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PubMed1993

Pneumothorax. Results of thoracoscopy and pleurodesis with talc poudrage and thoracotomy.

A retrospective study was performed of the evaluable data in 710 patients with a spontaneous pneumothorax. The male:female ratio was 3.4:1. A thoracoscopy was performed in 622 patients. The two main therapeutic strategies were pleurodesis with talc poudrage (n = 356) and thoracotomy (n = 248). The success rate of talc poudrage was 88 percent, and in the group failures who have undergone surgery afterwards, we found unexpected bullous structures in 20 of 37 patients. The success rate of operation (bullectomy, pleurectomy, or resection) was 97 percent. Our conclusion is that aggressive therapy in spontaneous pneumothorax is acceptable, with a high success rate with very few complications. The diagnostic thoracoscopic evaluation needs to be in experienced hands, especially to inspect the apical lobes with the Valsalva maneuver.

Adult↗
PubMed1993

Sleeve lobectomy, segmentectomy, and thoracoscopy in the management of carcinoma of the lung.

In patients with lung cancer, the goals of limited resection procedures of the lung and major airways are to provide an adequate cancer operation while preserving functioning lung tissue. Discussed in this article are sleeve lobectomy, an alternative to pneumonectomy in patients with cancer in a lobar orifice; segmentectomy or wedge resection, an alternative to lobectomy in those with a peripheral lung cancer; and thoracoscopy, an alternative to open thoracotomy for various chest malignancies.

Bronchi↗
PubMed1995

Application of thoracoscopy for lung metastases.

Lung nodules in patients with a history of malignancy usually require tissue diagnosis that will provide prognostic information and dictate further therapy. Patients with a favorable tumor histologic condition and limited tumor burden were often considered for resection. This is usually accomplished by wedge resection through open thoracotomy when the lesions were peripheral. However, complications related to open thoracotomy often exclude poor-risk patients, especially those with impaired pulmonary function. Currently, technique of thoracoscopic resection is opening up new vistas and unimagined options for the thoracic surgeon in the management of pulmonary diseases. With the application of thoracoscopy and small incisions, it is now possible for the thoracic cavity and its contained organs to be thoroughly explored. Our recent experience with the thoracoscopic resection as a primary treatment for lung metastases is the focus of this report. Forty-seven patients with a history of malignancy and new lung metastases underwent this type of resection. Postoperatively, there is less pain, quick functional recovery, and excellent cosmetic healing. It is a safe and promising approach.

Female↗
PubMed1996

Routine video-assisted thoracoscopy prior to thoracotomy.

We investigated the role of routine video-assisted thoracoscopy (VAT) prior to thoracotomy. From June 1993 to May 1995, we routinely performed VAT prior to all our elective thoracotomies in adults. Patients who planned to have video-assisted thoracic surgery (VATS), those who underwent emergency thoracotomy, and patients younger than 10 years old were excluded from this study. There were 63 patients (47 men and 16 women; age range, 16 to 84 years), of whom 39 (62%) had malignant disease and 24 (38%) had benign disease. In four cases, VAT could not be performed because of either pleural symphysis or inability to adequately collapse the upper lung. In six cases, thoracoscopic findings influenced subsequent management. Pleural metastases were found in two cases that led to abandonment of thoracotomy; in four cases, identification of chest wall involvement by a malignant or benign process led to proper planning of subsequent thoracotomy. There was no added morbidity from this procedure which took, on average, 6.2 min to complete (range, 3 to 17 min). There was no added cost for consumables. We concluded that: (1) routine VAT is a safe procedure; (2) it adds little to the overall cost or operating time; (3) it can provide useful information that could alter subsequent operative strategy. We recommend routine VAT prior to thoracotomy in patients with known or suspected intrathoracic malignancy and those suspected of having chest wall involvement on CT scans.

Adolescent↗
PubMed1998

Preoperative diagnosis with video-assisted thoracoscopy with miniaturized endoscopes in general thoracic surgery: a preliminary study.

