterior axillary line of the fourth intercostal space. The fiber of the laser was advanced through the operative channel of the thoracoscope. In all patients, the bleb (or blebs) detected in the apex of the upper lobe was successfully coagulated with low-power laser pulses. Then the parietal pleura of the first five ribs was partially scarified to achieve pleurodesis. There were no side effects. Thirteen patients were successfully treated without recurrence (maximum follow-up, 29 months). We conclude that this new therapy can play an important role in select patients with spontaneous pneumothorax.

Adult↗
PubMed1990

Thoracoscopy and talc poudrage for pneumothoraces and effusions.

The indications, technique, and results of thoracoscopic talc poudrage in the two clinical settings of pneumothorax and recurrent pleural effusion in chronically ill patients are reported. Forty patients underwent this treatment between May 1982 and September 1989. The patients ranged in age from 10 months to 78 years. Of the 20 patients who underwent treatment of pneumothorax, 9 had cystic fibrosis, 7 had severe chronic obstructive pulmonary disease, 2 had spontaneous pneumothoraces, and 2 had postoperative parenchymal bronchopleural fistulas. Nineteen patients (95%) had successful treatment. Of the 20 patients who underwent treatment of chronic effusions, 14 had malignant etiologies, 3 had chylothoraces, and 3 had other miscellaneous effusions. Eighteen patients (90%) in this group had successful treatment. There were two hospital deaths related to the underlying disease processes after the pleural space problems were successfully treated. This study suggests that proper selection of patients and full exploitation of the capabilities of thoracoscopy and talc poudrage will result in effective treatment with low morbidity and mortality.

Cystic Fibrosis↗
PubMed1991

Thoracoscopy in the diagnosis and management of recurrent pleural effusions.

Between April 1984 and July 1988, 102 patients with persistent or recurrent pleural effusions investigated by conventional methods in whom a diagnosis had not been achieved were submitted to thoracoscopy under general anesthesia. A positive diagnosis was obtained in 80.3% of the patients. The procedure was well tolerated, and although some of these were seriously ill patients, there were no procedure-related deaths.

Anesthesia, General↗
PubMed1993

Diagnostic thoracoscopy for pleural disease.

The most common use for diagnostic thoracoscopy in pleural disease is to clarify whether or not an effusion is malignant. General anesthesia with single-lung ventilation when combined with new endoscopic instrumentation produces a high diagnostic yield. These anesthetic and surgical techniques when used with talc pleurodesis yield a 90% success rate in treating benign and malignant pleural effusions.

Anesthesia, General↗
PubMed1993

Video thoracoscopy for masses of the posterior mediastinum.

Video thoracoscopy has evolved rapidly over the last 2 years. Improvements in technique and instrumentation allow for the diagnosis and treatment of diverse posterior mediastinal masses including neurogenic tumors, esophageal leiomyomata, paravertebral abscesses, and bronchogenic cysts.

Humans↗
PubMed1993

Video-assisted thoracoscopy and the staging of lung cancer.

Video-assisted thoracoscopy (VAT) provides an opportunity for evaluation and biopsy within the pleural space and at the pulmonary hilum. The application of a standardized approach for VAT in patients with primary lung cancers was evaluated. Of 49 patients, 6 patients could not be evaluated due to intrapleural adhesions. Of the remaining 43 patients, an unsuspected parietal pleural metastasis was identified in 2, obviating further surgery. The other 41 patients underwent anatomic resection after VAT staging, which was carried out during the same operative procedure. Pathologic staging of the specimens revealed 20 T1 N0, 10 T2 N0, 5 T1 N1, and 6 T2 N1 lesions. Among the T2 lesions, 10 of 16 (63%) involved visceral pleural invasion, all of which were identified at VAT staging. Among the N1 lesions, 6 of 11 (55%) were identified at VAT staging; in the remainder, N1 nodes were not accessible to biopsy. No morbidity or mortality was noted. Routine VAT staging in patients with lung cancer is a safe technique, reduces the need for an exploratory thoracotomy, and may identify patients with localized lung cancers who are at high risk for postoperative recurrence.

Humans↗
PubMed1993

Thoracoscopy training in a residency program.

Video-assisted thoracoscopy (VAT) is rapidly gaining application in a variety of thoracic surgical procedures. As a result, fellowship programs in thoracic surgery need to provide training in VAT techniques. Instruction should include emphasis on aspects of the open procedures, including the anatomic relationships as seen through an open thoracotomy and on cross-sectional imaging techniques. Standardization of the indications for VAT, as well as emphasis on the basic principles of visualization and operative manipulation, will serve to reinforce the advantages and limitations inherent to VAT. An initial exposure to VAT in a nonclinical context, including didactic instruction in the instrumentation and skills, review of videotapes, and animate or inanimate laboratory instruction, provides a controlled setting for learning the fundamentals. Interactive assistance with clinical VAT procedures should be encouraged once the basic principles are learned. Ultimately, guidelines and qualifications for performing VAT procedures should be incorporated into the requirements for thoracic surgical training programs.

Fellowships and Scholarships↗
PubMed1993

Effects of insufflation on hemodynamics during thoracoscopy.

Thoracic procedures once requiring open thoracotomy are now being performed with video-assisted thoracoscopy. To visualize adequately the intrathoracic structures, creation of an artificial pneumothorax by carbon dioxide insufflation under positive pressures has been advocated. We hypothesized that positive-pressure insufflation during thorascopy would cause significant hemodynamic compromise. Eight healthy female pigs underwent general endotracheal anesthesia and placement of monitoring lines. After placement of a thorascope, baseline hemodynamic measurements were obtained at 0 mm Hg (atmospheric pressure). Measurements were taken randomly at 5, 10, and 15 mm Hg using carbon dioxide insufflation after stabilization at each pressure. Data were analyzed using Page's test for noparametric variables. Insufflation pressures of 5 mm Hg or greater resulted in significant decreases in cardiac index, mean arterial pressure, stroke volume, and left ventricular stroke work index, whereas central venous pressure increased (p < 0.001). Changes in heart rate were not significant. We do not recommend routine positive-pressure insufflation during thorascopy because of the significant hemodynamic compromise in our experimental model.

