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PubMed1989

Spontaneous pneumothorax and fibrin glue sealant during thoracoscopy.

The prophylactic treatment of the application of fibrin glue to the pulmonary surface during thoracoscopy in idiopathic spontaneous pneumothorax resulted in rapid and total pulmonary expansion in 33 of 35 patients. The 2 failures were due to apical cysts larger than 2 cm. The successfully treated patients were hospitalized for a median of 4 days (range 2-12). No complications were observed. All regained full working capacity within 1 month of discharge. Post-treatment X-ray examination of the chest was uniformly normal. During an observation time ranging from 7-24 months (median 12 months), 3 recurrences (9%) were seen at 7, 12, and 16 months, respectively. The treatment seems (1) to reduce the need for thoracotomy (2) to be associated with a high success rate, short and long-term, (3) to minimize the duration of hospital stay and (4) not to disturb the normal pleuro-pulmonary anatomy.

Administration, Inhalation↗
PubMed2004

Thoracoscopy using a substernal handport for palpation.

BACKGROUND: A substernal handport allows palpation of the lung and thus circumvents one of the major limitations of thoracoscopy. METHODS: This approach has been used in 24 consecutive patients, primarily during planned metastasectomy or when palpation was needed for deeper or smaller lesions that were difficult to find. RESULTS: No long-term complications from this procedure were noted, and the 3 early complications were either minor or unrelated to the procedure. This approach allowed adequate resection to be accomplished by a less invasive approach in 67% of patients, although conversion to an open procedure was necessary in 33% of patients for anatomic and technical reasons. Among the 16 patients who underwent this procedure alone, the median length of stay in the hospital was 3 days. The rate of incomplete resection and of recurrence after metastasectomy was comparable to that for an open approach. CONCLUSIONS: Our experience documents that a substernal handport is safe, does not compromise the ability to perform an adequate metastasectomy, and allows biopsy of lesions that are otherwise not amenable to a minimally invasive approach. This technique should be included in the standard armamentarium of approaches for thoracic surgery.

Adult↗
PubMed2006

Resection of neurogenic tumors in children: is thoracoscopy superior to thoracotomy?

BACKGROUND: Minimally invasive resection of solid tumors is controversial because of concerns of inadequate resection and local recurrence. Thoracoscopy has been used in the diagnosis of mediastinal tumors in children, but its role in resection is unproved. The purpose of this study was to compare thoracoscopic and open approaches to the resection of thoracic neurogenic tumors in children. STUDY DESIGN: The tumor registry of a regional children's hospital was queried to identify patients who underwent resection of neurogenic tumors over a 6-year period. Thoracoscopic and open groups were compared for demographic, operative, oncologic, and outcomes characteristics. RESULTS: Seventeen children underwent resection of mediastinal neurogenic tumors (10 thoracoscopic resections, 7 open resections). Mean age was 4.7 years (range 6 months to 12 years). The thoracoscopic and open groups showed no difference in operative time or blood loss. Tumors in the two groups were comparable in size (5.2+/-2.2 cm versus 5.7+/-2.6 cm), histology, surgical margin, and stage. Hospital stay was shorter after thoracoscopic resection (1.9+/-0.7 days versus 4.1+/-2.5 days, p<0.05). There were no regional recurrences. Distant metastases developed in one patient in each group. Eight of 10 children with malignant tumors remain disease-free at an average of 25 months of followup (range 3 to 80 months). CONCLUSIONS: Thoracoscopic resection of neurogenic tumors achieved similar local control and disease-free survival when compared with open resection in this preliminary series. These results were accompanied by a shorter hospital stay. These findings suggest that thoracoscopic resection of neurogenic tumors in children may offer advantages to open resection and should be studied in the context of a large, cooperative trial.

Child↗
PubMed2004

Single-port thoracoscopy for the treatment of pleural empyema in children.

