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PubMed1993

Diagnostic and therapeutic thoracoscopy: techniques and indications in pulmonary medicine.

Recently thoracoscopy has been used with increasing frequency for the diagnosis and treatment of pleuropulmonary diseases. METHODS: The main requirements for thoracoscopy are rigid telescopes, forceps, scissors, stapler and a video recorder. The procedure can be performed either under general anaesthesia with or without double lumen intubation or under neuroleptanalgesia after inducing an artificial pneumothorax. At the end of the procedure a chest tube should always be inserted even if it is only for a few minutes until the lung re-expands after diagnostic thoracoscopy. Complications are exceptional and mortality is less than 0.017%. INDICATIONS AND RESULTS: Thoracoscopy is useful for diagnosis of a number of lung diseases. For pleural effusion, the sensitivity of thoracoscopy is 92-97% and its specificity is 99%. This is much better than needle pleural biopsy and/or fluid cytology. In malignant mesothelioma, thoracoscopy allows accurate staging. Similarly in spontaneous pneumothorax, classification based on the endoscopic aspects of the lung according to the classification of Vanderschueren allows a better selection of therapeutic alternatives. For diffuse pulmonary diseases, thoracoscopic lung biopsy has a sensitivity ranging from 60-98% depending on whether the underlying disease is sarcoidosis, idiopathic fibrosis, collagenous diseases or other rare diseases. Interventional thoracoscopy is a rapidly expanding domain. In this review the most widespread techniques are summarized. Thoracoscopic pleurodesis is performed for pleural effusion. It can be achieved by talc poudrage but other methods are available. For spontaneous pneumothorax, pleurodesis must be associated with treatment of the causal lesions. The other therapeutic procedures described here are sympathectomy for palmar hyperhidrosis, pulmonary biopsy using an endo-GIA stapler and pericardial biopsy.

Humans↗
PubMed1993

The role of ultrasound assisted thoracoscopy in the diagnosis of pleural disease. Clinical experience in 687 cases.

Ultrasonic examination is an established method used to differentiate between solid and liquid structures in the pleural space. It can estimate the volume of a pleural effusion and demonstrate whether the effusion is associated with loculations or adhesions. It is complementary to thoracoscopy. In the diagnosis of pleural disease ultrasonic-assisted thoracoscopy should only be used when the less invasive methods of diagnosis such as pleural aspiration for cytological, bacteriological and chemical examinations and needle biopsy of the pleura have not yielded a diagnosis. Although thoracoscopy is a relatively invasive procedure, it has the advantages of speed and accuracy in the diagnosis of pleural disease. This procedure is not widely used as it requires specialized instruments and equipment and may be time-consuming. The latter disadvantage may be minimized by the use of prior pleural sonography. The ultrasonic examination will indicate the optimal point of entry of the thoracoscopy to avoid adhesions. In order to evaluate feasibility, complications and clinical results in ultrasonic-assisted thoracoscopy, we investigated 687 patients with pleural diseases from 1987 to 1990. As prior induction of a pneumothorax under X-ray control was not necessary, the 20-30 min required for this procedure was saved in all patients. Very few complications were attributable to ultrasonic-assisted thoracoscopy as it could normally be performed under local anesthesia. A macroscopic diagnosis was made in 80% of malignant diseases and 77% of inflammatory diseases in our total of 687 thoracoscopies. The diagnosis of a malignant pleural effusion was confirmed histologically and cytologically in 95% of those 190 patients in whom it was present.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1998

A comparison of rigid -v- video thoracoscopy in the management of chest trauma.

Between December 1, 1994 and April 1,1998, 44 thoracoscopic procedures were performed in 42 patients following chest injuries. Indications included exploration in 15, retained haemothorax in 10, continued bleeding after chest tube placement in 3, air leak in 5 and empyema in 11. Video thoracoscopy was used in 24 cases and rigid thoracoscopy in 20, including 14 patients in whom video thoracoscopy was contraindicated. There was no difference in the operative times, length of stay or incidence of complications. Two formal and 3 "mini" thoracotomies were used in the video thoracoscopy group. Three "mini" thoracotomies were required in the rigid thoracoscopy group. Rigid thoracoscopy is an effective tool that, in selected cases, increases the utility of thoracoscopy in the management of chest trauma and its complications.

Contraindications↗
PubMed2005

Frozen section of pleural biopsies at medical thoracoscopy assists in correctly identifying benign disease.

