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PubMed2006

[Hans-Christian Jacobaeus (1879-1937): The inventor of human laparoscopy and thoracoscopy].

Already 94 years ago in 1910, Dr. Hans Christian Jacobaeus performed the first clinical laparoscopic surgery in Stockholm. His pioneering procedure was based on the animal experiments of Georg Kelling (1866-1945), a German physician from Dresden, who performed the first laparoscopic intervention in 1901 using a Nitze cystoscope in a dog. In 1910 Jacobaeus published his first experiences with laparoscopic surgery in the Münchner Medizinische Wochenschrift under the title "The possibility to perform cystoscopy in examinations of serous cavities." He used this technique for diagnostic purposes in unclear abdominal complaints and functional impairment. Jacobaeus was the first who pointed out the possibility of causing injury to organs, especially the gut, by inserting the trocar. In 1910 Jacobaeus recognized the immense diagnostic and therapeutic possibilities of laparoscopic surgery, but also the difficulties and limits. He also was the first who recognized the need to complete training sessions on animals and corpses. He demanded the development of special laparoscopic instruments to optimize and simplify the operation.

Animals↗
PubMed2002

[Development and clinical application of a thoracoscopy implantable plate frame for treatment of thoracolumbar fractures and instabilities].

The evolution of endoscopic spinal approaches and the associated possibilities for stabilization of the anterior column demands a new generation of spinal implants. Of particular interest is the possibility to implant using an endoscopic approach and the ability to achieve real angular stability so that for a suitable injury pattern an exclusively anterior procedure can be carried out. Since November 1999, a new type of anterior plate, MACS TL, developed to meet minimally invasive clinical requirements, has been used in the Berufsgenossenschaftliche Unfallklinik in Murnau, Germany for treating the mid and lower thoracic and lumbar region. The following reports on the results of the first 100 procedures carried out over a period of 15 months, of which 93% were performed endoscopically. The results convey a trend toward anterior endoscopic treatment of injuries of the anterior column using an implant with angular stability. The results now available on healing after fusion indicate the favorable influence of the stability provided by the implants on the bone-healing rate.

Adolescent↗
PubMed1999

[Thoracoscopy-guided management of the "anterior column". Methods and results].

Anterior thoracoscopic interbody stabilization and fusion was performed in 163 patients. Lesions treated were located between T4 and L3, most frequently occurring at T12/ L2. Operative time decreased dramatically as experience was gained with the procedure. 2 patients early in the series successfully were converted to an open procedure. One positioning related pressure harm on the thoracodorsal nerve and one irritation of the L1 root at the entrance site were both transitory. Postoperative control by X-ray and CTscan showed correct positioning of the bone graft, as well as the fixation device in all patients. Our experience with this minimally invasive procedure demonstrated the feasibility of the method. Major advantages compared to the open procedure are reduced morbidity of the approach, postoperative pain reduction, early recovery of function and shortened hospital stay.

Diaphragm↗
PubMed1993

Pain management principles and anesthesia techniques for thoracoscopy.

Thoracic surgeons have recently pursued innovative techniques that can help minimize postoperative pain. These have taken two basic directions. The first consists of a modification of the operative procedure itself, such that the surgical insult and hence the resulting pain are minimized. Modifications of the conventional thoracotomy technique have led to the development of the muscle-sparing thoracotomy and the linear or small transaxillary thoracotomy. The ultimate modification has been video-assisted thoracic surgery techniques, which are associated with a marked reduction in postoperative pain. The second approach centers on techniques that improve postoperative pain control. The recently published Agency Health Care Policy and Research guidelines provide a comprehensive review of the therapeutic options for postoperative pain control. These guidelines emphasize the value of nonsteroidal antiinflammatory drugs in conjunction with opioids as the preferred form of analgesia. Many authors have advocated the induction of spinal analgesia after thoracotomy, using either epidural opioids or local anesthesia, or both. Patient-controlled analgesia and multiple intercostal nerve blocks are other methods for managing postthoracotomy pain. The potential benefits conferred by aggressive pain control after thoracotomy are enormous for the patients, the surgeons, and the entire health-care system.

Analgesia↗
PubMed1993

Thoracoscopy for staging of lung cancer.

