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PubMed1997

Anterior release and fusion in pediatric spinal deformity. A comparison of early outcome and cost of thoracoscopic and open thoracotomy approaches.

STUDY DESIGN: A consecutive series of patients undergoing thoracoscopic anterior spinal release and fusion for scoliosis or kyphosis was compared with a consecutive series of patients treated with an open thoracotomy approach. OBJECTIVES: To compare the early clinical results, costs, and charges of performing an anterior thoracic spinal release and fusion with the two approaches. SUMMARY OF BACKGROUND DATA: The thoracoscopic approach to the spine is gaining acceptance, yet there are little data comparing the technique with standard open methods for the treatment of spinal deformity. METHODS: The first 14 thoracoscopic cases performed at the authors' hospital were compared with 18 open thoracotomy cases treated during the previous 12-month period. In each case the discs were excised and bone grafted before performing a posterior fusion. The early clinical outcomes and the hospital charges/costs were analyzed. RESULTS: The percent curve correction was similar between the thoracoscopic and open methods: scoliosis 56% and 60%, respectively; kyphosis, 88% and 94%, respectively. The blood loss and complication rates were similar between the two groups; however, the chest tube output was greater in the thoracoscopic group. The length of hospital stay was not reduced, and the cost of the open procedure is 29% less than the thoracoscopic approach. The minimally invasive thoracoscopic approach avoids cutting the chest/shoulder musculature, greatly decreasing the morbidity of anterior spinal surgery. CONCLUSIONS: The thoracoscopic technique is a safe and effective alternative to open thoracotomy in the approach to the anterior thoracic spine for the treatment of pediatric and adolescent spinal deformity.

Adolescent↗
PubMed1994

Efficacy of video assisted thoracoscopic lung biopsy: an historical comparison with open lung biopsy.

BACKGROUND: Video assisted thoracoscopic lung biopsies were compared with historical controls undergoing open lung biopsy to determine the diagnostic accuracy, effect on length of postoperative stay, and cost effectiveness of the new thoracoscopic technique. METHODS: The first 25 video assisted thoracoscopic lung biopsies performed in the Edinburgh Thoracic Unit were compared with 25 historical controls for complications, diagnostic accuracy, and length of postoperative stay. RESULTS: Statistical comparison showed equal diagnostic accuracy in both groups (96% v 92%), but mean (SD) inpatient stay was reduced in the video assisted thoracoscopic group (1.4 (0.7) days) compared with those undergoing open lung biopsy (3.1 (1.8) days). No postoperative complications were reported in the group which underwent video assisted thoracoscopic lung biopsies but three patients had postoperative complications in the open lung biopsy group. CONCLUSIONS: Video assisted thoracoscopic lung biopsy is as effective in providing histological diagnosis as is open lung biopsy. All postoperative complications were related to post thoracotomy pain and occurred only in patients undergoing open lung biopsy. Reduced postoperative disability in the video assisted thoracoscopic group decreased hospital stay, offsetting the increased cost in disposables. The overall cost of video assisted thoracoscopic and open lung biopsy was 712 pounds and 1114 pounds, respectively.

Adult↗
PubMed1996

Thoracoscopic sympathicolysis for essential hyperhidrosis: effects on pulmonary function.

