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PubMed2002

Treatment of primary spontaneous pneumothorax by simple talcage under medical thoracoscopy.

Medical thoracoscopy under local anesthesia with simple talc poudrage is a safe and cost-effective technique to prevent recurrences in the case of primary spontaneous pneumothorax. Pathogenesis of primary spontaneous pneumothorax, i.e. a pneumothorax occurring without any underlying lung disease, remains unclear; there is no proof that the air leak leading to air escape into the visceral pleura is located in blebs or bullae visualized during the procedure. Therefore we do not have any evidence that blebs or small bullae cauterization or resection adds any further benefit to pleurodesis. Pulmonologists doing thoracoscopic talc pleurodesis should learn to better control pain due to thoracoscopic talcage as it has been shown that thoracoscopic talcage is not more painful than a chest tube drainage in patients providing they receive at least some opioids. There is also a debate on the best surgical approach to treat pneumothorax but minithoracotomy with pleurectomy remains the gold standard although more expensive and associated with some morbidity or mortality.

Humans↗
PubMed2002

[Significance of cytohistologic examination of pleural biopsy samples obtained through diagnostic thoracoscopy for exudative pleurisy of obscure etiology].

Significance of results of cytologic (CE) and histologic (HE) examinations of the biopsy material, received during diagnostical thoracoscopy for the exudative pleurisy (EP) of nonestablished etiology was studied. There were 69 observations of EP analyzed. Following diagnosis was established: nonspecific, tuberculous, metastatic pleurisy and in pleural mesothelioma. The values of CE and HE characteristics were presented. The complex general value of cytohistologic diagnosis had constituted 94%. Causes of diagnostic mistakes occurrence were considered.

Adolescent↗
PubMed2003

[Minimally invasive esophagectomy with 10 cm thoracotomy assisted thoracoscopy for the thoracic esophageal cancer].

We have been successfully performing minimally invasive esophagectomy through a 10-cm thoracotomy and two trocar ports. Esophagectomy can be performed safely and efficiently via the thoracoscopy. We have also adapted hand assisted laparoscopic surgery (HALS) for the abdominal procedure through a 7-cm laparotomy and three trocar ports. One of the important points of esophagectomy for thoracic esophageal cancer is performing lymphadenectomy near either side recurrent laryngeal nerve. Another important point is to preserve the bronchial branch of the vagus nerve and both bronchial arteries if they are without cancerous invasion. We also preserve the azygos vein and the thoracic duct to minimize surgical invasion. Standard thoracotomy and laparotomy are significantly invasive procedures with potential complications and prolonged healing; minimally invasive esophagectomy has the potential to minimize morbidity and decrease healing time.

Esophageal Neoplasms↗
PubMed1992

The ascending laparoscope. Modern thoracoscopy.

Developments in laparoscopic endoscopy have increased the interest in thoracoscopy. New techniques and instruments, particularly video endoscopy, have greatly expanded the indications for laparoscopic procedures. These innovations and techniques are being applied and modified for thoracic application.

Adult↗
PubMed1992

Laser thoracoscopy for pleural effusion.

A potential, new, therapeutic modality for the treatment of recurrent symptomatic pleural effusion in a patient with metastatic carcinoma is presented using "minimal access surgery." Diagnosis at the time of thoracoscopy, as well as treatment using free-beam and contact-tip modalities, is outlined in detail. Also, a complication of inter-costal artery bleeding is presented, as well as its solution using the end-firing endoclip applier. This is an effective and useful procedure that should be particularly of interest to surgeons already using various scope methods. Surgeons currently express strong interest in accomplishing diagnosis and treatment goals in a variety of clinical situations using "minimal access surgery," a phrase coined at the 1989 International Congress of the Society of American Gastrointestinal and Endoscopic Surgeons. Enthusiasm about this procedure is evident across the country by the number of laparoscopic courses offered at a variety of institutions. Similarly, the chest allows certain applications of minimal access surgery resulting in accurate diagnosis and possible definitive treatment by use of the thoracoscope.

Aged↗
PubMed2005

[Thoracoscopy with continuous positive airway pressure and collapse of only the operated lobe].