The recent advancements in diagnosis and treatment of thoracic disease have been made mostly in line with advancements in endoscopic equipment design and refinement of thoracoscopic surgery techniques. Between March 1992 and February 1993, video thoracoscopic procedures were performed in 50 patients. Twelve of the 50 patients were diagnosed with lung cancer. Thoracic staging was performed in 6 patients (clinical diagnosis of suspicious intrapulmonary metastasis, 3 patients; intrapulmonary metastasis and/or lymph node metastasis, 1 patient; interlobar pleural effusion, 1 patient; and pleural dissemination, 1 patient). There were no complications or mortality associated with these procedures. Our initial experience has indicated that thoracoscopic staging for lung cancer is a safe and effective procedure.

Adenocarcinoma↗
PubMed1993

Thoracoscopy for spontaneous pneumothorax.

Video-assisted thoracic surgical approaches appear to be viable alternatives to thoracotomy when surgical management of spontaneous pneumothorax is required. Apical bullae of the lung can be resected, and pleural abrasion can be accomplished with minimal postoperative morbidity and usually a shorter postoperative stay in hospital. Fifteen patients with primary (n = 9) and secondary (n = 6) spontaneous pneumothoraces have recently been treated by our group with the video-assisted thoracic surgical approach. Secondary pneumothoraces in the 6 patients were a result of cystic fibrosis (n = 2) and chronic obstructive pulmonary disease (n = 2), iatrogenic (n = 1), and post heart-lung transplantation (n = 1). All were treated by endoscopic stapled resection of bullous disease and pleural abrasion. There were no deaths. In 2 patients with secondary spontaneous pneumothorax, recurrent pneumothoraces developed eventually requiring thoracotomy for direct surgical management.

Humans↗
PubMed1993

Thoracoscopy for diagnosis of diffuse lung disease.

Diffuse lung diseases due to a wide variety of conditions are amenable to diagnosis by means of clinical evaluation, bronchoalveolar lavage, transbronchial biopsy, and lung biopsy. The recently introduced technique of thoracoscopic wedge biopsy provides the potential advantages of greater selection of biopsy sites and reduced postoperative pain compared with that associated with standard open lung biopsy. Its overall accuracy cited in initial reports has exceeded 90%. Although it is supplanting open lung biopsy as the most common operative technique for diagnosing diffuse pulmonary abnormalities, the availability of thoracoscopic lung biopsy should not alter the current indications for the initial use of bronchoscopic techniques in selected patients. In addition, because of the additional risk carried by thoracoscopic lung biopsy, open lung biopsy should still be used preferentially in patients suffering from acute decompensation, pulmonary hypertension, or coagulation disorders.

Biopsy↗
PubMed1993

Thoracoscopy for autonomic disorders.

Sympathetic denervation of the arm, the hand, and the heart may now be performed using minimal thoracoscopic procedures. During a 5-year period more than 500 patients were operated on with no major and only a few minor complications. An operation time of 25 minutes, a hospital stay of 1 day, and sick leave of less than 1 week have made the operation suitable for autonomous disorders such as hyperhidrosis. Other conditions such as causalgia, vascular insufficiency, and angina pectoris may be improved or disappear after sympathectomy, but the recurrence rate in Raynaud's disease is high.

Autonomic Nervous System Diseases↗
PubMed1993

Thoracoscopy in Europe: views from North America.

A 4-month "minisabbatical" (June through September 1992) provided me with a selected view of the current status of thoracoscopic surgery as it is being performed in Europe. This experience comprised visits to three countries and a total of five clinical units doing endoscopic surgery. Observations are grouped into five categories: (1) the clinical spectrum of thoracoscopic procedures, (2) operating room design, (3) the evolution of instrumentation and imaging, (4) educational programs, and (5) strategies for testing innovative technologies. This short visit convinced me of the need for greater communication with our European colleagues.

Canada↗
PubMed1993

Application of thoracoscopy for diseases of the spine.

For anterior approaches to the thoracic spine, a posterolateral thoracotomy has been the standard approach. Recent expanded experience with video-assisted thoracic surgical techniques has allowed us to perform many thoracic spine procedures that previously required open approaches. These procedures include drainage of spinal abscesses, biopsy of vertebral bodies, discectomy for a herniated nucleus pulposus, and anterior releases for kyphoscoliosis. All procedures were successful, but experience is limited and follow-up still short. It is hoped that further experience will prove that this less invasive approach can be widely applied in the practice of thoracic spinal surgery.

Humans↗
PubMed1993

Implantable cardioverter defibrillator: the role of thoracoscopy.

Video techniques have been used in many centers to assist with pericardial patch placement for implantable defibrillators. Although there are some specific instances where this technique would be helpful, the success of the transvenous systems will limit the application of this approach.

Defibrillators, Implantable↗