Bilateral interruption of the upper dorsal sympathetic chain at the D2 and D3 level represents the only permanent cure for essential hyperhidrosis. Following surgical sympathectomy, significant and symptomatic changes in pulmonary function have been observed. Since functional effects of the surgical intervention cannot be excluded, we wondered whether such alterations also occurred after thoracoscopic sympathicolysis; these should then be attributable to the surgical denervation itself. Pulmonary function tests (PFTs), including spirometry and body plethysmographic measurement of lung volumes and airway resistance and conductance, were compared before and 6 weeks after thoracoscopic sympathicolysis in 47 patients. In order to virtually exclude any effects of thoracoscopy on the test results PFTs were repeated 6 months after thoracoscopic sympathicolysis in 35 patients. Essential hyperhidrosis was completely relieved in all patients, thereby confirming the interruption of the D2-D3 sympathetic chain. None of the patients developed respiratory symptoms after thoracoscopic sympathicolysis. Forced expiratory volume in one second (FEV1) (-3%), forced expiratory flow after exhaling 75% of vital capacity (FEF75) (-8%) and total lung capacity (TLC) (-3%) were slightly but significantly reduced at six weeks after thoracoscopic sympathicolysis; whereas airway resistance (Raw) had increased (+12%). After correction for the small decrease in lung volume (FEV1/forced vital capacity (FVC), specific airway resistance (sRaw), specific airway conductance (sGaw))significant changes in "volume-dependent" PFT parameters were no longer observed. Smoking status had no influence on the reduction in FEF75. At 6 months after thoracoscopic sympathicolysis, TLC had returned to preoperative values, whereas FEF75 remained decreased (-8.6%). The decrease in airway calibre was confirmed by small but significant changes in FEV1/FVC (-2%) and Raw (+29%). We conclude that thoracoscopic sympathicolysis in patients with essential hyperhidrosis causes only minimal and subclinical changes in pulmonary function secondary to a temporary small decrease in lung volume, which in turn is probably inherent to the thoracoscopic procedure. D2-D3 sympathicolysis, in itself, is responsible only for a small and permanent decrease in forced expiratory flow, which suggests that, at least in essential hyperhidrosis patients, airway bronchomotor tone is influenced by sympathetic innervation.

Adolescent↗
PubMed1999

Thoracoscopic mammary artery mobilization in redo minimally invasive coronary bypass operations.

BACKGROUND: It has been stated that thoracoscopic internal thoracic artery (ITA) mobilization is not recommended in the redo minimally invasive direct coronary artery bypass (MIDCAB) situation, presumably because adhesions from the previous coronary artery bypass grafting operation may preclude a thoracoscopic approach. However, there are advantages to thoracoscopic ITA mobilization in MIDCAB that could also be realized in the redo situation. METHODS: In 200 MIDCAB procedures over the last 3 and a half years, 11 patients, ages 49-83 (mean 69), were identified as having undergone an attempted ITA mobilization in a redo situation. RESULTS: Thoracoscopic ITA mobilization was successful in 9 out of 11 patients (81%). One patient had complete pleural symphysis precluding this approach, and 1 patient had poor mammary flow after harvest and this conduit was not used. Both failures were in female octogenarians. CONCLUSIONS: To realize the advantages of a thoracoscopic ITA mobilization MIDCAB, both right and left thoracoscopic ITA mobilization can safely be performed in the redo situation. Thoracic adhesions precluding a thoracoscopic approach were encountered in only 1 of 11 redo coronary artery bypass grafting patients.

Aged↗
PubMed2007

The autoclavable semirigid thoracoscope: the way forward in pleural disease?

Medical thoracoscopy is a valuable tool in the investigation and management of pleural disease. It has considerable advantages over conventional blind pleural biopsy and video-assisted thoracoscopic surgery. Despite this, the practice of this technique in the UK is limited. Most operators use the rigid thoracoscope, which may be an unfamiliar instrument to respiratory physicians. A semirigid thoracoscope is available but its use has not been possible in the UK as it requires sterilisation with ethylene oxide, which is not approved in this country. The present authors describe herein their experience with the first ever autoclavable semirigid thoracoscope. Medical thoracoscopy using the new instrument was performed in 56 patients between June 2004 and May 2006. All patients had been referred with a unilateral pleural effusion of unknown aetiology, where blind pleural aspiration had failed to yield an answer. Diagnostic samples were taken and talc poudrage performed where appropriate. The instrument was easy to handle and excellent views were obtained. Histologically adequate biopsy samples were obtained in 54 patients. The combination of clinical features, computed tomography findings and thoracoscopic biopsy enabled a definite diagnosis in 49 (90.7%) of these patients. There were no complications. The autoclavable semirigid thoracoscope has immense potential in the diagnosis and management of pleural disease. Its diagnostic yield in pleural disease is comparable to the conventional rigid thoracoscope. It is similar in design to the fibreoptic bronchoscope and respiratory physicians should be able to adapt to its use easily. It is also compatible with existing video processors and light sources available in most endoscopy suites. The fact that this instrument is autoclavable should open the field for its use in the UK as well as in other countries.