We report a case of diagnostic thoracoscopy of a right lobe in a patient with left upper lobe atelectasis due to invasion by a bronchial tumor. We anticipated difficulty in maintaining the desired oxygenation while using the conventional strategy of collapsing the whole operated lung and ventilating only the opposite one. The solution was to apply continuous positive airway pressure to 2 right lobes while only collapsing the lobe to be biopsied.

Biopsy↗
PubMed1992

Modern operative thoracoscopy.

Laparoscopic surgery has demonstrated advantages of less pain, early recovery, and cosmesis. Applying laparoscopic surgical techniques to thoracic procedures may allow for similar advantages. New instrumentation provides for greater versatility in treating thoracic conditions. Described herein is the use of thoracoscopy for a variety of thoracic procedures.

Biopsy↗
PubMedDate not supplied

[Thoracoscopy in the staging of tumors of the lung].

The Authors review the results of thoracoscopy in 15 cases of pleural effusions concomitant with tumours of the lungs. In addition to defining the aetiology of the pleural effusion, the investigation completes the staging of the malignancy and affords both the possibility of reducing the number of exploratory thoracotomies and of resolving a number of cases at exeresis.

Humans↗
PubMedDate not supplied

[Surgical thoracoscopy].

Surgical thoracoscopy is performed with laparoscopic material and instrumentation and is not limited to the therapeutic applications of classical pleuroscopy such as thoracic sympathectomy or pleurectomy for pneumothorax. It is a simpler, more rapid technique which causes less tissue damage and appears to be more effective than the other transparietal techniques. It has been performed twice for sympathectomy and five times for recurrent pneumothorax with excellent results.

Humans↗
PubMed1991

[Talc therapy during thoracoscopy of pneumothorax due to rupture of the bullae in emphysema. A study of 71 cases].

The treatment of pneumothorax for large emphysematous bullae is classically surgical. We report a study of 71 patients treated by pleural talc therapy using thoracoscopy with good or excellent long term results in 93% of cases at a cost of some minor side effects. These results were compared with other forms of medical treatment which were always less effective and with surgical techniques which had more severe side effects. These results enable us to stress the value of talc therapy using pleuroscopy in patients with respiratory failure.

Administration, Topical↗
PubMed1991

[Pleural talc treatment using thoracoscopy in lymphomatous pleurisy].

The authors report their experience of pleural talcage under thoracoscopy in 21 cases of lymphomatous pleurisy. This represents 9.6% of the total number of cancerous pleurisies treated with talc over four years. A successful result with talcage was achieved in 84% of cases. The success of failure of talcalge seems to depend on the macroscopic appearance (the existence of masses or nodules) as well as an abundance of pleural liquid, all constitute unfavourable factors. On the other hand the lymphoma (Hodgkins or non Hodgkins) does not seem to have any unfavourable effect.

Adult↗
PubMed1990

[The use of a plasma scalpel during thoracoscopy for the treatment of traumatic and spontaneous pneumothorax].

The authors suggest performing thoracoscopic coagulation of pleuropulmonary defects with a plasma stream (VSVU-160 apparatus) in patients with traumatic and spontaneous pneumothorax. A special nozzle and a manipulation trocar were designed for this purpose. Such combined thoracoscopy was used successfully in 31 patients with open and closed chest injury with rupture of the subpleural bullae. The manipulation makes it possible to reduce the number of emergency thoracotomies undertaken for hemo- and aerostatic indications.

Animals↗
PubMed1990

[Diagnosis of pleural metastatic carcinoma with fibrous bronchoscope in thoracoscopy].

45 cases suspected pleural tumors were performed thoracoscopy with fibrous bronchoscope. The diagnoses were as follows: metastatic carcinoma 23 cases, pleural mesothelioma 3 cases, pleural tuberculosis 10 cases, non-specific inflammation 4 cases, lymphoma 1 case, Hamman-Rich syndrome 1 case, and unknown cause 3 cases. 93.3 percent of the patients (42/45) were diagnosed clearly. Hence it gives the feasibility of reasonable treatment in the patients. The method of examination and the sight in fibrous bronchoscope have been described in detail.