Video-assisted thoracoscopy using a miniaturized endoscope (mini-VAT) was applied for preoperative diagnosis in general thoracic surgery. Thirty-one patients, including 27 with indeterminate pulmonary nodule and 4 with suspected pleural involvement of lung cancer or metastatic pleural tumor, underwent mini-VAT. As a pilot study, 14 of the former 27 patients underwent mini-VAT while receiving general anesthesia. As a prospective study, all the remaining 17 patients underwent mini-VAT while receiving local anesthesia. Solid scopes of three different sizes, 0.9, 1.9, or 4.0 mm diameter, were used. An artificial pneumothorax for scope introduction was produced by needle thoracentesis under atmospheric pressure. Automatic cutting needle biopsy was used for tissue sampling. In the pilot study group, mini-VAT with a 4.0-mm scope provided excellent visibility and diagnostic sensitivity of 100%. This study group showed the diagnostic sensitivity of needle biopsy for pulmonary nodule to be 100%. Hemorrhages and air leaks at biopsy sites were sealed with blood coagulation in a short time. In the prospective study group, mini-VAT with a 4.0-mm scope with the patients receiving local anesthesia provided a diagnostic sensitivity of 91% for pulmonary nodule and a diagnostic accuracy of 100% for suspected pleural involvement. Causes of failure of mini-VAT with the use of local anesthesia were cough reflex during needle biopsy and incomplete lung collapse for deeply located target in two cases. The adverse effects of the mini-VAT were paradoxical respiration in two cases in which local anesthesia was used. The patients who received only local anesthesia required no chest tube drainage. Mini-VAT is a simple, minimally invasive procedure suitable as a preoperative examination technique for histologic diagnosis, evaluation of disease progression, and selection of strategy in thoracic surgery.

Adult↗
PubMed1999

Thoracoscopy: window to the pleural space.

Thoracoscopy has provided chest physicians and surgeons with an opportunity to rethink their approach to patients with pleural and pulmonary disease. In this brief review, several methods pertaining to videothoracoscopic procedures are described, followed by a summary of the major indications for this procedure. The question of whether a thoracoscopic approach to diagnosis or treatment could replace more conventional approaches is addressed for several disease processes. Finally, a few thoughts about future directions of this emerging technology are shared.

Humans↗
PubMed1979

Thoracoscopy. Early diagnosis of interstitial pneumonitis in the immunologically suppressed child.

Interstitial pneumonitis in immunosuppressed patients demands prompt diagnosis and treatment. In an effort to achieve a simple yet highly accurate method of diagnosis, we have evaluated the usefulness of thoracoscopic examination. Twenty-seven procedures have been performed in 24 patients between the ages of 17 months and 18 years. All patients were immunosuppressed, most for treatment of malignant processes. All procedures have been performed under anesthesia with intravenously administered ketamine, without endotracheal intubation. A definitive diagnosis has been made in every case, with pneumonia due to Pneumocystis carinii being identified in 18 instances. Complications have been minimal and include four minor pneumothoraces, two instances of bleeding, and two instances of prolonged air leak. Mortality attributable to the procedure has been nil, although five patients have died due to their underlying diseases within 30 days of the thoracoscopic procedure. Thoracoscopy has proven to be a rapid and safe technique for providing accurate histologic and bacteriologic diagnoses in these critically ill children.

Adolescent↗
PubMed1989

Pleural and lung cryobiopsies during thoracoscopy.

Cryotherapy through rigid bronchoscopy has been used in the past three years in the treatment of endobronchial tumors. We performed pleural and lung cryobiopsies during thoracoscopy. The hemostatic properties and the quality of the histopathologic specimens obtained using this technique offer an innovative approach to the diagnosis of pleural effusion with associated lung disease.

Adult↗
PubMed2005

Tolerance of laparoscopy and thoracoscopy in neonates.

OBJECTIVES: Video-surgery in neonates is recent. Data on the respiratory, hemodynamic, and thermic effects during the first month of life are still sparse. This study aimed to evaluate the tolerance of video-surgery in neonates and to determine the risk factors of per-operative complications. METHODS: From 1994 to 2004, 49 neonates (mean age: 11 days; weight: 3285 g) underwent 50 video-surgical procedures. Indications for laparoscopy were duodenal atresias, volvulus with malrotation, pyloric stenosis, gastroesophageal reflux, cystic lymphangiomas, ovarian cysts, biliary atresia, and congenital diaphragmatic hernias; indications for thoracoscopy were esophageal atresias and tracheoesophageal fistula. RESULTS: Median operative time was 79 minutes. Mean insufflation pressure was 6.7 mm Hg (range: 3-13). Oxygen saturation decreased, especially with thoracic insufflation or high-pressure pneumoperitoneum. Systolic arterial pressure, which decreased in 20% of the patients, was controlled easily with vascular expansion. Thermic loss (mean postoperative temperature: 35.6 degrees C) was proportional to the duration of insufflation. No surgical incident was noted. Ten anesthetic incidents occurred (20%), 3 of which required temporary or definitive interruption of insufflation (O2 saturation <70%). Risk factors for an incident were low preoperative temperature, high variation of end-tidal pressure of CO2, surgical time >100 minutes, thoracic insufflation, and a high oxygen or vascular expansion requirement at the beginning of insufflation. CONCLUSION: The neonate's high sensitivity to insufflation is an important limiting factor of video-surgery. The described profile of the neonate at risk may help to reduce the frequency of adverse effects of this technique and improve its tolerance.