Adult↗
PubMed1990

[Treatment of spontaneous pneumothorax by electrocoagulation via a fiberoptic bronchoscope with a hysteroscope irrigation outer sheath as a thoracoscope].

Since 1981 in Yamagata Prefectural Central Hospital, the authors performed electro-coagulation therapy for air leakage from bullae (blebs) via a rigid thoracoscope in 31 patients with spontaneous pneumothorax. Among these patients, this treatment was unsuccessful in 14 patients (45.2%) because of 5 multiple or giant bullae and 9 cases in which it was impossible to visualize the bullae in the mediastinum or because of pleural adhesion. In order to widen the visual field and increase the mobility of the thoracoscope, we employed a fiberoptic bronchoscope with a hysteroscope outer sheath used for irrigation as a flexible thoracoscope. This method makes it possible to examine both mediastinal pleura and adhesive pleural space, and to electrocoagulate bullae which cannot be visualized by a rigid thoracoscope. It was possible to visualize the blebs in all 13 cases with spontaneous pneumothorax in which this examination was attempted. This therapeutic procedure causes the patients less pain and the hospitals more economical because no new thoracoscope is necessary. This method of thoracoscopic therapy of spontaneous pneumothorax using a fiberoptic bronchoscope is more successful, effective, economical and painless than by rigid thoracoscope and should be attempted before thoracotomy.

Adolescent↗
PubMed2006

Thoracoscopic and laparoscopic oesophagectomy improves the quality of extended lymphadenectomy.

BACKGROUND: Oesophagectomy with extended lymphadenectomy carries considerable morbidity due to parietal trauma. It is also technically extremely demanding because the difficult access even through a large thoracotomy requires the use of long instruments to reach the deepest recess in the chest cavity. Since the first thoracoscopic oesophagectomy reported by Cuschieri et al. [1] in 1992, different minimally invasive approaches have been proposed [2-12]. The aim of this video is to show the accurate and relative ease of an entirely thoracoscopic and laparoscopic oesophagectomy with an extended lymph node dissection of mediastinum in prone position (thoracoscopically) and celiac trunk (laparoscopically). METHODS: Oesophagectomy by thoracoscopy, laparoscopy and cervicotomy was proposed in a 63-year-old man with a lower third oesophageal cancer. General anaesthesia was performed with a double-lumen endotracheal tube and the patient was placed in prone position. Surgeons were positioned at the right side of the patient. Only three trocars were needed. A 10 mm 30-degree angled scope was inserted in the 7th intercostal space on the posterior axillary line and the remaining two 5 mm trocars were inserted in the 5th and 9th intercostal spaces on the posterior axillary line. Prone position allows an excellent visibility of the operative field even in an only partially deflated lung. In order to achieve a good exposure, transitory pneumothorax with CO2 (14 mmHg) was performed. The mediastinal pleura overlying the oesophagus was incised and the arch of azygos vein was isolated, ligated and divided. The oesophagus was circumferentially mobilized from the thoracic inlet down to oesophageal hiatus. Para oesophageal and subcarinal lymph nodes were dissected so as to remain in block with the surgical specimen. A 28 F chest tube was inserted in the 8th intercostal space on the anterior axillary line. In the second stage the patient was placed in supine position and pneumoperitoneum was established. Five trocars were placed along an ideal semicircular line, with the concavity facing the subcostal margin and a 30-degree angled laparoscope was used. The lesser omentum was widely opened up the right pillar of the hiatus. Mobilization of the greater curvature of the stomach was performed preserving the right gastroepiploic artery. A wide Kocher maneuver was performed. Celiac lymphadenectomy started with skeletonization of the hepatic artery until the root of left gastric artery was reached. This artery and the left gastric vein were dissected, clipped and sectioned. All fatty tissue and lymph nodes along hepatic artery, left gastric artery and celiac trunk were resected in block with the surgical specimen. Multiple applications of a linear endoscopic stapler were used to create the gastric tube. Finally the distal oesophagus was dissected, until the thoracoscopic dissection field was joined. In the third stage a left lateral cervicotomy was performed and the cervical oesophagus was dissected down to the thoracoscopic dissection plane. Oesophagus and stomach were delivered through the cervical incision and an oesophagogastric anastomosis was created by a linear stapler technique. Cervical and abdominal drainages were installed. RESULTS: The total operative time was 271 minutes (thoracoscopy: 106 minutes, laparoscopy 120 minutes and cervicotomy 45 minutes) and blood loss was about 100 ml. Histological examination demonstrated a squamous cell carcinoma. Both margins of resection were free of tumour and 29 lymph nodes were retrieved. The final stage was IIA (pT3N0Mx). CONCLUSIONS: Thoracoscopic and laparoscopic oesophagectomy with extended lymphadenectomy is technically feasible and safe. Thoracoscopic oesophagectomy in prone position improves the quality of dissection because: The oesophagus and aorto-pulmonary window are reached under excellent visibility, despite a partially deflated lung, which because of gravity will always remain out of harm's way. For the same reason small to moderate bleeding will not obscure the operative field. Dissection with the long endoscopic instruments is more accurate due to the support provided by the entrance site at the parietal level and the ergonomic position of surgeon. This article contains a supplementary video.

