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PubMed2001

Clinical pathway for impalpable or small lung lesions treated with coil marking and thoracoscopy.

OBJECTIVES: Advances in computed tomography are detecting increasingly impalpable or small pulmonary lesions. We propose a clinical pathway for managing such lesions. METHODS: We conducted a retrospective study in a community teaching hospital to describe the hospital schedules of 18 patients having 19 lesions 10 mm or less and ground glass attenuation. Under computed tomography, a coil (Complex Helical Fibered Platinum Coil-18) was placed at the proximal side of the lesion. Using thoracoscopy and radiographic fluorography, we conducted partial lung resection targeting the coil the next day, adding lobectomy, if required. RESULTS: Final diagnosis included primary and metastatic lung cancer (n = 14), atypical adenomatous hyperplasia (n = 1), and benignancy (n = 4). Patients were admitted 2* days before surgery (*Numbers are medians). On postoperative day 3, chest tubes were removed. Epidural analgesia was continued for 5 days. On postoperative day 7, patients were discharged. Their admission charge was a total of yen 979,610. CONCLUSIONS: The hospital course above may be applied to the clinical pathway for managing impalpable or small lung lesions.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed2000

Four-year experience with pleural abrasion using a rotating brush during video-assisted thoracoscopy.

BACKGROUND: Due to the high recurrence rate in primary spontaneous pneumothorax (PSP), surgical therapy is currently a well-accepted method of treating this condition. There is no general agreement about the best time for surgical intervention (i.e., after the first or second episode) or the optimal surgical approach,--i.e., tube thoracocenteses, thoracotomy, or video-assisted thoracoscopy (VATS) with or without pleurectomy or pleurodesis. The aim of this study was to verify the efficacy of VATS and mechanical brush pleurodesis using a rotating electrical brush system. METHODS: We treated 47 patients with PSP between June 1993 and June 1997. Follow-up ranged from 20 to 56 months. There were 38 male and nine female patients with a mean age of 26 years. Emergency thoracocenteses due to tension pneumothorax became necessary in three patients. All patients were treated by VATS and mechanical brush pleurodesis. Wedge resection was done if bullae or blebs were present (68.1%). RESULTS: Operating time was 20-60 min (mean, 35). There were no intraoperative complications and no conversions to conventional surgery. In the first few postoperative days, postoperative pain was controlled with nonsteroidal antirheumatic drugs and additional morphines. Drainage time was 3-7 days (mean, 4). Hospitalization time was 4-8 days (mean, 5). The recurrence rate was 2.1% (one patient). No postoperative bleeding or wound infection occurred in any of our patients. CONCLUSIONS: VATS combined with mechanical brush pleurodesis using the electrical brush system is a highly effective and safe treatment for patients with recurrent primary spontaneous pneumothorax.

Adolescent↗
PubMed1999

Usefulness of video thoracoscopy in the management of spontaneous and postoperation chylothorax.

BACKGROUND: The aim of this study was to evaluate indications and results of video thoracoscopy (VATS) in the management of nine chylothorax cases. METHODS: Four spontaneous chylothorax cases were treated by VATS and talc pleurodesis with immediate positive results. Among five postoperation chylothorax cases, two were treated early by VATS and selective lymphatic clipping (VATS group), and three had medical treatment (MT group). RESULTS: Duration of drainage was 4 days for the VATS group versus 15.3 days for MT group. Amount of collected chyle was 2.4 l versus 5.7 l, respectively. CONCLUSIONS: We suggest that VATS should be considered the treatment of choice for spontaneous chylothorax and could be indicated earlier in postoperation chylothorax.

Adult↗
PubMed2000

Video-assisted thoracoscopy system guidance in linear radiofrequency ablation.

