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PubMed1993

[Thoracoscopic surgery of the lung and pleura].

134 operations were performed using video-thoracoscopic techniques for patients, with diffuse lung disease (48), pneumothorax (46), peripheral coin lesions (29) und others (11). In 92% of the patients video-thoracoscopic operation was completed. Open reoperation was indicated only in patients with persistent pneumothorax (3). After hospital discharge open reoperation was performed once for recurrent pneumothorax. From our experience we conclude, that thoracoscopic surgery may be routinely indicated in future for lung biopsies, pneumothorax, peripheral coin lesions and pleural products.

Adult↗
PubMed1993

[Thoracoscopic lobectomy in the animal model].

To evaluate the possibility of a pure thoracoscopic lobectomy by preparation and selective division of hilar structures we performed left cranial lobectomies in 5 Göttingen mini-pigs. The vessels and the main bronchus were isolated and divided by an Endo-GIA stapler. As an alternative technique we used clips or endoscopic ligation. Inside the thoracic cavity the resected lobes were divided into 2 or 3 parts by the Endo-GIA. They could be extracted without destroying the tissue therefore making macroscopic examination possible. The intraoperative blood loss was minimal and all the pigs survived the operation. Two pigs were sacrificed initially, the remaining three one month later. These three showed no evidence of pleural fistula or atelectasis in remaining lung tissue either macroscopically or histologically. It appears that thoracoscopic selective lobectomy is technically possible at least in pig studies. Further studies will show whether thoracoscopic lobectomy in patient with malignancy is as effective as open radical thoracotomy techniques and if endoscopic mediastinal division is possible.

Animals↗
PubMed1996

Value of intraoperative intrathoracic ultrasonography during video-assisted thoracoscopic pulmonary resection.

Recent advances in endoscopic surgical equipment, video monitoring, and endoscopic surgical techniques have expanded the application of thoracoscopic surgery to pulmonary resection. One of the major limitations of this technique is the difficulty in identifying invisible pulmonary nodules in which manual palpation is not possible. To resolve this problem, we employed intraoperative intrathoracic ultrasonography during video-assisted thoracoscopic pulmonary resection. We conclude that intraoperative ultrasonography during thoracoscopic pulmonary resection is useful to identify pulmonary nodules, except inflammatory lesions.

Adult↗
PubMed1996

Video-assisted thoracoscopic surgery (VATS): preliminary experience in Ratchaburi Hospital.

Thoracoscopy is used as an adjunct to traditional diagnostic thoracoscopy. Because of advances in endoscopic surgical equipment and anesthetic technology, surgical treatment via thoracoscopic is now possible. Between June and November 1995, seven male and two female patients underwent thoracoscopic procedures under general anesthesia with a double-lumen endotracheal tube in Ratchaburi Hospital. The procedures for diagnostic purposes included 2 diffuse lung diseases, 1 pleural metastatic disease; and the procedures for therapeutic purposes included 1 case of massive pleural effusion, 2 of clot haemothorax, 2 empyema thoracis, and 1 solitary pulmonary nodule. The thoracoscopic procedures included 2 lung biopsies, 1 pleural biopsy, 2 decortication with removal of blood clots and 2 decortication of empyema, and 1 pulmonary wedge resection. There was no mortality associated with VATS. We believe that the patients have benefited from VATS in reducing post-operative pain, rapid recovery, and decreased scarring of the chest wall. VATS is a minimally invasive surgical technique causing a low morbidity rate and attaining a high diagnostic accuracy.

Adolescent↗
PubMedDate not supplied

Thoracoscopic surgery for lung cancer complicated by emphysema in elderly patients. Report of three cases.

We have experienced three elderly cases who underwent thoracoscopic surgery for lung cancer complicated by emphysema. Cases 1, 2 and 3, respectively aged 76, 78 and 80 years, had required the oxygen therapy preoperatively. Allowing for poor pulmonary reserve, a thoracoscopic partial pulmonary resection for lung cancer combined with Nd-YAG laser pneumoplasty for emphysema was designed. The respective values of forced expiratory volume in one second (FEV 1.0) for cases 1 and 2 increased from 470 and 820 to 860 and 1620 ml. Reductions in residual volumes (RV) for cases 1, 2 and 3 were from 2770, 4940 and 5230 to 2370, 4500 and 3250 ml. The degrees of respiratory failure in the Hugh-Jones classification for cases 1, 2 and 3 were up-graded from V, IV and IV, respectively, to III, II and II, postoperatively. In conclusion, our thoracoscopic treatment, designed for elderly patients with poor pulmonary reserve, allows improvement of emphysema as well as resection of lung cancer.

