Thoracoscopy: diagnostic and therapeutic indications.
This survey is a comprehensive review of the diagnostic and therapeutic indications for thoracoscopy.
Humans↗
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[Thoracoscopy in thoracic wall processes].
Main emphasis in the diagnosis of diseases in the chest wall region is on modern imaging methods, perthoracic puncture, and surgery. It is only rarely that diagnostic thoracoscopy appears to be indicated, especially in patients with enhanced operative risk.
Biopsy↗
[Diagnostic thoracoscopy in mediastinal space-occupying lesions].
Thoracoscopy is a helpful and safe procedure for diagnosing a variety of mediastinal masses if adequate information cannot be obtained out due to biological risk or patient non-compliance. An explicit description of thoracoscopic technique is given along with case reports demonstrating the efficiency of the method.
Adult↗
[Thoracoscopy: surgical technic].
Presentation of a surgical method in thoracoscopy, pleura biopsy and open lung biopsy using an intercostally introduced mediastinoscope and unilateral contralateral respiration. The results and advantages are explained.
Biopsy↗
Contraindications and complications to thoracoscopy.
Contraindications to thoracoscopy are mostly only relative. Complications are rare if the technical conditions are fulfilled.
Humans↗
Thoracoscopy in malignant mesothelioma.
Thoracoscopy is a suitable diagnostic method in malignant mesothelioma, since it enables simultaneously histopathological diagnosis, identification of asbestos fibres, staging of tumour spread, and pleurodesis therapy.
Biopsy↗
Thoracoscopy in rheumatoid pleural effusion.
In rheumatoid pleural effusion a positive diagnosis can be made by thoracoscopy, preferably supported by the identification of microscopic structural changes in the parietal pleura. Biochemical changes and the finding of the so-called rheumatoid arthritis cells (RA-cells) are non-specific.
Arthritis, Rheumatoid↗
Thoracoscopy in perspective.
The indications for thoracoscopy are undiagnosed pleural disease effusions of tumors; when tissue specificity is important for future treatment and adequate tissue is needed for estrogen binding studies; undiagnosed pleuropulmonary disease; biopsy of pulmonary lesions undiagnosed by other means; mediastinal masses, particularly in children; hilar masses; preoperative screening preliminary to thoracotomy for resection in malignant disease, particularly those with effusions; in spontaneous pneumothorax, to define the abnormality and indicate the need for thoracotomy; for postresection space problems; trauma, and, of course, for intrapleural pneumonolysis.
Adolescent↗
Thoracoscopy: new method of early diagnosis of cardiac herniation.
Cardiac herniation is an uncommon but rapidly fatal complication of radical pneumonectomy. Although operative correction is simple, a successful clinical outcome requires early diagnosis and thoracotomy. A patient is described in whom a left-sided cardiac herniation through a pericardial defect occurred following radical pneumonectomy. The diagnosis was suspected by persistent hypotension and radiographic changes. Confirmation of the diagnosis was achieved by thoracoscopy, performed with local anesthesia in the operating room. Immediate thoracotomy resulted in a successful outcome.
Heart↗
[Hemodynamics of microcirculation during thoracoscopy under anesthesia].
Under the conditions of the thoracoscopy under anaesthesia the behaviour of the haemodynamic measuring values is investigated in 10 patients of either sex. The time of intubation and the phase of the open thorax represent the most remarkable periods of examination which are parallel to the alterations of the arterial oxygen partial pressure and the pressure parameters of the circulations within the lesser an the systemic circulatory system. The investigation results obtained from the behaviour of the oxygen partial pressure will prove to be decisive, whether treatment with thorax opening under simultaneously carried out analytic blood-gas measurements should be recommendable.
Adult↗
[Thoracoscopy with pleural brushing. A new diagnostic method for pleural diseases].