The transcatheter creation of linear endocardial lesions in the atria has been attempted to restore sinus rhythm in patients with atrial fibrillation (AF). However, due to fluoroscopic limitations, there are a number of technical difficulties involved with using this procedure, which include determining the ablation site, orienting the catheter tip, and confirming tip-tissue contact. The present study was performed to assess the feasibility of employing a transthoracic approach to linear radiofrequency ablation using a video-assisted thoracoscopy system (VATS) to anatomically guide the experimental setting in beating swine hearts. AF was induced pharmacologically by aconitine solution. Epicardial radiofrequency linear ablation of the right atrium was conducted under VATS monitoring using an ablation catheter that was inserted and manipulated through trocar ports. The ablation energy setting was 80 degrees C with 30s duration per ablation. The thoracoscopic visual field for transthoracic ablation was adequate, and the ablation catheter was positioned and anchored safely on the atrial epicardium. The restoration of sinus rhythm was confirmed in the limb lead and atrial electrograms, and transmural heat degeneration was confirmed by postmortem histological examination in all specimens. Our results suggest the potential usefulness of VATS for providing adequate anatomical guidance in epicardial linear radiofrequency ablation.

Animals↗
PubMed1993

Equipment for thoracoscopy.

The combining of miniaturized video technology with thoracoscopy now allows surgeons to perform a variety of thoracic procedures percutaneously. Both rigid and flexible video thoracoscopes are available. The rigid endoscope has a camera located proximally at the eye-piece and is capable of excellent resolution. However, visualization of the entire pleural cavity is difficult because of the rigid chest wall. Placing the video camera at the distal end of a flexible thoracoscope, as in the electronic video thoracoscope (EVE-L; Fujinon, Wayne, NJ), yields better visualization of these relatively inaccessible areas. However, disadvantages of the flexible thoracoscope include increased expense and complexity, reduced resolution as compared to rigid systems, and the need for a strobed light source, thus making video-assisted surgery more difficult. Thoracoscopic wedge excisions of the lung are now possible because of the adaptation of gastrointestinal staplers for percutaneous use. The initial design consisted of a reloadable 30-mm disposable stapler. Newer models, however, have a longer staple line and some are reusable. Future refinements may allow the head of the instrument to articulate, thus permitting it to be applied to the lung at various angles. Thoracoscopic ports that provide an air-tight seal are available but are not essential; therefore, standard thoracotomy instruments can be utilized through small open incisions. Specialized disposable thoracoscopic instruments are also available, including scissors, dissectors, and fan retractors. It is hoped that the future will bring improved optics, better staplers, and refined percutaneous instrumentation.

Humans↗
PubMed2007

Cytokine response is lower after lung volume reduction through bilateral thoracoscopy versus sternotomy.

BACKGROUND: Lung volume reduction surgery performed through bilateral video-assisted thoracoscopy (BVATS) was associated in the National Emphysema Treatment Trial with a statistically significant reduction in intensive care unit days, failure to wean, hospital stay, and cost, and earlier recovery compared with median sternotomy. Studies comparing other minimally invasive techniques with "open" procedures, including pulmonary lobectomy, have demonstrated reduced serum proinflammatory mediators postoperatively. We measured these levels after lung volume reduction surgery through BVATS and sternotomy. METHODS: Serum cytokine levels were measured by radioimmunoassay in 9 consecutive, steroid-free patients undergoing sternotomy and lung volume reduction surgery and 6 undergoing BVATS and lung volume reduction surgery. The groups were not statistically different with respect to age, partial pressure of arterial carbon dioxide, percent forced expiratory volume in 1 second, percent residual volume, percent total lung capacity, diffusion capacity of the lung for carbon monoxide, 6-minute walk, or apical perfusion fraction. Proinflammatory interleukin 6 and interleukin 8 and antiinflammatory interleukin 10 were evaluated preoperatively and postoperatively on days 1, 4, and 5. Clinical data were prospectively collected. RESULTS: There were no major postoperative complications or deaths. Interleukin 6 levels were lower in the BVATS than the sternotomy group (p = 0.016 by repeated measures analysis of variance). Interleukin 8 levels were lower in the BVATS group at most postoperative time points, but there were no significant differences in interleukin 8 or interleukin 10 levels between the sternotomy and BVATS groups at any individual time point or by analysis of variance. CONCLUSIONS: Use of a BVATS approach to lung volume reduction surgery is associated with reduced postoperative release of proinflammatory cytokines compared with a sternotomy approach. This may account for the reduction in recovery time and some measures of postoperative morbidity seen with the BVATS approach.

Aged↗
PubMed2005

A simplified technique for implantation of left ventricular epicardial leads for biventricular re-synchronization using video-assisted thoracoscopy (VATS).