OBJECTIVES: Medical thoracoscopy and thoracoscopic talc poudrage (TTP) are accepted procedures in the management of pleural effusions. The relative merits of TTP compared with pleurodesis via intercostal catheter (ICC) continue to be debated. However, of the two procedures, only medical thoracoscopy allows both tissue diagnosis and pleurodesis to be achieved reliably in one procedure. The aim of this study was to assess the feasibility and accuracy of using frozen section analysis of samples taken during medical thoracoscopy to assist the thoracoscopist's decision to complete the procedure with a TTP. METHODOLOGY: Twenty patients with undiagnosed pleural effusions after at least one diagnostic pleurocentesis underwent medical thoracoscopy and biopsy. RESULTS: Frozen sections were easily performed within the timeframe of medical thoracoscopy. The final diagnosis based on paraffin sections was malignant in 10 cases and benign in 10 cases. Frozen section at the time of thoracoscopy (before TTP) correctly identified nine of 10 cases as being benign and six of 10 cases as malignant. In the malignant group, reasons for incorrect identification as benign were sampling from superficial benign adipose tissue overlying the malignant deposits, difficult access to the most involved parts of the pleura and intense cellular infiltrate initially thought to be benign. CONCLUSION: Frozen sections taken during medical thoracoscopy have the potential to facilitate decision-making prior to pleurodesis, particularly for accurate identification of benign histology on thoracoscopic pleural biopsies, in order that pleurodesis is not performed unnecessarily.

Aged↗
PubMed1998

Thoracoscopy in the horse: diagnostic and therapeutic indications in 28 cases.

Thirty-two thoracoscopies were performed in 28 horses. Sixteen horses were affected with pleuropneumonia whereas 12 were affected with various other thoracic conditions. The indications for thoracoscopy was diagnostic in 19 cases, therapeutic in 11 cases and both diagnostic and therapeutic in 2 cases. Twenty-six thoracoscopies were done standing whereas 6 were performed under general anaesthesia. The specific procedures performed during thoracoscopy were exploratory only (7), biopsy of the lung and lymph nodes (10), drain placement into pleural effusions (2) and abscesses (5), exploration prior to thoracotomy (2), transection of pleural adhesions and decortication (1) and window pericardectomy (2). Diaphragmatic hernia repair (2) and partial pneumonectomy (1) were initiated thoracoscopically but conversion to thoracotomy was necessary for completion. Standing thoracoscopy was well tolerated in most horses. Transient exacerbation of pulmonary compromise evidenced by tachypnoea was readily alleviated by reinflation of the lung. Standing thoracoscopy provided good visualisation of the dorsal and lateral structures of the thorax. The ventral thoracic structures and the cranial ventral diaphragmatic surfaces of the lungs were best visualised in dorsal or lateral recumbency under general anaesthesia. Thoracoscopy is a safe and useful diagnostic and therapeutic tool in horses with thoracic diseases.

Anesthesia, General↗
PubMed2005

Predictors of pleural malignancy in patients with pleural effusion undergoing thoracoscopy.

STUDY OBJECTIVES: Thoracoscopic pleural biopsy is highly accurate in the diagnosis of pleural malignancy. However, no scientific evidence is currently available to guide the physician's decision as to when and in which patients with pleural effusion thoracoscopy is indicated. The application of predictive criteria of malignancy might improve the indication of thoracoscopy in patients with undiagnosed pleural effusion. METHODS: Prospective study of 93 patients referred for thoracoscopy at a tertiary hospital. Clinical variables were obtained prior to thoracoscopy by clinical history and review of previous data, patient interview, and physical examination. Radiologic variables were obtained by evaluation of chest radiograph and chest CT images by two independent readers. After thoracoscopy, all patients without a diagnosis were sent for long-term follow-up. RESULTS: Thoracoscopy demonstrated 94% sensitivity and 100% specificity in the diagnosis of pleural malignancy. Variables, which in a multivariate model are associated with pleural malignancy, include a symptomatic period > 1 month, absence of fever, blood-tinged pleural fluid, and chest CT scan findings suggestive of malignancy. Receiver operating characteristic analysis showed that the use of these four criteria offered adequate classification in 95% of patients. Twenty-eight patients had all four criteria, and all had malignancy; 21 patients had at most one criterion, and none had malignancy. CONCLUSION: Clinical and radiologic criteria of patients with pleural effusion permit different risk levels for pleural malignancy to be distinguished. Consequently, application of the four proposed criteria permits better indication of thoracoscopy in patients with undiagnosed pleural effusion.