Blood Loss, Surgical↗
PubMed1998

Thoracoscopic techniques for the management of intrathoracic metastases. Results.

BACKGROUND: The authors reviewed a series of 74 patients with cancer metastatic to the chest cavity undergoing thoracoscopic procedures. Indications, feasibility, and outcome of thoracoscopy were analyzed. METHODS: Perioperative and survival data on patients undergoing 89 operative thoracoscopic procedures between January 1991 and August 1993 were retrieved from a prospective database. These procedures included pulmonary wedge resection (n = 61), lobectomy (n = 2), pleurodesis (n = 11), pleural biopsy (n = 7), decortication (n = 1), and mediastinal mass resection (n = 2). In 13 cases, combined procedures were performed. Five thoracoscopies were converted to open thoracotomies to facilitate resection. RESULTS: Thoracoscopic pulmonary resections were performed for either diagnostic (n = 45) or curative (n = 18) intent. Diagnostic thoracoscopies were done for lesions in which less invasive biopsy attempts had failed to provide tissue, or that were considered too small for successful percutaneous biopsy. Thoracoscopic diagnostic accuracy was 100%. For the 18 patients undergoing potentially curative resection, mean follow-up is 15.4 months. Sixteen of these patients are currently alive, and eight are free of disease. Five complications related to the procedure included persistent air leak (n = 2), atrial fibrillation (n = 2), and urinary retention (n = 1). Overall hospital stay for thoracoscopic lung resection was 4.6 +/- 2.2 days, for converted open thoracotomy 6.8 +/- 1.9 days, and for patients undergoing pleurodesis 8.9 +/- 5.3 days. Mean chest tube duration after thoracoscopic resection was 2.6 +/- 1.6 days. CONCLUSIONS: Thoracoscopic procedures are safe, well tolerated, and useful for diagnosis and treatment of selected patients with suitable intrathoracic metastatic disease.

Adult↗
PubMed2000

Anterior thoracoscopic surgery followed by posterior instrumentation and fusion in spinal deformity.

Many authors believe thoracoscopic surgery is associated with a lower level of morbidity compared to thoracotomy, for anterior release or growth arrest in spinal deformity. Others believe that anterior release achieved thoracoscopically is not as effective as that achieved with the open procedure. We evaluated the clinical results, radiological correction and morbidity following anterior thoracoscopic surgery followed by posterior instrumentation and fusion, to see whether there is any evidence for either of these beliefs. Twenty-nine patients undergoing thoracoscopic anterior release or growth arrest followed by posterior fusion and instrumentation were evaluated from a clinical and radiological viewpoint. The mean follow-up was 2 years (range 1-4 years). The average age was 16 years (range 5-26 years). The following diagnoses were present: idiopathic scoliosis (n = 17), neuromuscular scoliosis (n = 2), congenital scoliosis (n = 1), thoracic hyperkyphosis (n = 9). All patients were satisfied with cosmesis following surgery. Twenty scoliosis patients had a mean preoperative Cobb angle of 65.1 degrees (range 42 degrees-94 degrees) for the major curve, with an average flexibility of 34.5% (42.7 degrees). Post operative correction to 31.5 degrees (50.9%) and 34.4 degrees (47.1%) at maximal follow-up was noted. For nine patients with thoracic hyperkyphosis, the Cobb angle averaged 81 degrees (range 65 degrees-96 degrees), with hyperextension films showing an average correction to 65 degrees. Postoperative correction to an average of 58.6 degrees was maintained at 59.5 degrees at maximal follow-up. The average number of released levels was 5.1 (range 3-7) and the average duration of the thoracoscopic procedure was 188 min (range 120-280 min). There was a decrease in this length of time as the series progressed. No neurologic or vascular complications occurred. Postoperative complications included four recurrent pneumothoraces, one surgical emphysema, and one respiratory infection. Thoracoscopic anterior surgery appears a safe and effective technique for the treatment of paediatric and adolescent spinal deformity. A randomised controlled trial, comparing open with thoracoscopic methods, is required.