OBJECTIVE: Cardiac re-synchronization therapy for treatment of heart failure requires transvenous insertion of both a right ventricular and left ventricular pacing lead. Implantation of the latter by way of the coronary sinus often fails. Therefore, alternative techniques for insertion are required. We applied a simple video-assisted surgical technique (VATS) using only two ports for the insertion of left-ventricular screw-in electrodes. METHODS: Fifteen patients (M: 10; F: 5; mean age: 62.2 years; range: 46-76 years) with heart failure meeting the ACC/AHA guidelines for implantation of biventricular pacing underwent transvenous insertion of the right atrial sensor lead and the right ventricular pacing lead. In all of them transvenous implantation of the left ventricular pacing lead failed, and they were planned for VATS. In right-lateral decubitus position and under single-lung ventilation a camera port and a flexible instrumentation port were inserted in the forth intercostal space. By using routine instruments, a T-shaped incision was made lateral to the phrenic nerve and an electrode was screwed in. The lead was guided subcutaneously to the pacemaker. RESULTS: Mean skin-to-skin operating time was 55+/-16 min, no conversion to thoracotomy was necessary. All patients were extubated in the operating room and remained in the intensive care unit for less than 24h. Chest tubes were removed after a mean of 1.6+/-0.5 days and the patients were discharged after a mean of 4+/-1.3 days. Intraoperative and postoperative pacing thresholds at 1 and 7 months were satisfactory in all cases and there was no lead dislocation. All but two patients had an improvement of their NYHA function class. There was neither surgical morbidity nor mortality. CONCLUSIONS: Video-assisted thoracoscopy over two ports seems to be an excellent alternative procedure for epicardial lead implantation. It is readily available and produces good pacing results at a short intervention time and tolerable stress for the patients.

Aged↗
PubMed2003

Suction versus water seal after thoracoscopy for primary spontaneous pneumothorax: prospective randomized study.

BACKGROUND: The objectives of the study were to review our experience of video-assisted thoracoscopic apical pleurectomy and to evaluate whether suction or water seal is superior in the postoperative treatment of primary spontaneous pneumothorax. METHODS: One hundred consecutive patients undergoing thoracoscopy for primary spontaneous pneumothorax from January 1995 to December 1999 were prospectively randomly assigned after surgery to receive suction or water seal to their chest tubes after a brief period of suction. RESULTS: There were 50 patients in each group. The two groups were evenly matched for age and operation performed. The method of management was stapling of an identified bleb or apex of the upper lobe and apical pleurectomy. Postoperative prolonged air leak longer than 5 days occurred in 8 patients (8%), 7 in the suction group and 1 in the water seal group (p = 0.03). The mean duration of chest tube days was lower in the water seal group (2.7 days) than in the suction group (3.8 days; p = 0.004). The mean hospital stay in the water seal group was 3.7 days and in the suction group it was 4.8 days (p = 0.004). Mean follow-up was 48 months (range, 30 to 60) for all patients. Pneumothorax recurred in 2 patients (2%). The recurrences occurred in the first year. CONCLUSIONS: Video-assisted thoracoscopic apical pleurectomy is effective and safe for treating primary spontaneous pneumothorax. Placing chest tubes on water seal after a brief period of suction shortens the duration of chest tube placement and hence the hospital stay.

Adolescent↗
PubMed2006

[A new surgical technique for thoracic parathyroid glands: video-assisted thoracoscopy with intraoperative Tc-MIBI scintigraphy].

Ectopic mediastinal parathyroid glands are uncommon (1-11% of all cases of hyperparathyroidism). Median sternotomy used to be performed to resect them, with large and painful incisions that prolonged the length of hospital stay. Current imaging techniques (thoracic computed tomography and Tc-mibi scan) can accurately locate the ectopic glands, allowing minimally invasive exploration. We report a new surgical technique: video-assisted thoracoscopic resection associated with intraoperative Tc-mibi scintigraphy for ectopic mediastinal parathyroid glands. This technique allows minimally invasive access and reduces complications and length of hospital stay. Therefore we believe that video-assisted thoracoscopy could become the technique of choice in patients with high surgical risk and a fifth ectopic parathyroid gland. We report the case of a 49-year-old man in whom surgery was successful.

Choristoma↗
PubMedDate not supplied

[Resection of a mediastinal parathyroid adenoma by video-assisted thoracoscopy radio-guided by a gamma probe. A case report].

