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PubMed1994

[Thoracoscopy for the treatment of spontaneous pneumothorax].

Video-assisted thoracoscopy has used for lots of thoracic disorders. Spontaneous pneumothorax may be ideally suited for thoracoscopic management. Stapling of apical blebs and pleurodesis can now be performed thoracoscopically. We compared our results with thoracoscopic management of spontaneous pneumothorax in 12 patients (group I) with a group of 8 patients (group II) previously subjected to lateral thoracotomy. Operative time and hospital stay were less in group I (P < 0.05), as the use of parenteral narcotics after 24 hours (P < 0.05). There have been no recurrences to date in group I. Video-assisted thoracoscopic management is safe and offers the benefits of shorter hospital stays and less pain.

Adolescent↗
PubMed1995

A comparative retrospective study of thoracoscopy versus thoracotomy for the treatment of spontaneous pneumothorax.

Thoracoscopic surgery has been claimed to reduce patient disability, recovery time, and hospital costs compared with open surgery. We analyzed 25 patients who had undergone thoracoscopic surgery and compared the outcome to 24 patients who had undergone conventional surgery for spontaneous pneumothorax. The thoracoscopic group was able to return to work and daily activities earlier and had less impairment of shoulder movement. There was a loss of sensation corresponding to the dermatomes where the thoracoscopic ports were placed, which could have resulted from compression of the intercostal nerves by the instruments. However, a similar loss of sensation was found in the thoracotomy group. We conclude that thoracoscopy may be the method of choice for the treatment of spontaneous pneumothorax, although further methodological development should be done.

Activities of Daily Living↗
PubMed1995

Use of thoracoscopy and a minimal thoracotomy, in mammary-coronary bypass to left anterior descending artery, without extracorporeal circulation. Experience in 2 cases.

A new surgical approach to mammary-coronary bypasses, to the left anterior descending artery, without the use of extracorporeal circulation, is described here. A minimal left anterior thoracotomy and the use of thoracoscopy are combined in this procedure performed in two patients (54-year-old male and 56-year-old male). Results were excellent: both patients were soon discharged from hospital (3 days patient 1 and 36 hours patient 2). Neither blood nor inotropic drugs were required. New angiographies previous to discharge were done, showing 100% patency of the mammary grafts. Both patients are angina-free. Due to its simplicity, and with more experience, this technique could be a good alternative for patients with severe lesions of the left anterior descending artery.

Extracorporeal Circulation↗
PubMed1994

Thoracoscopy in infants and children.

Thoracoscopy is a rapidly advancing technique in the diagnosis and treatment of children. Miniaturization of instrumentation and improved optics now allow extensive intrathoracic procedures to be performed in infants as small as 2 kg. Procedures such as lung biopsy and resection, biopsy or removal of mediastinal masses, esophageal surgery, and even patent ductus arteriosus closure can now be performed safely with minimally invasive techniques.

Anesthesia, General↗
PubMed1995

[The diagnostic value of thoracoscopy in solid masses of the mediastinum].

Despite the accuracy of percutaneous biopsy of mediastinal masses under CT scan or sonographic control, there is still a need for surgical biopsy either because of difficult location or because of insufficiency of the percutaneous biopsy, especially for those of the tumors requiring an immunological classification. The thoracoscopic approach of mediastinal masses is an alternative to the usual surgical biopsies performed through thoracotomy, sternotomy or anterior mediastinotomy. The procedure is performed under general anaesthesia and one-lung ventilation. In a series of 44 cases, an histological diagnosis was obtained in 41 cases (93.1%). There was one haemorrhagic complication requiring thoracotomy (2.3%). The mean post-operative duration of stay was 3.2 days. We conclude that thoracoscopy is the method of choice in case of failure or contraindication of percutaneous biopsy. There is still a role for mediastinoscopy for laterotracheal lymph nodes.

Adult↗
PubMedDate not supplied

[The clinical picture of pleural tuberculosis (based on the results of thoracoscopy in 500 patients with a pleural exudate)].

The author presents results of 500 thoracoscopies performed in 500 patients with pleural effusion. Tuberculosis and malignant tumors prevailed (51.8 and 20.8% respectively). Endoscopic examination of pleural cavity amplified by pleural biopsy and cytohistological study of obtained material was shown to be highly effective. In the author's opinion, wet pleurisy is sure to be a surgical problem. To solve it, he considers necessary to allocate 8-10 hospital beds for every 1.5 million of population (in thoracal department of surgical and pulmonological centres, TB dispensaries) right up to organization of pleural pathology departments.

Biopsy↗
PubMed1994

Open tube thoracoscopy for removal of intrapleural foreign bodies.

Failure to remove all sponges and surgical instruments from the operative field after thoracic surgical procedures can lead to serious complications. Fortunately this occurrence is rare and preventable. Two patients are described in whom intrapleural foreign bodies were successfully removed by open tube thoracoscopy, a technique that the authors recommend as the procedure of choice in such cases.

Child, Preschool↗
PubMed1994

Combined thoracoscopy and mediastinoscopy for the evaluation of mediastinal lymph node metastasis in left upper lobe lung cancer.

Cervical mediastinoscopy has an important but limited role in the evaluation of mediastinal adenopathy of the aorticopulmonary window in patients with left lung cancer. Thoracoscopy is another valuable diagnostic procedure in the assessment of mediastinal adenopathy. Combined thoracoscopic and mediastinoscopic evaluation may be more accurate for assessing mediastinal lymph node metastasis in left lung cancer than either procedure alone.