Adolescent↗
PubMed2004

Video-assisted thoracoscopic surgery of mediastinal bronchogenic cysts in adults: a single-center experience.

BACKGROUND: Mediastinal bronchogenic cysts are rarely diagnosed in adults, hence surgical experience is limited particularly with regard to video-assisted thoracoscopic surgery. In support of the thoracoscopic approach we report our single-center experience in this rare entity. METHODS: Between June 1995 and December 2002, a nonselected series of 12 consecutive patients presenting with mediastinal bronchogenic cysts underwent video-assisted thoracoscopic surgery. Six cysts (50%) had been diagnosed 2 to 22 years prior, only three of which became symptomatic. In asymptomatic patients (n = 7) surgery was performed because of increasing cyst size (n = 3), patient's request (n = 3), or suspected metastasis (n = 1). RESULTS: Mediastinal bronchogenic cysts were correctly diagnosed by computed tomography in 83% (10/12) and by magnetic resonance imaging in 100% (9/9). Using a three-trocar technique thoracoscopic surgery was successfully performed in 11 of 12 cases (92%). We noted no signs of acute cyst infection. No serious postoperative complications were observed. In 1 patient conversion to open thoracotomy was necessary due to extensive pleural adhesions. In another case thoracoscopic excision of the cyst wall was incomplete. Patients with thoracoscopic excision were discharged after a median of 5.5 days (range 4 to 14 days). No recurrences or complications were observed during a mean follow-up of 40.5 months. CONCLUSIONS: Considering the low conversion and complication rate in our series, video-assisted thoracoscopic surgery should be the primary therapeutic choice among adults with symptomatic mediastinal bronchogenic cysts. Surgical intervention in patients with asymptomatic and uncomplicated cysts appears optional.

Adult↗
PubMed2005

Unnoticed glove perforation during thoracoscopic and open thoracic surgery.

BACKGROUND: Surgeons tend to underestimate the risk of transferring infection during thoracoscopic operations, although data on glove perforation in thoracoscopic operations have not been reported. METHODS: Unnoticed perforations of the gloves worn by the same primary surgeon during thoracoscopic procedures and open thoracotomy were studied. Gloves with gross damage and those changed due to assumed damage were excluded. Gloves were tested by filling with water and squeezing to inflate each finger, which could detect a perforation by a 30-gauge needle. RESULTS: Perforation was found in 25% after thoracoscopic operation, although this was significantly lower than 70% after open thoracotomy. Twelve percent of the gloves worn during thoracoscopic operation were perforated. The perforation rate was higher for gloves worn for more than 2 hours during thoracoscopic operation. CONCLUSIONS: Glove perforation occurred without being noticed in 25% of thoracoscopic procedures, and in 12% of the gloves used during the procedure. Glove change within 2 hours is recommended.

Adolescent↗
PubMed2005

Neonatal thoracoscopic repair of congenital diaphragmatic hernia: selection criteria for successful outcome.