Blood Pressure↗
PubMed1997

Sonographic guidance for the localization of peripheral pulmonary nodules during thoracoscopy.

OBJECTIVE: The value of sonographic guidance during video-assisted thoracoscopic surgery (VATS) was studied in 13 patients with one or more peripheral pulmonary nodules who later underwent wedge resection. SUBJECTS AND METHODS: After a review of the chest radiographs and CT scans of each patient, sonographic guidance for VATS was requested by the attending surgeon when the nodule or nodules in question were determined to be too small or too deep in the lung parenchyma from the pleural surface for location by VATS. A multifrequency (5.0-, 6.5-, or 7.5-MHz) sonographic probe was introduced through a thoracoscopic port during VATS. The nodule or nodules in question were located by intraoperative sonography or determined by inspection and confirmed by sonography before wedge resection. The size and location of each lesion and the time needed for sonographic guidance were recorded. RESULTS: Sonography revealed a peripheral pulmonary nodule in 12 of the 13 patients. Of these, it confirmed the suspected location of the pulmonary nodule in six. In the remaining six patients, the surgeon was unable to locate the nodule without the use of sonography. The additional operative time required for sonographic guidance during VATS averaged 7.5 min. However, the time commitment of radiology personnel during surgery varied and was sometimes lengthy (maximum, 150 min). CONCLUSION: Sonographic guidance during thoracoscopy helped to locate lesions and determine their size and proximity to pleural surfaces. Sonographic guidance can be done safely and can be completed expeditiously. Unlike percutaneous hookwire techniques, sonographic guidance does not require an additional invasive procedure to locate the peripheral pulmonary nodule.

Aged↗
PubMed1999

[Anesthetic management of patients with malignant pleural effusion undergoing hyperthermic perfusion under thoracoscopy].

Nine patients with malignant pleural effusion due to lung cancer had been scheduled for hyperthermic treatment with warmed distilled water (40 degrees C) under thoracoscopy. This treatment aims to produce adhesion of the lungs to reduce pleural effusion. To evaluate the risk of general anesthesia for patients with lung cancer at the end stage, we examined the problems of perioperative management. Seven out of nine patients were classified into ASA physical status > or = III and seven patients into Hugh Jones > or = III Shapiro's score was > or = 5 in four patients. The average %VC was 60 +/- 16 and % FEV1.0 was 41 +/- 18% (means +/- SE). A double lumen endotracheal tube was inserted and anesthesia was maintained with inhalational anesthetics. In two cases, one-lung ventilation could not be maintained because of severe hypoxemia during hyperthermic perfusion. Hypertension occurred in three cases and hypotension in one by direct heat stimulation of the cardiopulmonary system. Although their preoperative risk was poor, there were no major complications and the quality of life was improved. We stress that careful anesthetic management is important for avoiding hypoxemia and hemodynamic instability during this treatment.

Aged↗
PubMed1999

[Role of video-assisted thoracoscopy in diagnosis of neoplasms in mediastinal organs].

Diagnostic potential of video-assisted thoracoscopy was evaluated in 66 patients (36 males and 30 females) with neoplasms (aged 24-68 yrs). When used in conjunction with biopsy, it confirmed the following diagnoses: lymph proliferative disease (23), mediastinal malignancies (11), sarcoidosis (21), benign mediastinal tumors (7), Castleman's benign lymphoma (2) and mediastinal cyst (2). Clinical diagnosis was substantially changed in 40 (61%) cases as a result of videothoracoscopy application. It has proved precise, fairly safe and conservative; it has a potential in diagnosis of mediastinal tumors.