Aged↗
PubMed1997

Thoracoscopic thoracic splanchnicectomy for chronic pancreatitis with intractable abdominal pain.

The therapeutic advantages of a thoracoscopic thoracic splanchnicectomy (TTS) to relieve the pain of chronic pancreatitis patients was evaluated. The TTS procedure (four bilateral and five unilateral TTS), was performed on nine patients from April 1993 to October 1995. Based on radiographic images, the pancreatic duct of seven cases were diagnosed as being "nondilated" (<3 mm), whereas two cases were "dilated" (> or = 3 mm). A 5-mm thoracoscope was introduced through the fifth intercostal space on the anterior axillary line, and an additional two cannulas were introduced under direct thoracoscopic vision. The sympathetic chain, at a level from Th 5 to 9, was then resected and electrocoagulated. We performed a unilateral TTS corresponding to the symptomatic side; however, if pain relief was insufficient, an additional sympathectomy was done on the other side. The early postoperative course was uneventful, and immediate pain-relief was normally possible after TTS except for three patients who demonstrated minor intercostal neuralgia at the site of the trocars inserted for TTS. Six of nine patients were able to return to their preoperative work of lifestyle at a maximum follow-up of 24 months (the median and mean durations were 15.0 and 13.7 months, respectively). In addition, no postoperative deterioration of either the endocrine or exocrine function of the pancreas was observed. In conclusion, TTS proved to be a safe and reliable procedure for the pain relief of the chronic pancreatitis.

Abdominal Pain↗
PubMed1998

[Thoracoscopic diagnosis and therapy of lung metastases].

INTRODUCTION: The purpose of this study was to evaluate the impact of thoracoscopy on staging and therapy of peripheral pulmonary nodules in patients with a cancer history. PATIENTS AND METHODS: Videothoracoscopy (VATS) was performed in patients presenting peripheral pulmonary nodules (< 3cm) in CT-scan. 65 patients (63%) presented less than 3 nodules and 39 patients (37%) had multiple lesions in the lungs. History revealed a primary gastro-intestinal cancer in 35 patients (34%), a sarcoma in 26 patients (25%), breast cancer in 13 patients (13%) and miscellaneous primary cancer in 22 patients (21%). VATS was performed under general anesthesia using a standard equipment (Olympus). Double lumen endotracheal intubation was carried out. Thoracoscopic pulmonary resection was accomplished with endoscopic stapler (Autosuture Multi-Fire Endo GIA 30). The specimens were removed in a retrieval bag and a tube was inserted into the thoracic cavity. RESULTS: In 24 patients (23%) conversion to thoracotomy was performed, because of adhesions (n = 12), technical reasons (n = 8), no tumor detectable (n = 4). Thoracoscopic wedge resection for coin lesions was performed in 61 of the 80 patients (76%). Three patients underwent decortication and in 16 patients biopsy was sufficient for therapeutical considerations. Additional informations in comparison to conventional diagnostic were found in 39 patients (49%). The treatment regimen altered in 32 patients (40%). CONCLUSIONS: In this study VATS proved to be a sensitive technique for staging of pulmonary coin lesions. Additional informations were achieved in 49% and therapeutic strategy was changed in 40% of the patients due to the distant spread of malignancy or detection of benign lesions obtained by thoracoscopic staging.

Adult↗
PubMed1996

Animal model for thoracoscopic laser ablation of emphysematous pulmonary bullae.