We present a case of primary hyperparathyroidism in a 47 year old woman. The pre-operative 99mTc-sestaMIBI scan detected a single parathyroid adenoma located in the anterior or medium mediastinum. Surgery was carried out following 99mTc-sestaMIBI administration and using gamma probe radio-guided video-assisted thoracoscopy. The aim of this case report is to present this technique that allows adenoma resection with minimally invasive surgery. A reduction of surgical complications and an increase in the probability of surgical success could be obtained.

Adenoma↗
PubMed1999

[Role of video-thoracoscopy in the pretreatment evaluation of lung carcinoma].

INTRODUCTION: Lung cancer is the first cause of cancer mortality in male patients in France. Treatment varies depending on the histological type and the disease extent at diagnosis. CURRENT KNOWLEDGE AND KEY POINTS: Videothoracoscopic staging appears to be an accurate method to assess the stage of lung cancer to guide rational management as it allows for 1) an accurate tissue diagnosis when standard methods failed, 2) the identification of a parietal or mediastinal invasion when suspected by CT-scan findings, 3) lymph node sampling of sites that are poorly or not reachable with mediastinoscopy, 4) the diagnosis of pleural or pericardial metastases in patients with effusion or indeterminate nodules, and finally 5) the conclusive answer to the diagnostic dilemma caused by the presence of a contralateral pulmonary nodule in patients with a potentially curable tumor. FUTURE PROSPECTS AND PROJECTS: Video-assisted thoracoscopy thus appears to have a complementary role in intrathoracic lung cancer staging when conventional methods are equivocal. Its main side-advantage is the opportunity to proceed without delay to the surgical treatment, when appropriate, in the same operative settings, or to perform in the same session various procedures, i.e., talc poudrage and pericardial window, to palliate adverse symptoms occurring in some of those patients. Obviously, equally efficient and less invasive approaches should have been considered previously. To date, however, videothoracoscopic evaluation of tumor resectability is not achievable. Finally, one may suppose that positron emission tomography will probably reduce the role of those invasive surgical procedures in a near future.

Humans↗
PubMed2000

[Bilateral lung reduction by video-assisted thoracoscopy in a patient with non-bullous pulmonary emphysema and laryngeal neoplasia].

Lung reduction has been show to be a promising treatment for the final phases of non-bullous pulmonary emphysema. The role of video-assisted thoracoscopy (VAT) in this disease has not yet been established. We report a case of bilateral non-bullous pulmonary emphysema in which transplantation was ruled out because of laryngeal neoplasm treated three months earlier. Using VAT, we performed bilateral lung reduction in the apical zones with good therapeutic results. We find that in patients reduction by VAT, although not a curative treatment, leads to immediate postoperative improvement in lung function and dyspnea, and does not exclude the possibility of later performing lung transplantation.

Carcinoma, Squamous Cell↗
PubMed2003

The role of thoracoscopy in the management of lung cancer.

The use of video-assisted thoracic surgery (VATS) has allowed surgeons to perform complex procedures that previously required a thoracotomy. While VATS is well accepted in the management of benign thoracic disease, its role in the management of lung cancer continues to evolve. VATS is utilized in many aspects of the management of lung cancer including the evaluation of indeterminate pulmonary nodules and pleural effusions, staging of mediastinal lymph nodes, and the resection of primary and metastatic tumors. However, concerns regarding cost, training issues, and adherence to oncological principles have caused some surgeons to proceed more slowly. This review discusses the current role of thoracoscopy in the management of lung cancer.

Humans↗
PubMed2001

Thoracoscopy for minimally invasive axillo-coronary artery bypass.

Minimally invasive axillo-coronary artery bypass via a small thoracotomy or a limited sternotomy was performed in five patients. For this approach, videoscopy was used to determine the intrapleural path of each vein graft, which was curved by the expanded lung tissue and had the potential for kinking or distortion. Postoperative angiography confirmed the patency of each graft with no kinking or distortion. Thoracoscopy facilitates this approach, allowing appropriate placement of the vein graft in the chest cavity.

Aged↗
PubMed1997

Bilateral thoracoscopy for sympathectomy in the treatment of hyperhidrosis.