BACKGROUND/PURPOSE: This report is an evaluation of a single-port technique for the thoracoscopic treatment of pleural empyema in children. METHODS: Ten consecutive patients with pleural empyema were treated by means of a "Single Port Thoracoscopy" (SPOT). Mean age was 6.9 years (range, 2 to 13 years). The surgery was performed 5 to 26 days after the onset of symptoms. Three patients received this treatment as the first procedure, whereas the other 7 underwent closed placement of a chest tube, 3 to 12 days before the surgery. Only 1 11.5-mm thoracoport was used. Through this single port, standard scopes and instruments were introduced simultaneously to debride and unify the pleural space. RESULTS: Satisfactory debridement of the pleural cavity was achieved in all cases. Mean operating time was 70 minutes (range, 60 to 140). There were no intraoperative complications. The chest tube was removed 2 to 5 days after the surgery. Eight patients remained afebrile from the day of the surgery, and 2 had mild fever that disappeared 36 hours after the surgery. Mean hospital stay after SPOT was 4 days (range, 3 to 7). CONCLUSIONS: SPOT is a safe and effective proceeding for the treatment of pleural empyema in children with the advantage of better cosmetic results than the multiport techniques.

Adolescent↗
PubMed2005

Extrapleural, submuscular bars placed by bilateral thoracoscopy--a new improvement in modified Nuss funnel chest repair.

BACKGROUND: Thoracoscopic Nuss funnel chest repair still has a significant complication rate. Bar dislocation, pneumothorax, pleural effusions, and pericarditis seem to be caused mechanical irritation by the bar. We intended to reduce these problems by further technical modification of the Nuss technique. METHODS: Of 157 prospectively followed modified Nuss repairs, the last 57 patients had the bars placed in an extrapleural position and fixed by 10 to 14 pericostal sutures under bilateral thoracoscopy. RESULTS: Entirely, extrapleural bar position was feasible in 53 of 57 patients. Four patients had minor holes over one of the bars, predominantly on the left side of the thorax. Pleural effusions, pneumothorax, and pain were greatly reduced, so that we discontinued the so far routine use of bilateral pleural drainages. CONCLUSIONS: Extrapleural bar position is feasible in more than 90% of modified Nuss repairs. It reduces pleural secretion and pain, and seems to reduce pneumothorax, pulmonary bar adhesions, and pericardial effusions. The technique is easy and safe, and reduced the incidence of most complications in this early experience of 57 adolescent patients, although no sportive restrictions were imposed at all.

Adolescent↗
PubMed1985

The management of empyema thoracis by thoracoscopy and irrigation.

A technique of irrigation for the management of empyema is described. Initial thoracoscopy under general anesthesia enabled full debridement and division of loculi within the empyema cavity under direct vision. Irrigation with two tubes was instituted until three consecutive cultures of irrigation fluid became sterile; then the chest drains were removed. The results in 12 patients are presented. Using this method, irrigation was required for an average of 14 days and chest drains were removed after an average of 20 days. Patients remained in the hospital for an average of 4.8 weeks. Tuberculous empyema was not found to be a contraindication to the irrigation technique.

Adult↗
PubMed1976

Direct diagnostic thoracoscopy.

Direct diagnostic thoracoscopy under general anesthesia using the mediastinoscope or bronchoscope has been done in 40 patients. No deaths or serious morbidity occurred. We recommend the use of this technique when other efforts fail to establish a diagnosis in patients with pleural disease.

Aged↗
PubMed1997

Early evacuation of traumatic retained hemothoraces using thoracoscopy: a prospective, randomized trial.

BACKGROUND: Failure to adequately evacuate blood from the pleural space after trauma may result in extended hospitalization and complications such as empyema. METHODS: Patients with retained hemothoraces were prospectively randomized to either a second tube thoracostomy (group 1, n = 24) or video-assisted thoracoscopy (VATS) (group 2, n = 15). Group 1 patients in whom additional tube drainage failed were subsequently randomized to either VATS or thoracotomy. Study end points included duration and costs of hospitalization. RESULTS: During a 4-year period, 39 patients were entered into the study. Patients in group 2 had shorter duration of tube drainage (2.53 +/- 1.36 versus 4.50 +/- 2.83 days, mean +/- standard deviation; p < 0.02), shorter hospital stay after the procedure (3.60 +/- 1.64 versus 7.21 +/- 5.30 days; p < 0.02), and shorter total hospital stay (5.40 +/- 2.16 versus 8.13 +/- 4.62 days; p < 0.02). Hospital costs were also less in this group ($7,689 +/- 3,278 versus $13,273 +/- 8,158; p < 0.02). There was no mortality in either group. No group 2 patient required conversion to thoracotomy. In 10 group 1 patients additional tube placement failed, and this subset was randomized to VATS (n = 5) or thoracotomy (n = 5). No significant difference in clinical outcome was found between these subgroups. CONCLUSIONS: In many patients treated only with additional tube drainage (group 1), this therapy fails, necessitating further intervention. Intent to treat with early VATS for retained hemothoraces decreases the duration of tube drainage, the length of hospital stay, and hospital cost. Early intervention with VATS may be a more efficient and economical strategy for managing retained hemothoraces after trauma.