Biopsy, Needle↗
PubMed1999

[Thoracoscopy versus thoracotomy. The dilemma of the comparison and its meaning for quality assurance in thoracic surgery].

The need for scientific investigation into the benefits of thoracoscopy in comparison to thoracotomy as well as State intervention to assure quality in the field of surgery motivated the members of the commission of endoscopic surgery of the German Society of Thoracic Surgery to conduct a pilot project at their hospitals. This pilot project was expected to analyse data on the outcome and a selection of variables concerning trauma and postoperative quality of life of some 400 patients treated between 8/95 and 10/95 at 5 thoracic surgical clinics. On completion of the pilot project the course of 141 patients undergoing different thoracic operations at 4 thoracic surgery departments had been documented to various degrees. 60 patients for various indications received a thoracoscopy, 72 a thoracotomy. In 9 patients thoracoscopy was converted to thoracotomy (6.4%). Eight of the 141 patients died in the postoperative course (5.7%), overall morbidity was 15.6%. There was a slight but statistically not significant difference concerning mortality and morbidity in favor of thoracoscopy (1.7 vs. 9.7% and 10 vs. 19.4%). But, there was a selection of malignant diseases, higher age and high risk patients towards thoracotomy. In subgroups of patients undergoing operations not bigger than the resection of three lung wedges only time of operation and length of incision revealed to be significantly shorter for thoracoscopy (69(25-190) min vs. 128(24-240)min, p = 0.0013; 6(4-8)cm vs. 23(12-35)cm, p = 0.0001). Borderline significance was reached by the Spitzer-Index in advantage for thoracoscopy (8(2-10)points vs. 7(0-10)points, p = 0.0728). Thoracotomy and thoracoscopy are access procedures used with different indications in different patients. Differences concerning trauma and quality of life if present are marginal and will need studies to be outlined. Quality assurance in thoracic surgery using a standardized documentation will not succeed under the given circumstances.

Adult↗
PubMed2002

[Thoracoscopy--the method of choice in the determination of a malignancy as the cause of pleural effusion of unknown etiology].

UNLABELLED: After complete pulmological investigation remains about 20% of all the pleural effusions without etiological diagnosis designated as unexplained pleural effusions. Thoracoscopy enables further investigation with the final aim--establishing of the etiological cause of the unexplained pleural effusions. Recently numerous studies demonstrated that the malignancy is the most frequent cause of this aforementioned pleural effusions. OBJECTIVE: Descriptive-analytic appraisal of validity of thoracoscopy in establishing of malignancy as a cause of idiopathic pleural effusions. TASKS: To establish if the malignancy is the most frequent cause of unexplained pleural effusions, to establish diagnostic-thoracoscopic sensitivity and specificity for malignant disease as cause of pleural effusions and to establish positive and negative predictive value of thoracoscopy for malignancy. PATIENTS AND METHODS: In the period between 06.11.1984 and 01.02.2002, included in this investigation were all patients with pleural effusions of unknown origin who were referred to the Clinic for Thoracic Surgery--UCC Sarajevo, for thoracoscopy after less invasive means of diagnosis had failed. Investigation had clinical-manipulative, descriptive-analytic and retrospective-prospective design. RESULTS: There were 74 patients with the pleural effusions of unknown origin. The malignancy was found in 47.3% (35/74) patients. Diagnostic sensitivity of the method for malignancy was 89.7% and the specificity 100.0%. The positive predictive value of the thoracoscopy for malignancy was 100.0% and negative predictive value 89.7%. CONCLUSIONS: The malignancy was the most frequent cause of idiopathic pleural effusions. Thoracoscopy has high specificity and sensitivity in regard to discovering of malignancy as a cause of idiopathic pleural effusions. Undiagnosed malignancy by thoracoscopy excludes malignancy as a cause of pleural effusion with high security.

Adult↗
PubMed1984

Therapeutic thoracoscopy.