BACKGROUND/PURPOSE: Complications of open conversion, hypercarbia, and intestinal injury have plagued minimally invasive approaches to congenital diaphragmatic hernia (CDH) repair in neonates. To safely begin using minimally invasive techniques for neonatal CDH repair, we formulated preoperative selection criteria and operative techniques that would enhance chances for successful thoracoscopic primary diaphragm repair and uncomplicated outcome. METHODS: During the period from January 2003 to October 2004, neonates were selected for thoracoscopic CDH repair using anatomic and physiologic criteria. Anatomically, all patients were required to have stomach in the abdomen by radiography. Physiologically, all patients were required to be on minimal ventilator support with preoperative ventilator peak inspiratory pressures in the low 20s mm Hg. No patient could have clinical evidence of pulmonary hypertension at the time of surgery. Thoracoscopic CDH repair was performed using 3 trocars (3 and 5 mm). The hernia contents were reduced into the abdomen using 5-mm Hg insufflation, and the diaphragms were repaired primarily using interrupted 3-0 Ethibond simple sutures (Ethicon, Inc, Piscataway, NJ). Posterolateral diaphragm stitches were passed around the posterolateral ribs and tied extracorporeally. RESULTS: Thirty neonates with CDH were admitted to Children's Hospital Boston and Vanderbilt Children's Hospital during the study period. Eight patients (27%) met selection criteria and 7 underwent thoracoscopic CDH repair. Primary diaphragmatic repair was successfully accomplished thoracoscopically in all neonates without perioperative complication. Preoperative anatomic criteria correlated accurately with intact esophageal hiatus and primary diaphragm repair. Physiologically, each patient tolerated intrathoracic insufflation and CDH repair without clinical pulmonary hypertension or blood pressure lability. Three patients had intraoperative respiratory acidosis that was reversed with ventilator changes. Operative times averaged 152 minutes and ranged from 212 to 106 minutes. Postoperative mechanical ventilation ranged from 0 to 7 days, and the length of hospitalization ranged from 5 to 32 days. Longest follow-up has been 17 months. One patient required reoperation for recurrent CDH at 10 months after repair, but there have been no other long-term complications. CONCLUSIONS: Neonatal thoracoscopic CDH repair is safe in selected patients who have good preoperative pulmonary function and anatomy amenable to primary diaphragmatic repair. A wider range of neonates may be acceptable for thoracoscopic CDH repair with increasing surgical experience.

Female↗
PubMed2000

Thoracoscopic thymectomy in juvenile myasthenia gravis.

BACKGROUND: Although transsternal thymectomy is an effective method in the treatment of juvenile myasthenia gravis (JMG) it is traumatic in pediatric patients. Thoracoscopic thymectomy offers an effective and less traumatic approach with respect to cosmesis and postoperative recovery. METHODS: A retrospective analysis of 6 consecutive patients treated with thoracoscopic thymectomy was performed. Perioperative parameters and cost analysis were compared with those of 6 consecutive open procedures performed before the study. RESULTS: Thoracoscopic thymectomy can be performed in patients as young as 1.6 years. There was no conversion to open procedure and no perioperative morbidity and mortality. The length of operating time and the surgical cost of thoracoscopic procedure were not significantly different from those of open procedure. The length of hospitalization, however, was significantly shorter with thoracoscopic procedure, and hence the overall cost was significantly reduced (P < .05). An intermediate follow-up shows that outcome after thoracoscopic procedure is equally as effective as open procedure. CONCLUSIONS: Thoracoscopic thymectomy offers an equally effective but cosmetically more acceptable approach than sternotomy. It has a quicker recovery period and appears to be a less costly alternative to transsternal thymectomy.

Adolescent↗
PubMed2003

Primary thoracoscopic treatment of empyema in children.

OBJECTIVE: The optimal treatment of pediatric empyema remains controversial. The objective of this study is to compare the use of conventional management versus primary thoracoscopic drainage and decortication in children with empyema. METHODS: Conventional management has consisted of chest drain insertion under general anesthesia plus intravenous antibiotics. Thoracoscopic drainage and decortication has consisted of primary thoracoscopic drainage and decortication plus antibiotics. The clinical course of 54 patients treated conventionally between 1989 and 1997 was compared with that of 21 patients treated by means of thoracoscopic drainage and decortication between September 2000 and September 2001. RESULTS: Results of the study demonstrated that patients in the drainage-decortication group had fewer invasive interventions per patient than those in the conventional management group (1.0 vs 1.26). Patients undergoing thoracoscopic drainage and decortication also had significantly shorter durations of intravenous antibiotic therapy (7.6 +/- 1.2 vs 18.2 +/- 7.5 days), chest tube drainage (4.0 +/- 0.5 vs 10.2 +/- 6.1 days), and hospital stays (7.4 +/- 0.8 vs 15.4 +/- 7.4). Moreover, there were no open thoracotomies and decortications in the thoracoscopic drainage and decortication group, whereas in the conventional management group 39% (21/54) of patients underwent an open procedure. CONCLUSION: Although the 2 groups were not prospectively randomized and they were treated in different time periods, the results of this study support the use of thoracoscopic surgery as the primary therapeutic modality in children presenting with pleural empyema. This strategy appears to offer significant benefits over conventional treatment in terms of duration of treatment and the need for more invasive surgery.