Adenocarcinoma↗
PubMed1994

Anesthesia for thoracoscopy: an overview.

Advances in technology have provided the means to reduce the length of stay for some surgical patients while offering increased quality of care. Videoscopic surgery is a rapidly expanding technology with increasing applications. When used in place of open thoracotomy, thoracoscopy offers the patient a less traumatic treatment modality. This procedure presents challenges to the anesthetist in choosing anesthetic technique, patient monitoring, and maintenance of cardiorespiratory function in the presence of pneumothorax and a variety of coexisting disease states.

Anesthesia↗
PubMed1993

[Video-assisted thoracoscopy and thoracic surgery: the first 50 patients].

We report our first full year of clinical experience with video assisted thoracic surgery. From September 1991 to October 1992, 50 patients were treated using endoscopic surgical techniques. There were 29 men and 21 women with a mean age of 48 years, ranging from 17 to 76 years. Drainage and talc poudrage of pleural effusions, with or without pleurodesis, was done in 18 patients (36%), blebectomies with pleurectomy or pleural abrasion was done in 11 patients (22%), and 7 patients (14%) underwent wedge resections of pulmonary lesions. Four other patients (8%) underwent resections or biopsies of mediastinal tumors, and 3 (6%) pericardial windows were done for cardiac tamponade. Finally, one chest wall biopsy and one empyema drainage were carried out, and 5 thoracoscopies were limited to the exploration of the chest. Complications occurred in 5 patients (10%). There was one mortality. Video-assisted thoracic surgery is efficacious in the treatment of various thoracic diseases and associated with satisfactory results in selected patients.

Adolescent↗
PubMed1994

[A case of coccidioidomycosis that was extirpated under thoracoscopy].

We report a case of coccidioidosis, which occurred in a 49-year-old Japanese man. He came back to Japan in 1994 after living in California in the U.S. for 2 years, and showed a round shadow in the left lower lung field on chest X-ray. A tumor was 1.4 cm in diameter and located in the left S8 showed by chest CT and the bronchography. It was extirpated under thoracoscopy. Histology of the tumor revealed chronic inflammation of the lung tissue, that contained a spherule of a diameter of 20-60 microns and endospores of a length of 2-6 microns. These structures were identified morphologically as coccidioides immitis. Only 3 cases of benign residual coccidioidal lesions have been reported in Japan including this case.

Chronic Disease↗
PubMed1993

[Diagnostic and therapeutic thoracoscopy: apropos of 100 cases].

Results and complications of 100 consecutive thoracoscopies performed with local anesthesia, in our department of pneumology are reviewed. The group is constituted by 60 men and 40 women with an average age of 56.1 +/- 16.7 years (13-81). Age difference between tumoral (n = 58) and tuberculous patients (n = 13) was statistically significant (59.6 +/- 12.8 vs 39.3 +/- 18.7; p < 0.001). The most frequent symptom on presentation was dyspnea, an significant association was detected between fever and tuberculosis (p < 0.001). Final diagnosis were: tumor (n = 58), non-specific inflammation (n = 16), tuberculosis (n = 13), pneumothorax (n = 11) and pneumonia (n = 2). In 14 patients some complication of the procedure appeared, all of these had little clinical significance and were resolved with minimal nursing care. To diagnose tumor, macroscopic aspect showed a sensitivity of 96.1%, specificity of 86% and 92% assurance.

Adolescent↗
PubMed1993

The evolving role of thoracoscopy in the diagnosis and treatment of chest disease.

Between April 1, 1988 and April 1, 1993, 88 patients underwent thoracoscopic procedures for diagnosis or treatment or both of diseases which had previously been approached by standard thoracotomy in our practice. Fifty-three (60.2%) were men and 35 (39.8%) women. The median age was 63, range 19 to 88 years. Although the indications for operation generally fell into one of five categories, the ultimate diagnoses established by the procedure spanned a wide array of chest pathology. Morbidity and mortality remained low and length of stay in hospital was favorable in comparison with a subset of patients with malignant pleural disease who underwent thoracotomy for diagnosis. Thoracoscopy, or video-assisted thoracic surgery (VATS), is a procedure which compares favorably with traditional thoracotomy in selected patients and its horizons as a diagnostic and therapeutic tool continue to expand.

Adult↗
PubMed1993

[New diagnostic and therapeutic prospects in peripheral nodules of the lung: surgical video thoracoscopy].

The new findings and results of laparoscopic surgery lead us to apply this technique in thoracic surgery. Thoracoscopy is an old diagnostic procedure, but advanced imaging techniques, improved optics and new classes of instrument have paved the way for many diagnostic and therapeutic approaches, before not feasible. Now it is possible to treat spontaneous pneumothorax, removal of mediastinal and peripheral tumors, with minimally invasive surgery. It is our belief that thoracoscopic surgery will be a valuable tool in the near future for a variety of chest disorders.

Anesthesia, General↗
PubMed1993

[Video-thoracoscopy diagnosis and treatment of persistent post-traumatic pneumothorax].

Despite correct chest tube drainage, 2 patients had persistent pneumothorax after blunt chest trauma and were referred for further treatment. Videothoracoscopy revealed small lung lacerations caused by rib fragments. A small wedge resection performed via thoracoscopy by the use of an endostapler resulted in immediate and permanent relief of air leakage.

Aged↗