Pleural brushing can be performed under thoracoscopic examination. The combined use of all three methods of diagnosis (macroscopy, biopsy, cytology) achieved optimal diagnostic results. From September 1980 to October 1981 we have performed 150 thoracoscopies for pleural effusions, while the results of conventional pleural cytology and biopsy were negative. In 108 cases pleural brushing and biopsy were both performed. The diagnosis was in 37 cases non malignant disease states associated with effusions and in 71 cases tumoural effusions. Among the 37 cases of non malignant diseases states associated with effusions were 6 mechanical effusions, 27 inflammatory processes, 4 infectious processes. Among the 71 cases of tumoural effusions were 3 benign pleural lipomas, 50 metastatic carcinomas, 18 carcinomatous mesotheliomas. We studied the diagnostic accuracy of pleural brushing: in non malignant diseases pleural brushing show the non tumoural features of the process, in metastatic tumours biopsy was positive in 80% of the cases; pleural brushing in 78% of cases; taken together they allowed the diagnosis in 86% of the cases, in carcinomatous mesotheliomas biopsy was positive in 82.3%, pleural brushing in 78%; taken together they allowed the diagnosis in 89% of the cases. Pleural brushing allows a rapid cytological diagnosis, enhances the histological results and may be used to get cellular material in areas dangerous to biopsy.
Adenocarcinoma↗
[Pulmonary biopsy using thoracoscopy].
Pulmonary biopsies were taken under thoracoscopy from 16 patients presenting with insoluble diagnostic problems. This method enabled the authors to make a diagnosis, which was not contradicted by the course of the disease, in 14 cases of diffuse or circumscribed pathology touching the lung cortex. There was no major incident.
Biopsy↗
[Our experience with thoracoscopy (author's transl)].
The last two years, we carried out 25 thoracoscopies in 26 patients. The examination was not possible in 2 cases, because of severe adhesions, in one case neoplastic and in the other, fibrous. One patient had a bilateral exploration on two separate occasions. All these examinations were carried out under general anesthesia with differential intubation or, on occasion, tracheal intubation. The first 15 cases were carried out using the rigid bronchoscope with a cold light; the subsequent examinations were carried out using the Storz thoracoscope. From a diagnostic point of view, our patients broke down in the following manner: -metastatic pleurisies - 6, -pleural effusion in reaction to bronchial carcinoma -2, -post-radiotherapic pleural effusion - 1, -benign asbestos pleurisy -5, -cirrhotic pleural effusion - 1, -inflammatory pleurisy - 9. We carried out talcum adhesion of the pleura in only 4 cases : 2 cases of neoplastic pleurisy, 1 post-radiotherapy pleurisy, and 1 inflammatory pleurisy. There were 2 infectious complications in this series : one in a patient with diabetes, leading, indirectly, to death. The second was cured by pleuro-pulmonary decortication.
Chronic Disease↗
[Lung biopsy by thoracoscopy (author's transl)].
60 patients had 1 to 7 biopsies during thoracoscopy under light anaesthesia without tracheal intubation. Biopsies were performed under direct vision using a separation puncture. Double-spoon biopsy forceps (5 mm in diameter) connected to a 120 watt diathermy apparatus avoided any air leak age and ensured haemostasis as the biopsy was taken. The dry weight of the biopsies ranged between 5 and 40 mg, allowing appropriate studies with light or electron microscope, for bacteriological and mineral analysis, and for hormone receptors search in cancer cases. A size 20 to 30 Charrière drain was left for a mean of 3 days. No serious complications arose. Ten patients had a 38 degrees C fever for a few hours. In one case early in the study a drain had to be changed on the third day. An histopathological diagnosis was made in 12 out of 14 patients with localised pulmonary opacities and in all 14 cases with diffuse opacities. In 32 cases of pleural involvement the presence or absence of concomitant lung involvement could be demonstrated. Asbestos fibres counts by electron microscopy correlated fairly with previous exposure to asbestos. The sensibility of the technique was 96% (percent of true positives) and the specificity 100% (percent of true negatives). Thoracoscopic lung biopsy may thus be compared very favourably to techniques of lung biopsy and deserves a larger studies in order to confirm its low morbidity.