Adenocarcinoma↗
PubMed1990

[Thoracic sympathectomy by thoracoscopy. Apropos of 15 cases].

Thoracic sympathectomy is generally performed by thoracotomy. Apart from the surgical approach, the thoracoscopic technique allows vision and physical or chemical destruction of the thoracic sympathetic system. We studied the possibilities of their technique. Thoracoscopy is performed under local anesthesia after creation of a pneumoserosa. Local anesthesia of the second sympathetic ganglion is performed. The ganglion is destroyed by injection of 8cc of phenol. Fifteen patients have been treated (15 to 70). The first five patients were failures and led to improvement of the technique. We have 8 good results. If we exclude the first five patients, we observe 8 good results and 2 failures. The thoracoscopic approach to the second sympathetic ganglion is not always possible (local pleurodesis). When it is possible, the results of local treatment by phenol are as good as those of surgery.

Adolescent↗
PubMed1990

[The diagnosis of pleural effusion using thoracoscopy].

By analysis the results of thoracoscopy in 57 patients suffering from pleural effusion of unknown cause in the Surgical Department of Marienhospital Herne, it is clear that we can reach the exact diagnosis in 98% of these patients by this examination, which can be done in local anaesthesia with little complications. In the same time the histological examination of the tissue and the cytological examination of the effusion make the diagnosis sure and in the same time improved the complaints of the patients by removing of effusion.

Adolescent↗
PubMed1990

[The value of initial thoracoscopy in the treatment of pneumothorax].

Various methods have so far been used to treat pneumothorax, including rest, needle exsufflation and blind drainage. The results obtained are varied but the recurrence rate is high, averaging 50%. With thoracoscopy, not only can the pleura be explored and the cause of pneumothorax investigated, but specific treatment of the lesions can be carried out in some cases and symphysis can be obtained by pleural poudrage, thereby avoiding recurrences. One-hundred and eleven cases of pneumothorax collected over a 5-year period are reviewed in this study; the results of exploration and those of endoscopic treatments are given and commented upon.

Adolescent↗
PubMed1990

The management of empyema thoracis by thoracoscopy and irrigation.

A technique of irrigation for the management of empyema thoracis is described. Initial thoracoscopy using a laparoscope under general anaesthesia enabled adequate debridement and breakdown of loculi within the empyema cavity under direct vision. Following this procedure irrigation of the cavity with two tubes was started and continued until three consecutive cultures of drained irrigation fluid became sterile. The procedure was then discontinued. The results in 14 patients are presented using this method, irrigation was required for an average of 14 days. Patients remained in hospital for an average of 4.8 weeks. Tuberculous empyema was not found to be a contra-indication to the irrigation technique.

Adult↗
PubMed1990

[Thoracic sympathectomy by thoracoscopy. Apropos of 15 cases].

UNLABELLED: Thoracic sympathectomy is achieved using the trans-axillary route during the course of a thoracotomy. The indications are Raynaud's phenomenon, digital arteriopathy, and hyperhidrosis. Alongside the surgical approach in theory it is possible to use a thoracoscopic approach for a thoracic sympathectomy, to achieve a physico-chemical destruction, we have studied this possibility using this technique. MATERIAL AND METHODS: Thoracoscopy is achieved under local anaesthetic after creating a pneumothorax. The approach is through the 2nd intercostal space in the mid-clavicular line. Anaesthesia of the 2nd sympathetic ganglion is achieved, the ganglion is destroyed by injection of 8 c.c's of Phenol. 15 patients were treated (15 to 7). The presented with palmar hyperhidrosis (7), digital arteriopathy (6) or Raynaud's syndrome (2). RESULTS: The first 5 patients were failures which led to a more precise technique. Overall we observed 8 favourable results. If we exclude the first 5 cases we achieved 8 favourable results and 2 failures. The approach to the 2nd sympathetic ganglion using the thoracoscope is not always possible: the vision may be obscured. When it is possible phenolization may yield excellent results comparable to those of surgical sympathectomy. CONCLUSION: Palmar hyperhidrosis for which we have obtained the best results seems to us to be an extra indication of this technique which enables a cure at the price of a relatively simple procedure and a brief period of hospital stay.

Adolescent↗