Thoracoscopy was originally devised for diagnostic purposes but has subsequently come to have several therapeutic applications as well. This report reviews our experience with 13 patients in whom thoracoscopy was used in a therapeutic capacity. In three patients intrapleural foreign bodies (segments of polyethylene catheters) were removed endoscopically. In two patients open postpneumonectomy empyema cavities were explored and debrided thoracoscopically. In the remaining eight patients thoracoscopy was used to facilitate chemical pleurodesis in the treatment of effusions or pneumothoraces, after resectable disease had first been ruled out. Our conclusions are as follows: (1) Thoracoscopy can serve therapeutic as well as diagnostic functions. (2) Excellent exposure can be obtained during general anesthesia by use of one-lung ventilation. (3) Thoracoscopy is a safe, simple, and effective means of removing intrapleural foreign bodies. (4) Thoracoscopy allows chemical pleurodesis to be applied selectively to patients who will not require future thoracotomy; i.e., those with proved incurable malignant disease or with recurrent pneumothoraces without gross abnormalities of the pulmonary parenchyma. (5) Chemical pleurodesis is facilitated by this technique, which assures uniform exposure of all pleural surfaces to the sclerosing agent. (6) Pleurodesis is less painful when the sclerosing agent is introduced during general anesthesia. (7) Thoracoscopy allows safe, complete, visually guided débridement of open postpneumonectomy empyema cavities.

Adult↗
PubMedDate not supplied

Thoracoscopy in the evaluation and management of thoracic trauma.

Video-thoracoscopy was used to evaluate and manage patients after thoracic trauma. It was used in 29 patients. Indications included retained hemothorax in 16 patients, empyema in 11, evaluation for the source of thoracic bleeding in 1, and an airleak in 1. The mechanism of injury was blunt trauma in 8 cases, 10 with stab wounds, and 11 with gunshot wounds. In blunt trauma, thoracoscopy was carried out an average of 11.7 days post injury, chest tubes were removed after an average of 7 days post thoracoscopy, and discharge averaged 10.7 days after thoracoscopy. The failure rate was 12.5% with no mortality. In stab wounds, it was carried out an average of 8.8 days post injury, chest tube removal occurred after 6.1 days, and discharge averaged 7.8 days after thoracoscopy. The failure rate was 20% with no mortality. In gunshot wounds, it was carried out an average of 7.5 days after injury, chest tubes were removed after 9.9 days, and discharge averaged 16 days post thoracoscopy. The failure rate was 9% with a mortality of 9%. Overall, the failure rate for thoracoscopy was 13.8% (4/29). The mortality rate was 3.5% (1/29). It was successfully performed up to 30 days post injury. It proved to be effective in the management of empyema, evacuation of clotted hemothorax, and diagnosis of ongoing thoracic bleeding.

Humans↗
PubMed1982

Thoracoscopy for intrathoracic neoplasia in children.

The technique of thoracoscopy allows a unique opportunity to examine the entire hemithorax. Between July 1975 and April 1981 we performed over 150 thoracoscopic procedures for evaluation of intrathoracic pathology at the University of Florida. Twenty-five of these procedures, performed in 23 patients, were undertaken for the diagnosis or staging of intrathoracic tumors in patients whose ages ranged from 8 mo to 18 yr. Forty-eight percent were for parenchymal tumors, 44% for mediastinal masses, and 8% for pleural disease. Twelve of these patients had at least 1 invasive procedure performed prior to thoracoscopy without a diagnosis being established. In 17 procedures a positive tissue diagnosis of malignancy was obtained, and in 6 of these cases areas of previously unsuspected intrathoracic tumor involvement were identified by thoracoscopy. In 3 patients simultaneous thoracoscopy-guided transdiaphragmatic needle biopsy of the liver was performed with a positive tumor diagnosis being achieved in 1. The clinical course of the patients following the 8 procedures in which neoplasia was not encountered confirmed the diagnosis of benign disease in all but 1. A single patient with an enlarged mediastinal lymph node had a falsely negative thoracoscopy biopsy and was subsequently diagnosed as having recurrent Hodgkin's disease. The overall diagnostic accuracy in these patients was, therefore, 92%. Complications in these patients have been minimal, and there was not mortality due to the thoracoscopic procedure. These clinical results would suggest an important role for thoracoscopy in the evaluation of intrathoracic neoplasia in children.

Adolescent↗
PubMed1990

Thoracoscopy.