Adult↗
PubMed1999

Video-assisted thoracoscopy: role in the management of intrathoracic pathology.

A retrospective study was done from October 1992 to December 1996 of 48 patients who underwent video-assisted thoracoscopy. A male to female ratio of 3.7:1 was seen, with a mean age of 50 +/- 19 years. The underlying diagnoses included spontaneous pneumothorax (n = 23), malignant pleural effusion (n = 16), lung disease (n = 4), trauma (n = 2), empyema (n = 2) and oesophageal carcinoma (n = 1). The use of this modality is discussed in the treatment of various intrathoracic pathologies.

Adolescent↗
PubMed1999

[Interventional medical thoracoscopy].

Interventional thoracoscopy is an important tool for diagnosis of pleural disease. We present a description of available material and thoracoscopic methods, discussing therapeutic informations for: pleural effusion, pneumothorax, sympathectomy, empyema. Instruction for each therapeutic situation are presented together with expected results.

Humans↗
PubMed2001

Bronchial blocker compared to double-lumen tube for one-lung ventilation during thoracoscopy.

BACKGROUND: Video-assisted thoracoscopic surgery (VATS) requires one-lung ventilation with a properly collapsed lung. This study compared the Broncho-Cath double-lumen endotracheal tube with the Wiruthan bronchial blocker to determine the advantages of one device over the other during anaesthesia with one-lung ventilation for thoracoscopy. METHODS: Thirty-five patients undergoing VATS were randomly assigned to one of two groups. Sixteen patients received a left-sided double-lumen tube (DLT) and nineteen a Wiruthan bronchial blocker (BB). The BB group was subdivided in two: BB in the right mainstem bronchus (BBR) for right-sided VATS (9 patients), BB in the left mainstem bronchus (BBL) for left-sided VATS (10 patients). The position of the devices was checked using a fibreoptic bronchoscope. The following variables were measured: 1) number of unsuccessful placement attempts; 2) number of malpositions of the devices; 3) time required to place the device in the correct position; 4) number of secondary dislodgements of the devices after turning the patient into the lateral decubitus position. The quality of lung deflation was evaluated by the surgeons who were blinded to the type of tube being used. RESULTS: The number of unsuccessful placement attempts was one in the DLT group (1/16), three in the BBL group (3/10) and none in the BBR group (0/9). The number of malpositions was significantly greater in the BBL group (10/10) compared to the DLT group (2/16) and to the BBR group (1/9) (P<0.001). The time (mean+/-SD) required to place a BBL was 4.21 min+/-1.28, significantly longer than the time required to place a DLT (2.26 min+/-0.55, P<0.0006) or a BBR (2.41 min+/-0.53, P<0.008). The difference in placement time between DLT and BBR was not significant. The number of secondary dislodgements was one in the DLT group, one in the BBR group and none in the BBL group (NS). The quality of lung deflation was judged excellent or fair in all patients in the DLT and the BBL groups and poor in 44% of the patients in the BBR group. CONCLUSION: It took significantly longer to place a left BB than a DLT (P<0.0006) or a right BB (P<0.008). The number of initial malpositionings of the left BB was significantly greater than in the other groups (P<0.001). The quality of lung deflation was better in the BBL and in the DLT groups than in the BBR group. We conclude that for routine use during left-sided VATS, the use of a DLT is preferable to a left BB because of its greater ease of placement. For right-sided VATS, DLT and right BB showed the same facility of placement but the DLT provided a better quality of lung deflation.

Adult↗
PubMed2001

"Hybrid" revascularization: video-thoracoscopy assisted MIDCAB combined with angioplasty.

A "hybrid" revascularization technique has been developed for cases in which a chronic total occlusion of the left anterior descending coronary artery (LAD) cannot be recanalized by percutaneous coronary intervention, but the lesions in the right coronary artery and/or left circumflex artery are very good candidates for angioplasty. This technique, which uses video-thoracoscopy assisted minimally invasive direct coronary artery bypass to recanalize the occluded LAD and angioplasty to dilate favorable lesions in other vessels, would achieve complete revascularization in selected patients with multi-vessel disease. In this preliminary study of four patients, angioplasty and stenting were successful in all patients without any complications; complete revascularization was achieved in all 4 patients. No recurrence of angina and no cardiovascular events developed during follow-up; this study therefore supports the belief that the "hybrid" revascularization technique is both feasible and safe.

Adult↗