BACKGROUND AND OBJECTIVE: Thoracoscopic laser techniques have been described for treatment of pulmonary bullae. Clinical application of this procedure has proliferated despite limited data regarding efficacy or optimal techniques. The objective of this study was to develop an animal model for investigating laser treatment of bullous lung disease. STUDY DESIGN/MATERIALS AND METHODS: Sixty-two New Zealand White rabbits (3-5 kg) were injected intravenously with 0.35 cc sterile-filtered Sephadex G-100 beads (1 g/100 cc suspension). Three hours later, rabbits were anesthetized, intubated, and 10 cc 0.7% heat-treated or 1% untreated carrageenan solution was instilled endotracheally into a catheter wedged in a mainstem bronchus. RESULTS: Bullae formed over 4-6 weeks in 33% of the animals treated with 0.7% heat-treated carrageenan, and 90% of animals receiving 1% untreated carrageenan (P < 0.005) as demonstrated by serial thoracoscopy. Thoracoscopy was performed at 6-8 weeks using 5 mm trocars under general anesthesia and mechanical ventilatory support. Animals developed pulmonary bullae ranging in size from 0.5 to 2 cm. Bullae were ablated under thoracoscopic visualization using a CO2 laser with a 4 mm OD rigid probe and short focal length in a defocused mode, or an Nd:YAG laser with a 0.4 mm diameter flexible fiberoptic probe. Animals recovered quickly following thoracoscopy. CONCLUSION: We have successfully developed an animal model for thoracoscopic laser ablation of emphysematous pulmonary bullae. This animal model should be useful in investigating treatment of bullous lung disease in humans.

Animals↗
PubMed1996

Advantages of limited thoracoscopic sympathectomy.

BACKGROUND: Thoracoscopic resection of the first through the fourth thoracic sympathetic ganglion for palmary and axillary hyperhidrosis and Raynaud's syndrome is associated with a high initial success rate. However, the reported incidence of compensatory hyperhidrosis of the trunk and legs and Horner's syndrome are high. This study assesses the results of thoracoscopic sympathectomy limited to transection of the interganglionic trunk or resection of one or two thoracic ganglia. METHODS: Twenty-eight thoracoscopic sympathectomies were done for dystrophy of the hand (n = 9), palmar and axillary hyperhidrosis (n = 6), and Raynaud's syndrome (n = 4). The extent of sympathectomy varied from interganglionic division between the second and third ganglion (n = 12), to resection of the third ganglion (n = 12), to resection of the second and third ganglion (n = 4). RESULTS: Sympathectomy resulted initially in relief of symptoms in all cases. Horner's syndrome did not occur. CONCLUSIONS: After a median follow-up of 11 months, two of nine patients with dystrophy judged the result of operation as good. All patients with hyperhidrosis and Raynaud's syndrome judged the result of sympathectomy as good. Compensatory hyperhidrosis was experienced by two patients with dystrophy of the hand who had removal of the second and third sympathetic ganglion.

Adolescent↗
PubMed1995

Thoracoscopic repair of thoracic spine trauma.

Modern concepts of treating thoracic and lumbar spinal trauma are based on posterior transpedicular fixation techniques which confer angular stability and instrument only a few levels of the spine. In addition, to prevent secondary losses in postoperative reduction of kyphotic deformities, transpedicular resection of torn discs, and inter- and intracorporeal bone grafting are included in the repair procedures for the entire damaged motion segment. However, due to the small size of the pedicles, a transpedicular approach to the injured vertebral body is not possible in the upper thoracic spine. Patients whose thoracic spine trauma is not serious enough to require ventral instrumentation through open thoracotomy, but who present with an unstable vertebral fracture, may profit from additional ventral bone grafting to stabilize the fracture. The present study examined the feasibility of thoracoscopic ventral bone grafting in seven patients with unstable fractures of the upper thoracic spine. For primary repair, we stabilized the fracture by using posterior transpedicular screw systems (rods or plates). Simultaneously, spongiosa was harvested from the posterior iliac crest and deepfrozen. Repair was completed a few days later via a ventral thoracoscopic approach. The main location of the ventral osseous defect was identified by intraoperative radiology. After mechanical removal of destroyed connective tissue and disc material, fusion was performed using the previously harvested spongiosa, which was placed into the intervertebral disc space and the anterior osseous defect. Our results show thoracoscopic bone grafting to be technically possible and associated with low morbidity, with a potential of yielding satisfactory long-term results.

Adult↗
PubMed1994

Video thoracoscopic excision of an intercostal neurilemoma presenting as a lateral chest wall tumor.

Thoracoscopic surgery has expanded with advances in endoscopic surgical instrumentation. We report on a 21-year-old woman with a complete thoracoscopic resection of an intercostal neurilemoma, which occurred extrapleurally in the ninth intercostal space of the lateral thoracic wall. The tumor was 70 x 40 x 25 mm in size, but a thoracotomy with a rib resection was avoided. The patient had an uncomplicated postoperative course and was discharged on the fourth postoperative day. Thoracoscopic resection of an intercostal neurilemoma, presenting as a lateral chest wall tumor, may be a safe and useful approach with an improved cosmetic result.