This article presents endoscopic evaluation of the pleural cavity, or thoracoscopy, an effective diagnostic technique that can be employed to provide additional diagnostic information in cases of intrathoracic disease. The techniques of thoracoscopy are described, and normal and abnormal findings are discussed. Thoracoscopy allows visual examination of the pleural space and surrounding structures without surgical exploration. The stress, expense, morbidity, and mortality of thoracoscopy are far less than those of thoracotomy. Disease for which thoracoscopy has been employed diagnostically include primary and metastatic neoplasia, hilar lymphadenopathy, pericardial effusion, spontaneous pneumothorax, and diaphragmatic hernia. Therapeutically, thoracoscopy has been used for drainage of pericardial effusion.

Animals↗
PubMed1999

Diagnostic thoracoscopy.

Thoracoscopy is a minimally invasive diagnostic technique that provides access to the thoracic cavity for evaluation of intrathoracic pathology without surgical intervention. Intrathoracic structures can be visualized better with thoracoscopy than with an open thoracotomy. Indications for thoracoscopy include pleural effusion, pericardial effusion, intrathoracic masses, pneumothorax, primary pulmonary disease, and trauma. Thoracoscopy is technically similar to laparoscopy, using the same basic instrumentation and principles, but is easier to perform than laparoscopy. Patient preparation, anesthesia, and patient positioning are essentially the same for thoracoscopy as for a standard open thoracotomy. Thoracoscopy provides minimally invasive access to important diagnostic information with a very low incidence of complications.

Animals↗
PubMed1998

Medical thoracoscopy.

Thoracoscopy has received increasing attention over the past decade as a result of the considerable advances that have been made in the development of endoscopic instruments. In contrast to the newly established video-assisted thoracoscopic surgery, the classic way to perform thoracoscopy is using only local anesthesia and sedation (medical thoracoscopy) making the procedure less invasive and expensive. The leading diagnostic indication for medical thoracoscopy today is an exudative pleural effusion of unknown origin offering a yield of more than 90% in malignancy or tuberculous pleurisy. In addition, talc poudrage during thoracoscopy is the most effective way to perform pleurodesis. For spontaneous pneumothorax, the second most important indication, medical thoracoscopy allows staging as well as therapeutic measures such as coagulation of blebs or talc poudrage. Other indications such as biopsy for diffuse lung disease or peripheral nodules are now reserved for video-assisted thoracoscopic surgery.

Diagnosis, Differential↗
PubMed1998

Medical thoracoscopy in the diagnosis of unexplained pleural effusion.

Approximately 20% of pleural effusions remain without an established aetiology after evaluation. Thoracoscopy has a very high sensitivity for the diagnosis of both benign and malignant diseases and greatly increases the diagnostic yield for pleural effusion. We sought to evaluate the diagnostic yield and safety of medical thoracoscopy at this institution. The records of all patients undergoing medical thoracoscopy for the evaluation of undiagnosed pleural effusion between 1990 and 1996 were reviewed. The procedure was performed under local anaesthesia with sedation using a Stortz rigid thoracoscope. Fifty-eight patients had thoracoscopy, most having had two (range: 1-6) non-diagnostic pleural aspirations and biopsies of the pleura. Nineteen patients were found to have mesothelioma and nine metastatic malignancy. Three patients were considered likely to have tuberculous pleural disease, six had asbestos related benign pleural fibrosis and three post-cardiotomy syndrome. There was one chylous effusion of uncertain aetiology, one posttraumatic and two other benign effusions, both of which resolved without clear aetiology. On seven occasions the pleural space could not be adequately accessed, but none of these patients had prior computerized tomography (CT) or ultrasound of the pleural space. There were five false negative diagnoses of malignancy, but no false positives. The diagnostic sensitivity for pleural malignancy was 85% and specificity 100%. There were no major complications, but four patients had late tumour seeding at the thoracoscopy site. Medical thoracoscopy is a safe procedure with a high diagnostic yield. Pre-operative evaluation of the pleural collection using ultrasound or CT increases the likelihood of successful access to the pleural space and may increase diagnostic yield.

Adult↗
PubMed1998

Thoracoscopy--state of the art.