Thoracoscopic sympathectomy has been established as the least invasive technique with high success rates for treatment of palmary hyperhidrosis [1,4,5]. In our procedure both sides are treated during the same operation. A bilateral thoracoscopy was performed in 20 patients for incapacitating hyperhidrosis. Immediate complications at operation were minimal. All patients reported satisfaction with the procedure in spite of compensatory sweating. The short hospital stay has significant financial benefits and these are increased if both sides are treated at the same time. This procedure is more aggressive than the single side procedure but the morbidity is not increased.

Adolescent↗
PubMed1999

Gas movement in the nonventilated lung at the onset of single-lung ventilation for video-assisted thoracoscopy.

To assess the potential for atmospheric nitrogen to enter the nonventilated lung following the initiation of single-lung ventilation, the nonventilated lung of 10 patients undergoing video-assisted thoracoscopy was connected to the air in a water-filled spirometer, and gas movement out of and back into the lung was measured. Airway pressure from both lungs and pleural pressure from the nonventilated side were also measured. With each breath of positive-pressure ventilation to the ventilated lung prior to the thoracic cavity being opened to the atmosphere, the pressure transmitted to the opposite hemithorax generated a mean (range) tidal movement of gas in the nonventilated lung of 134 (65-265) ml. In addition, ongoing gas exchange resulted in a progressive influx of gas from the spirometer over the 110-120 s measurement period of a mean (range) volume of 155 (70-320) ml. This easily preventable influx of atmospheric nitrogen could, in theory, predispose to arterial desaturation and to delayed lung collapse after the parietal pleura is opened.

Adolescent↗
PubMed2004

Postoperative analgesia in video-assisted thoracoscopy: the role of intercostal blockade.

OBJECTIVES: This study examined (1) the opioid and nonopioid requirement of patients undergoing video-assisted thoracoscopy (VATS) as a measure of postoperative pain and (2) whether percutaneous intercostal blockade might reduce morphine requirements and improve analgesia in VATS procedures. DESIGN: A combined retrospective and prospective study. SETTING: A university teaching hospital. PARTICIPANTS: Patients undergoing VATS procedures. INTERVENTIONS: A retrospective analysis of 26 sequential patients; perioperative intercostal blockade with bupivacaine, either with or without dextran 40, in 26 prospective patients. MEASUREMENTS AND MAIN RESULTS: Retrospective: opioid and nonopioid analgesic requirements of 26 sequential patients who had undergone VATS surgery without intercostal blockade were determined from a study of the case records. Twenty-six additional patients undergoing VATS surgery by the same surgeon were randomly divided to receive either percutaneous intercostal nerve block using plain bupivacaine 0.375% or bupivacaine 0.375% in dextran 40. The duration of local anesthesia was assessed. Postoperative opioid and nonopioid analgesic requirements were compared with the retrospective group. CONCLUSIONS: Postoperative morphine requirements after VATS surgery are considerable, with pleurectomy being the most painful procedure. Intercostal blockade with bupivacaine provided effective pain relief and a dramatic reduction in morphine requirements. This technique is recommended for VATS surgery, especially if day-case procedures are being contemplated.

Analgesics↗
PubMed2002

Submuscular bar, multiple pericostal bar fixation, bilateral thoracoscopy: A modified Nuss repair in adolescents.

BACKGROUND/PURPOSE: Thoracoscopic Nuss repair of funnel chests is used increasingly, but has a high bar dislocation rate. The authors intended to reduce this by technical modifications of the original Nuss technique. METHODS: In 40 patients from 12.3 to 42.1 years of age (mean, 17.6 +/- 5.8) the bars were placed directly on the ribs in a submuscular position and fixed by a minimum of 14 absorbable figure of 8 sutures around the bar and the underlying rib placed under bilateral thoracoscopy. Two stabilizers were used in all patients, the bar was introduced from the left in severe cases, and a second bar was implanted in most beyond 16 years of age. All patients underwent follow-up to date in a prospective observation study. RESULTS: There was no bar or stabilizer dislocation, no prolonged pain or neuralgia, but one traumatic seroma, one pleural, and one pericardial effusion. One bar was easily removed after 13 months. CONCLUSIONS: Submuscular position provides a far better bar fixation and soft tissue coverage of Nuss implants. The technique is technically more demanding but safe and has reduced the incidence of bar dislocation to zero in this early experience of 40 adolescent patients, although no sportive restrictions were imposed on the patients at all.

Adolescent↗