Chest Tubes↗
PubMed1998

Midterm results of thoracoscopic surgery for pulmonary metastases especially from colorectal cancers.

Indications for thoracoscopic metastatectomy remain controversial because not all metastatic tumors may be detected without the manual palpation that is possible with thoracotomy. However, the accuracy (92%) of preoperative lung imaging in patients with one or two lesions led us to re-evaluate thoracoscopic metastatectomy with patient survival as the primary end point. Thoracoscopic wedge resection using an endoscopic stapling device or video-assisted thoracic surgery (VATS) lobectomy was performed in patients with one or two pulmonary metastases. Thoracoscopic resection was performed in 27 patients with 22 solitary lesions and 5 patients with two lesions. The primary tumors were colorectal cancer (15), testicular cancer (3), osteosarcoma (2), and seven other histologies. In 5 of 27 patients (18.5%) a thoracoscopic operation was converted to a VATS procedure, which requires minithoracotomy to identify metastasis primary by digital palpation. The 3-year survival rate for colorectal cancer patients who underwent thoracoscopic resection was 56.4%, in comparison to 48.6% in historical control thoracotomy patients (n = 16). There was no statistically significant difference between the two groups. Thoracoscopic resection of one or two colorectal cancer lung metastases results in a survival rate similar to standard thoracotomy, and thereby provides an acceptable alternative to this more invasive approach.

Adolescent↗
PubMedDate not supplied

Thoracoscopic surgery in childhood cancer.

PURPOSE: Recent advances in minimally invasive surgery, especially thoracoscopy, have allowed many new applications in children. The authors' purpose was to review their experience with thoracoscopic surgery in childhood cancer. They hypothesized that thoracoscopy can be efficacious, safe, and cost-effective and has the potential to change the way we care for children with cancer. PATIENTS AND METHODS: The authors reviewed their thoracoscopic experience of the past 7 years. Thoracoscopic procedures performed included biopsy and resection of masses, resection of lung nodules, biopsy of infiltrates, and lobectomy. Some resections required conversion to open thoracotomy. RESULTS: Sixty-three thoracoscopic procedures were performed on 52 children; 8 required conversion to open thoracotomy and 55 were completed by thoracoscopy alone. The overall success rate was 98.4%. There were three complications and no deaths. The mean surgery time was 1.2 hours, mean length of hospital stay was 1.9 days, and mean number of chest tube days was 0.7. CONCLUSIONS: Thoracoscopic surgery in the treatment of children with cancer can be efficacious, safe, and cost-effective. Mediastinal masses can usually be biopsied and resected by thoracoscopy alone. Conversion to open thoracotomy for a more complete resection can be safely accomplished if needed. Thoracoscopic removal of lung nodules allows more accurate staging and early initiation of chemotherapy. Thoracoscopic biopsy of lung infiltrates can be safely performed in intubated, critically ill children and changed the treatment in all of these patients. Surgery time and days in hospital were decreased compared with historical thoracotomy data.

Adolescent↗
PubMed2003

A comparison between the prone and lateral position for performing a thoracoscopic anterior release and fusion for pediatric spinal deformity.