Adult↗
PubMed1995

Needle-localized thoracoscopic resection of indeterminate pulmonary nodules: impact on management of patients with malignant disease.

BACKGROUND: The efficacy and therapeutic impact of needle-localized thoracoscopic resection (NLTR) was examined in patients with cancer who present with small indeterminate pulmonary nodules (IPNs). METHODS: Between December 1991 and August 1992, 30 patients underwent needle localization of 33 IPNs under computed tomography (CT) guidance followed by thoracoscopic resection. All previous attempts to characterize these small pulmonary nodules (mean size 7.9 +/- 4.9 mm) had failed. Twenty patients had an established diagnosis of cancer 1 month to 20 years before detection of the lung abnormality, whereas the remaining patients had no prior history of cancer. RESULTS: Histology of NLTR specimens in patients with a previous diagnosis of malignancy included 13 malignant and seven benign lesions. In all patients with cancer, therapeutic decisions were influenced by NLTR results. Thoracoscopic related complications were noted in two patients. Average length of hospital stay for NLTR was 6.7 +/- 3.9 days. CONCLUSION: NLTR in this series has proven to be a safe, well-tolerated, and accurate method for diagnosing and influencing the management of recently identified IPN. NLTR appears warranted for small pulmonary nodules not amenable to less invasive diagnostic modalities.

Adult↗
PubMed1998

Benign fibrous mesothelioma successfully treated by thoracoscope-assisted surgery: report of a case.

We report herein the case of an 84-year-old man in whom a benign fibrous mesothelioma (BFM) was successfully treated by thoracoscope-assisted surgery. In September 1996, the patient underwent a sigmoidectomy for colon cancer, soon after which a followup examination disclosed a coin lesion on his chest X-ray film. The patient was readmitted to our hospital in November 1996 for further investigation of this tumor. A chest computed tomography scan revealed a 3.5 x 3.0 cm homogeneous tumor arising from the pleura. A needle biopsy was performed under ultrasonographic guidance, and the specimen was histopathologically diagnosed as a BFM. In view of his poor respiratory function, the tumor was excised by thoracoscope-assisted surgery. This case report serves to demonstrate the benefits of thoracoscope-assisted surgery for such patients.

Aged↗
PubMed2002

Thoracoscopic right upper mediastinal dissection for left lung cancer.

OBJECTIVE: In left lung cancer, left and right mediastinum lymphatic spread occur equally frequently. We evaluated the safety and effectiveness of thoracoscopic right upper mediastinal dissection, implemented prior to left lung resection for left lung cancer. METHODS: Between January 1999 and May 2000, 17 patients with left lung cancer underwent thoracoscopic right upper mediastinal dissection prior to resection of the left lung and left mediastinal dissection for left lung cancer. These patients had either enlarged left hilar or bilateral mediastinal nodes, or either a tumor at least 3 cm in diameter or tumor extension to the hilum, mediastinum, or chest wall. Tumor and lymph nodes were examined with hematoxylin and eosin and immunohistochemical staining of cytokeratin for micrometastasis. RESULTS: In 3 patients (17.6%), metastasis occurred in right paratracheal nodes. The 30-day mortality was 0% and morbidity 35.3% (6/17). Postoperative complications occurred in 3 of 4 patients (75%) undergoing induction chemotherapy, but none were lethal. CONCLUSION: Thoracoscopic right upper mediastinal dissection is safe and feasible in treating advanced left lung cancer.

Aged↗
PubMed2001

Life-threatening pneumothorax of the ventilated lung during thoracoscopic pleurectomy.