Adolescent↗
[Thoracoscopy. Results in pleural cancer (author's transl)].
Macroscopic features and related problems of pleural cancer, as seen by thoracoscopy, are presented. A reference is made to its frequent localization in the pleural bases and to its ascending progression. In cases of lung cancer with pleural effusion, such a technique opens the possibility to treat those patients in whom the non-metastatic nature of the effusion is confirmed. The higher yield of this procedure, as compared to needle pleural biopsy, is discussed and the possibility of performing intraoperative pleurodesis is emphasized.
Biopsy, Needle↗
[Thoracoscopy: therapeutic value in emergency pleuro-pulmonary syndromes and diagnostic value (author's transl)].
Thoracoscopy, a diagnostic method of high precision, may be considered to be a lifesaving gesture in certain dramatic situations. It offers the possibility of a precise diagnosis and effective therapeutic measures, which may be performed endoscopically. Such dramatic situations are represented above all by haemopneumothorax, high tension spontaneous pneumothorax and fulminating pleural effusions, as in Meigs syndrome. Pathology involved may range from traumatic, degenerative or inflammatory conditions to tumours of pathognomic malformations. A number of clinical cases spectacular by virtue of their clinical features, endoscopic diagnosis and successful treatment in dramatic circumstances, are presented.
Adult↗
The safety and versatility of video-thoracoscopy: a prospective analysis of 895 consecutive cases.
BACKGROUND: The application of video-endoscopy to general thoracic surgery is radically changing the approach to many benign and malignant diseases of the chest. Since July 1991, we have performed 794 purely thoracoscopic and 101 video-assisted thoracic surgical (VATS) procedures on 860 patients. STUDY DESIGN: Comprehensive, prospectively acquired data examining the specific indications for and outcomes of this new technique were prospectively entered into a thoracic surgical database. Preoperative, intraoperative, postoperative, and outcome variables were studied for the entire group as well as three high-risk cohorts: age over 70 years (n = 198), forced expiratory volume in one second (FEV1) of less than 1 L (n = 46), and Karnofsky performance index of less than 8 (n = 61). RESULTS: The 895 cases involved 449 men and 446 women of ages 15 to 89 years (mean 56 +/- 16 years standard deviation). The indications for surgery were diagnostic in 501 cases (56 percent), therapeutic in 244 cases (27 percent), and both diagnostic and therapeutic in an additional 150 cases (17 percent). The specific procedures performed were operations on the lung (569 cases), pleura (196 cases), esophagus (42 cases), mediastinum (51 cases), and pericardium (37 cases). Fifty-seven percent of the procedures were for a malignant process and 43 percent were for benign or infectious pathology. There were nine deaths for a series operative mortality rate of 1.0 percent. Thirteen patients (1.4 percent) required conversion to a limited thoracotomy for technical reasons. There were 127 complications in 121 patients yielding a morbidity rate in all patients of 14 percent. Mortality rates in the elderly, poor lung function, and depressed performance index cohorts were 1.5, 2.1, and 9.8 percent, respectively. Morbidity rates in these high-risk populations were 19, 30, and 18 percent, respectively. The median postoperative length of stay was three days after closed thoracoscopy and five days after VATS resection. CONCLUSIONS: These data underscore the flexibility, safety, efficacy, and potential for cost savings of videoscopic surgery in patients with thoracic diseases. The ability to perform excisional biopsy improves diagnostic specificity and sensitivity to nearly 100 percent. Video-assisted thoracic surgical techniques also offer a minimally invasive procedure with acceptable risk to patients heretofore inoperable by standard thoracotomy.
Adolescent↗
Thoracoscopy: a collaborative surgical approach.
Perioperative nurses, surgeons, anesthesiologists, certified registered nurse anesthetists, and pharmacists are meeting the challenge of decreasing thoracic surgical patients' length of hospital stay with thoracoscopy. This innovative alternative to traditional thoracotomy procedures has been achieved through an attentive team approach using the fundamental perioperative skills of assessment, positioning, safety, and sharing of knowledge.
Humans↗