STUDY DESIGN: Retrospective review of all patients who had a single stage thoracoscopic anterior release and spine fusion followed by a posterior spinal fusion with posterior instrumentation. OBJECTIVE: To analyze the results and complications of patients undergoing a thoracoscopic anterior release and fusion comparing those performed prone with those in the lateral position. SUMMARY OF BACKGROUND DATA: The lateral position has traditionally been used when performing a thoracoscopic anterior spinal release and fusion during a single-stage anterior spinal release and fusion/posterior spinal fusion with instrumentation. Although some have reported the thoracoscopic technique in the prone position, there are no direct comparison studies between the prone and lateral position. METHODS: A retrospective review was performed of all patients who had a single stage thoracoscopic anterior spinal release and fusion and posterior spinal fusion with instrumentation from a single institution. The medical record was reviewed to determine demographic data, positioning of the patient, levels fused, anesthesia time, operative time, chest tube drainage, and complications. Radiographs were reviewed to determine preoperative curve magnitude and postoperative curve correction. The Student t test was used to compare groups and statistical significance was defined as P < 0.05. RESULTS: There were 16 patients in the prone group and 27 in the lateral group. Adolescent idiopathic scoliosis was the most common diagnosis in both groups. All patients had a single-stage thoracoscopic anterior spinal release and fusion/posterior spinal fusion with instrumentation. In the prone group, the patient was positioned prone on a Hall-Relton frame or roll (small patients) for both the anterior spinal release and fusion and posterior spinal fusion with instrumentation. There were no significant differences between the prone and lateral groups with respect to age, gender, height, weight, and curve magnitude (73.8 degrees vs. 71.5 degrees ). There were fewer fused anterior levels in the prone group (5.3 vs. 6.2) (P = 0.05). When analyzing parameters that reflect potential difficulties imposed by the prone position, there were no statistically significant differences noted between groups, although there was a trend toward less anterior operative time per disc (24.3 vs. 25.9 minutes/disc), greater blood loss/anterior disc level (33.5 vs. 26.8 cc/disc), greater total chest tube drainage (445 vs. 419 cc), and less days with the chest tube in place (2.2 vs. 2.3 days) for the prone group when compared to the lateral group. There were statistically significant differences between the prone and lateral groups with respect to anesthesia preparation time (42.8 vs. 64.8 minutes), delay between the completion of the anterior procedure and the start of the posterior procedure (11.8 vs. 69.5 minutes), and the incidence of complications related to the use of single-lung ventilation (0 vs. 14.8%)(P < 0.05). Patients in the prone group required less time on oxygen after surgery (34.8 vs. 51.6 hours) and were discharged home earlier (4.6 vs. 5.5 days) (P < 0.05). CONCLUSIONS: A thoracoscopic anterior spinal release and fusion in the prone position appears to achieve the same results as when performed in the lateral position for pediatric spinal deformity. The prone position saves time in the operating room due to decreasing the time needed by the anesthesiologists and the transition time between the anterior and posterior procedures. Potentially serious complications related to single-lung ventilation are avoided with bilateral-lung ventilation in the prone position.

Adolescent↗
PubMed2003

Use of video-assisted thoracoscopic surgery to reduce perioperative morbidity in scoliosis surgery.

STUDY DESIGN: A case series of idiopathic scoliosis patients treated with thoracoscopic anterior instrumentation was compared to a similar group of patients treated by open anterior instrumentation. OBJECTIVES: To evaluate the morbidity associated with thoracoscopic instrumentation compared to the open approach for thoracic scoliosis. METHODS: A consecutive group of thoracoscopically treated patients with Lenke 1 adolescent idiopathic scoliosis was compared to similar patients gathered from the DePuy-AcroMed Harms Study Group database. Perioperative outcome measures as well as early postoperative functional outcomes (pulmonary function, shoulder strength) were compared. RESULTS: There were 38 thoracoscopic instrumentation cases with greater than 6 months' follow-up that were compared to 68 anterior open instrumentation cases. The radiographic outcomes were similar (60% +/- 11% vs. 59% +/- 17% thoracic curve correction for the thoracoscopic and open groups, respectively). The reduction in forced vital capacity was significantly (P = 0.01) greater in the open group (0.6 +/- 0.3 L) compared to the endoscopic group (0.4 +/- 0.3 L). There was a trend towards greater return of shoulder girdle strength and range of motion 6 weeks after surgery in the thoracoscopic patients. CONCLUSION: The thoracoscopic approach for instrumentation of scoliosis has advantages of reduced chest wall morbidity compared with the open thoracotomy method but allows comparable curve correction.

Adolescent↗