"Medical" thoracoscopy as compared with "surgical" thoracoscopy (which is more precisely known as video-assisted thoracic surgery (VATS)) has the advantage that it can be performed under local anaesthesia or conscious sedation, in an endoscopy suite, using nondisposible rigid instruments. Thus, it is considerably less invasive and less expensive. The main diagnostic and therapeutic indications for medical thoracoscopy are pleural effusions and pneumothorax. Due to its high diagnostic accuracy, approaching almost 100% in malignant and tuberculous pleural effusions, it should be used when pleural fluid analysis and needle biopsy are nondiagnostic. In addition, medical thoracoscopy provides staging for lung cancer and diffuse malignant mesothelioma. Talc poudrage, as the best conservative method for pleurodesis in 1998, can also be performed with medical thoracoscopy. It can also be effectively used in the early management of empyema. In spontaneous pneumothorax it allows staging, thereby facilitating treatment decisions, and in addition coagulation of eventual blebs and talc poudrage for efficient pleurodesis. Medical thoracoscopy is a safe procedure which is even easier to learn than flexible bronchoscopy. Due to its high diagnostic and therapeutic efficiency, it should be applied increasingly in the management of the above-mentioned pleuropulmonary diseases.

Empyema↗
PubMed2005

Treatment of sonographically stratified multiloculated thoracic empyema by medical thoracoscopy.

INTRODUCTION: In cases of empyema, some form of intervention, either chest tube drainage, thoracoscopy, video-assisted thoracic surgery (VATS), or thoracotomy, with or without pleural fibrinolysis, is required. What the best approach is and when and how to intervene is a matter of debate. STUDY OBJECTIVE: To analyze the safety and outcome of medical thoracoscopy in the treatment of multiloculated empyema. METHODS: We report a retrospective series of 127 patients with thoracic empyema treated with medical thoracoscopy from 1989 to 2003 in three hospitals in Switzerland and Italy. All patients had multiloculated empyema as identified by chest ultrasonography. In the absence of multiloculation, or in case of fibrothorax, simple chest tube drainage or surgical VATS/thoracotomy were performed, respectively. RESULTS: Mean age +/- SD was 58 +/- 18 years (range, 9 to 93 years). In 47%, a microbiological diagnosis was made. Complications occurred in 9% of patients (subcutaneous emphysema, n = 3; air leak of 3 to 7 days, n = 9). No mortality was observed. Forty-nine percent of patients received postinterventional intrapleural fibrinolysis. Medical thoracoscopy was primarily successful in 91% of cases. In four patients, the insertion of an additional chest tube or a second medical thoracoscopy was required. Finally, 94% of patients were cured by nonsurgical means. Six percent of patients required surgical pleurectomy, mostly through thoracotomy. CONCLUSION: Multiloculated empyema as stratified by ultrasonography can safely and successfully be treated by medical thoracoscopy.

Adolescent↗
PubMed1999

[Thoracoscopy versus thoracotomy in spinal surgery: comparison of 2 paired series].

PURPOSE OF THE STUDY: This study was carried out to compare the intraoperative and postoperative results of conventional surgery of the thoracic spine by thoracotomy with those of the thoracoscopic technique to determine the advantages of this new approach. MATERIAL AND METHODS: A series of twenty-nine patients operated by thoracoscopy for a spinal disorder was matched regarding the etiology of spine disease and type of surgical procedure with twenty-four patients operated by thoracotomy. This matching procedure yielded two similar groups of twenty patients. The criteria used for evaluation were the duration of the procedure, blood loss, intraoperative complications, the duration of stay in postoperative intensive care, the duration and yield of pleural drainage, the time until return to the upright position, duration of use of WHO grade-three analgesics (morphine derivatives), the postoperative complications, and the length of hospitalization. RESULTS: There was a significant difference in three parameters: the duration of the procedure (thoracotomy, 172 min; thoracoscopy, 246 min; p < 0.006), intraoperative bleeding (thoracotomy, 837 mL; thoracoscopy, 447 mL; p < 0.0009), and duration of use of WHO grade-three analgesics (thoracotomy, 4.5 days; thoracoscopy, 2.3 days; p = 0.011). There was no difference in the intra- or postoperative complication rates of the two methods. DISCUSSION: The better view provided by thoracoscopy and its preservation of the wall structures probably explain why there was less bleeding and postoperative pain with this technique. The insufficiency of the current thoracoscopic instrumentation and the learning curve account for the longer duration of these interventions. CONCLUSION: These data confirm the usefulness of thoracoscopy which is less traumatizing, less hemorrhagic, and causes no more complications than thoracotomy. The longer operative duration is currently a minor drawback, and should shorten with experience and the development of specific instrumentation.

Adolescent↗