Adolescent↗
PubMed1998

Axillary thoracoscopy.

Thoracoscopy can be done safely and effectively through working ports placed in the axilla in patients whose pathology is in the upper half of the thorax. We have used this technique successfully in 37 patients with no complications. Advantages include superior cosmesis, optimal access to the apex of the chest, and, if necessary, easy conversion to axillary thoracotomy.

Adolescent↗
PubMed2003

Development of a canine model of pulmonary emphysema and imaging of the emphysematous lung with infrared thoracoscopy.

BACKGROUND: The surgeon must use the results of preoperative computed tomography findings and scintigraphic studies to make a subjective decision during lung volume reduction surgery with regard to the best incision line. OBJECTIVES: Our purpose was to develop an objective and real-time method of detecting areas of pulmonary emphysema by using infrared thoracoscopy. METHODS: Pulmonary emphysema was developed in various lobes of the lung in the dog by injecting porcine pancreatic elastase through the bronchi. One month after the injection, chest computed tomography and lung biopsy were performed. Infrared thoracoscopic study was then performed to reveal the presence of the emphysematous lung tissue. Simultaneously, indocyanine green was injected intravenously, and the time taken for each type of lung tissue to stain blue was measured. RESULTS: Chest computed tomography and histologic examinations revealed pulmonary emphysema-like areas in the porcine pancreatic elastase-injected lung. The computed tomography numbers of the porcine pancreatic elastase-injected lung tissue, normal lung tissue, and the tracheal lumen were -868.8 +/- 18.6, -752.2 +/- 32.5, and -1013 +/- 27.1, respectively. There were significant differences between the porcine pancreatic elastase-injected lung and the normal lung (P <.0001). The time for staining to begin was 10.7 +/- 4.8 seconds for normal lung tissue and 25.8 +/- 9.4 seconds for the emphysematous tissue; the onset of staining emphysematous lung tissue was significantly delayed (P =.003). CONCLUSIONS: We developed a successful canine model of pulmonary emphysema by injecting porcine pancreatic elastase. Infrared thoracoscopic examination revealed that the staining of emphysematous lung using indocyanine green injection was significantly greater than of normal lung.

Animals↗
PubMed1997

Thoracoscopy in acquired immunodeficiency syndrome.

OBJECTIVE: The role of thoracic surgery in patients with acquired immunodeficiency syndrome (AIDS) continues to evolve. This review seeks to evaluate the outcome, morbidity, and mortality associated with video-assisted thoracoscopic surgery for empyema and pneumothorax in patients with AIDS. METHODS: A retrospective review was conducted of patients with AIDS in whom video-assisted thoracoscopic surgery was performed for empyema (group 1) or intractable pneumothorax (group 2). RESULTS: Twenty patients with AIDS (95% male, mean age 37.4 years, mean CD4 count 76 cells/ml3) underwent thoracoscopy. Surgery was performed for empyema (group 1) in 11 (55%) and intractable pneumothorax (group 2) in nine (45%). Three patients (15%) died within 30 days of the operation. At mean follow-up (29 months), overall survival was 55%. For those who survived the hospitalization and died within the follow-up period (35.3%), mean survival time was 8.2 months (range 1 month to 27 months). In group 1, surgical procedures were performed after 8 days of chest tube drainage and included pleural debridement and mechanical pleurodesis (n = 11) along with lung biopsy (n = 6). Survivals at 30 days and 29 months' follow-up were 90.9% and 45.4%, respectively. In group 2, significantly depressed CD4 counts (average 33.2 cells/ml3) were noted along with a more prolonged preoperative hospitalization (18.5 days) with 14.2 days spent with a chest tube before the operation. In this group, operative procedures included mechanical pleurodesis and talc poudrage (n = 9), bleb resection (n = 7), and lung biopsy (n = 1). Two deaths (22%) occurred within 30 days of the operation and survival at 29 months' follow-up was 66%. CONCLUSION: Video-assisted thoracoscopic surgery performed in patients with AIDS for the treatment of empyema and intractable pneumothorax is effective, can be performed with little operative morbidity and mortality, and is associated with acceptable long-term survival. Video-assisted thoracoscopic surgery is best performed soon after the diagnosis of intractable pneumothorax or empyema has been established.