PURPOSE: To report the case of a patient who underwent right thoracoscopic pleurectomy with lung exclusion and developed contralateral (left) pneumothorax with resulting life-threatening alteration of the respiratory and cardiovascular functions. CLINICAL FEATURES: A 28-yr-old male was admitted to the intensive care unit for a well tolerated, second episode of spontaneous right pneumothorax and scheduled for right thoracoscopic pleurectomy. Anesthesia was induced and maintained with sufentanil and propofol. A double lumen endotracheal tube (ETT) was inserted, its correct positioning checked clinically and by fiberoptic bronchoscopy and the patient was placed in the left decubitus position. Approximately one hour into the procedure, during the second period of right pulmonary exclusion, SpO2 values decreased within two minutes to 78%. End tidal capnography (EtCO2) values decreased to 6-8 mmHg within seconds and peak airway pressure increased to values between 50 and 60 cm H2O. Severe cyanosis, sinus bradycardia and arterial hypotension developed. The surgical procedure was stopped, propofol administration discontinued, bipulmonary ventilation reinstituted and the patient placed in the supine position which restored hemodynamic and respiratory function. Inspection and auscultation were consistent with tension left pneumothorax which was evacuated. CONCLUSION: Pneumothorax of the ventilated lung during one lung ventilation for thoracoscopic procedures must be diagnosed quickly. Reinstitution of bipulmonary ventilation should probably be the first therapeutic attitude.

Adult↗
PubMed2002

Evaluation of inflammatory-response-induced thoracoscopic surgical stress.

OBJECTIVE: Due to the paucity of reports evaluating stress induced by thoracoscopic surgery with minithoracotomy, we assessed this stress based on the inflammatory response to surgery. METHODS: Differences in pre- and postoperative peripheral white blood cell (WBC) count, serum C-reactive protein (CRP), and serum interleukin-6 (IL-6) were evaluated, defined as dW, dCRP, and dIL-6. Thoracoscopic partial lung resection cases were divided into 2 groups by access route: Group A patients in which surgery was concluded via several small access ports. and Group B patients going surgery via small access ports plus minithoracotomy. We also compared dW in standard lobectomy with exploratory thoracotomy (thoracotomy without lobectomy) cases. RESULTS: No significant difference was seen in dW, dCRP, or dIL-6 between groups. dW in response to exploratory thoracotomy was lower than that in standard lobectomy (p = 0.06). CONCLUSIONS: Surgical stress induced by thoracoscopic partial lung resection does not increase significantly when minithoracotomy is added. Postoperative inflammatory response may, however, be influenced by the extent of surgical trauma.

C-Reactive Protein↗
PubMed1998

Experience with thoracoscopic surgery for primary bronchial stump fistula after pneumonectomy.

UNLABELLED: After a left pneumonectomy, thoracoscopic closure with fibrin glue was performed for a fistula on the bronchial stump and the postoperative state progressed favorably thereafter. In this paper, we report on this successful case. CASE: A 61 year-old male, who underwent a left pneumonectomy on January 17, 1996 for pulmonary carcinoma (T 3 N 1M 0 stage III A). The bronchial stump was covered with anterior serratus muscle flap. On April 1 (the 76th postoperative day), after two courses of Carboplatin and Vindesine treatment, the patient suddenly developed a fistula on the bronchial stump. Bronchofiberscopic closure with fibrin glue was attempted, but failed to close the fistula. Thoracoscopic surgery was then performed on May 15 (the 45th day after the onset of the fistula). After the intrathoracic opening of the fistula was found with a contrast medium, fibrin glue was injected to fill up to the bronchial stump, and communication with the thoracic cavity was blocked. Owing to coverage with a myocutaneous flap, the patient's general postoperative state remained relatively stable. Thoracoscopic surgery is useful as a treatment for some cases of bronchial stump fistula after pneumonectomy.

Bronchial Fistula↗
PubMed1998

[A case of both lung giant bullae treated by thoracoscopic bilateral resection].

We experienced a case of multiple bilateral giant bullae of the lungs and treated by thoracoscopic bilateral resection. A 46-year-old male was admitted to our hospital on the diagnosis of bilateral giant bullae of the lungs. Chest CT scan and lung perfusion scintigraphy showed giant bullae at the apex of both lungs and at the left lower lobe. The border of the bullae was relatively clear, and the other lung was almost normal although it was compressed by the bullae. We evaluated this case and found that it was a good indication for a thoracoscopic bilateral resection. The patient was positioned on his back, and a successful thoracoscopic bilateral resection was performed. The patient was discharged from the hospital on the 10th day postoperatively. Chest CT scan, lung perfusion scintigraphy and respiratory function test performed 2 months postoperatively, showed remarkable improvement. We would recommend this surgical technique in patients with similar diagnosis.

Endoscopy↗