Animals↗
PubMed1995

The role of thoracoscopy in the diagnosis of interstitial lung disease.

A study was undertaken to evaluate the safety and efficacy of thoracoscopic lung biopsy for interstitial lung disease. The relation between operative findings, pathologic findings, and preoperative computed tomographic scan findings was examined. Twenty-six patients, 10 male and 16 female, underwent thoracoscopic lung resection to diagnose interstitial lung disease. Sixteen patients were outpatients for an elective procedure; 10 were inpatients including 2 who were ventilator dependent. The mean length of operation was 54 minutes and the mean length of chest tube duration, 1.3 days. There were no deaths. Staphylococcal pneumonia developed in 1 patient postoperatively. One patient with systemic pulmonary hypertension was ventilator dependent for 48 hours. A double-lumen endotracheal tube was used in all but 2 patients. Twelve-millimeter trocar ports were used to allow easy interchange of staplers and endoscopic instruments. Biopsy of at least two lobes was performed in each patient with resection of a piece of grossly abnormal lung. A single chest tube was left routinely. The pathologic diagnosis was usual interstitial pneumonitis in 7 patients. Four patients had interstitial fibrosis and 4, granulomas. Three patients had diffuse alveolar damage and 3, Wegener's granulomatosis. Two patients had bronchiolitis obliterans with organizing pneumonia. One patient each had lymphangioleiomyomatosis, eosinophilic granuloma, and cytomegalovirus. Sixteen patients underwent preoperative computed tomographic scanning. The scans were assessed by 2 radiologists who were blinded to the surgical results. Computed tomography accurately predicted the site of disease in most instances. Four patients had at least one lobe with no evidence of disease on computed tomography but with interstitial lung disease found thoracoscopy.(ABSTRACT TRUNCATED AT 250 WORDS)

Biopsy↗
PubMed1994

Comparative merits of thoracoscopy, mediastinoscopy, and mediastinotomy for mediastinal biopsy.

Between April 1992 and April 1993, we performed fifty-four mediastinal biopsies in 51 patients with a mediastinal mass. Nine of these had lung cancer with mediastinal lymphadenopathy, and the remaining 42 had various primary mediastinal lesions. We have performed twenty video-assisted thoracic surgical procedure, twenty-six mediastinoscopies, and eight anterior mediastinotomies. In 3 patients the diagnosis was not obtained by mediastinoscopy, and video-assisted thoracoscopy was performed. We conclude that mediastinoscopy is indicated for the majority of lesions involving the peritracheal space. Restaging of lymphoma and highly infiltrative lesions are better managed by video-assisted thoracic surgery. Anterior mediastinotomy is indicated when feasible under local anesthesia for tumors infiltrating the anterior chest wall. In all other cases video-assisted thoracic surgery is preferable because it allows removal of large tissue biopsy specimens and even resection with wide surgical exposure and low operative trauma.

Adolescent↗
PubMed1976

Thoracoscopy for diagnosis of intrathoracic lesions in children.

Disenchantment with available techniques for specific diagnosis of intrathoracic pulmonary lesions in children has led us to explore the usefulness of thoracoscopy. We have performed this technique in nine patients ranging in age from 17 mo to 16 yr. The procedure is performed under intravenous anesthesia with the patient spontaneously breathing oxygen. A fiberoptic rod lens system is employed for the direct observation and biopsy of pulmonary parenchymal or chest wall lesions. Adequate tissue has been obtained in each case to allow a specific diagnosis. There has been no mortality from this procedure and only minor morbidity. We believe that this technique offers a rapid and simple method for the diagnosis of diffuse or localized disease of pulmonary parenchyma or chest wall in children.

Adolescent↗
PubMed1995

Thoracoscopy in the management of pediatric empyema.

The surgical management of empyema consists of (1) aggressive therapy with thoracotomy and decortication or (2) conservative treatment with chest tube drainage and intravenous antibiotics. Recently, Kern and Rodgers introduced thoracoscopic debridement as an adjunct to the management of children with empyema, with promising results. Hence, the authors report their experience with thoracoscopy in the management of pediatric patients with empyema. In the last years, 10 children have undergone thoracoscopic debridement (TD) for empyema. The average age was 6.9 years (range, 2 to 16). Children underwent TD an average of 14 days (range, 8 to 16) after initial presentation and 4 days (range, 2 to 6) after admission to the authors' hospital. Indications for TD were persistent requirement of supplemental oxygen and failure of conservative medical management that consisted of antibiotics and tube thoracostomy. Three children had positive pleural fluid cultures for Streptococcus pneumoniae. In all cases, preoperative ultrasound or chest computed tomography examination showed dense pleural fluid with septation. During surgery, TD allowed for lung expansion and precise chest tube placement in all patients except one who required conversion to minithoracotomy and decortication for persistent encasement with a thick pleural peel. There were no postoperative complications related to the procedure. After TD, all children had prompt clinical improvement. The patients were weaned from supplemental oxygen by postoperative day 2, and following early chest tube removal, nine children were discharged home by postoperative day 7 (range, 3 to 10). One child required further hospitalization for underlying renal failure. In the authors' hands, TD was effective in producing prompt clinical improvement in children with empyema.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