AIDS-Related Opportunistic Infections↗
PubMed1999

Video-assisted thoracoscopy.

New therapeutic modalities for disorders of the pediatric spine must include video-assisted thoracoscopy. The endoscopic approach to the spine has involved an evolutionary approach. What began as an isolated drainage of a vertebral abscess was continued as a method of single discectomy; release of the annulus fibrosis with or without ligation of segmental vessels; rib resection for costoplasty; rib harvesting for intervertebral fusion; and most recently, insertion of correctional implants and fusion.

Adolescent↗
PubMed1987

Diagnostic and therapeutic uses of pleuroscopy (thoracoscopy) in lung cancer.

Pleuroscopy (thoracoscopy) is a simple procedure to perform that has both diagnostic and therapeutic utility. With a diagnostic accuracy of 90 per cent, it should be readily performed by surgeons who treat patients with lung cancer. A well-performed pleuroscopy may spare many patients the morbidity of an unnecessary thoracotomy.

Aged↗
PubMedDate not supplied

[An assessment of the resectability of lung cancer by exploratory video thoracoscopy].

We describe our experience using exploratory video-assisted thoracoscopy (EVT) to definitively evaluate resectability in patients with lung cancer who are candidates for surgical resection. In a single procedure we performed full visual and surgical exploration of the pleural cavity, lung, mediastinum, as well as of the pericardial cavity when required. The technique was used in 151 patients. Resection was judged non viable in 18 (11.9%) and performance of exploratory thoracotomy was deemed unnecessary. In 3 cases thoracotomy proved necessary for exploration. Nineteen patients were treated by video-assisted surgery; standard thoracotomy was used to resect 111. Morbidity and mortality were null in the group undergoing EVT in whom resection was judged viable. We conclude that EVT should be used in all patients with lung cancer who are being considered for surgery before a thoracotomy is performed. EVT can be performed as part of the same surgical act, as it supposes a savings in exploratory thoracotomies (amounting to 11.9% in our series).

Adult↗
PubMed2000

Thoracoscopy in horses.

With the recent development of video-assisted thoracic surgery, visual inspection of the thoracic cavity has been used to provide a more accurate diagnosis and prognosis of thoracic diseases and to better manage these diseases. Equipment, techniques, and complications for standing thoracoscopy in horses are described.

Animals↗
PubMed2001

Anesthesia for thoracoscopy.

Thoracoscopy has become a widely used method of achieving minimally invasive thoracic surgery. The anesthesiologist providing perioperative care for VATS is challenged to evaluate the patient carefully; to design a safe anesthetic regimen, taking into account preexisting disorders; to ameliorate physiologic alterations associated with one-lung ventilation and CO2 insufflation; and to provide safe, effective perioperative anesthesia and postoperative pain control.

Anesthesia↗
PubMed2001

Complications of thoracoscopy.

Thoracoscopy is a minimally invasive thoracic surgical technique that is gaining widespread use for several surgical procedures. Although the complication rate is relatively low, there are definable risks associated with the technique. Careful attention to patient selection and an understanding of the complications associated with one-lung ventilation and video-assisted surgical techniques can help one to anticipate and prevent complications.

Contraindications↗
PubMed1995

Prevention of tumour seeding following thoracoscopy in mesothelioma by prophylactic radiotherapy.

To determine the usefulness of prophylactic radiotherapy following thoracoscopy or pleural aspiration in patients with mesothelioma we reviewed the case notes of patients treated at St Mary's Hospital between 1990 and 1994. Twenty patients have received treatment to 38 sites and tumour seeding was prevented in all patients available for follow-up. Four patients acted as their own controls by developing nodules at untreated sites. Prophylactic radiotherapy is highly effective in preventing tumour seeding in mesothelioma.

Humans↗