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PubMedDate not supplied

Video-assisted thoracoscopic management of mediastinal tumors.

BACKGROUND: Many successful attempts at removing benign mediastinal tumors with the video-assisted thoracoscopic technique have been reported, but no formal report has been published regarding malignant mediastinal tumors treated with this technique. We report our preliminary experience with video-assisted thoracoscopic removal of mediastinal tumors, benign or malignant. METHODS: Seven patients with mediastinal tumors treated with video-assisted thoracoscopic surgery were reviewed from January 1999 to April 2000. Their tumor pathologies included benign or malignant thymoma, neurilemmoma, and teratoma. RESULTS: The mean operation time was 240 minutes. The mean blood loss was 173 mL. The mean insertion time of chest tubes was 3 days. The mean admission time was 6 days. No deaths occurred during the study. Morbidity occurred in 2 patients. No tumor recurrence has been seen during the mean follow-up of 7 months. CONCLUSIONS: The short-term results support the feasibility of VATS in managing technically resectable mediastinal tumors. Yet the long-term prognosis for the malignant lesions is deferred and needs further study.

Adolescent↗
PubMed1999

A developmental history of thoracoscopic surgery.

Thoracoscopic surgery, an old yet new discipline, has a history of 88 years, undergoing 4 stages in its course of development, namely, development, flourishing, decline and rejuvenation. This author claims that its developmental history can be divided into 5 periods, viz. embryonic stage of traditional thoracoscopic surgery and its flourishing, stagnation period, and the development and mature period of modern thoracoscopic surgery. In China, this discipline starts rather late and lags behing the advanced level of the world as a whole.

China↗
PubMed2001

Upper dorsal thoracoscopic sympathectomy for palmar hyperhidrosis. The use of harmonic scalpel versus diathermy.

BACKGROUND: Upper dorsal thoracoscopic sympathectomy, the treatment of choice for primary palmar hyperhidrosis, is not devoid of long-term complications, like Horner's syndrome and postoperative neuralgia. It has been postulated that propagation of heat induced by diathermy may be responsible for some of these sequelae. To assess this hypothesis, a study was undertaken to evaluate the use of harmonic scalpel, which does not dissipate heat. METHOD: Sixteen patients with primary palmar hyperhidrosis underwent upper dorsal thoracoscopic sympathectomy using the harmonic scalpel on one side and diathermy on the other. Follow-up was made two years postoperatively. RESULTS: The length of the procedure with each instrument was similar. There was no localization of postoperative pain, which could be attributed to either device. No Horner's syndrome or postoperative neuralgia occurred. CONCLUSION: The present study proved the safe use of harmonic scalpel for upper dorsal thoracoscopic sympathectomy, but did not detect any important advantage of either instrument over diathermy.

Adolescent↗
PubMed2001

[Video-assisted thoracoscopical surgery for pericardial cyst: report of two cases].

Two cases of pericardial cyst are reported. Case 1: A 51-year-old man, was admitted to the hospital because of an abnormal shadow on a chest CT scan. We confirmed a cystic mediastinal tumor situated between the superior vena cava and azygos vein. The cystic tumor was excised with a video-assisted thoracoscopic surgical procedure. Histopathological examination revealed a mesothelial-lined structure. Patient 2, a 34-year-old woman was admitted to the hospital because of an abnormal shadow on a chest radiographic film. Chest CT scan showed a cystic mediastinal tumor. The cystic tumor was excised with a video-assisted thoracoscopic surgical procedure. Histopathological examination revealed a mesothelial-lined structure. We would recommend video-assisted thoracoscopic surgery which is of great value in the treatment of pericardial cyst.

Adult↗
PubMed2001

A case of primary leiomyosarcoma of the chest wall successfully resected under the video-assisted thoracoscopic approach.

We report a case of a 62-year-old woman with primary leiomyosarcoma of the chest wall which was successfully resected under the video-assisted thoracoscopic approach. The disease was found during the treatment for a malignant melanoma of the left heel. On the preoperative CT images, the lesion was suspected to be a metastasis of the malignant melanoma. The thoracoscopic surgery revealed that the tumor originated from the parietal pleura, and it was resected with a 5-mm margin of normal pleura. Histopathologically, the tumor was diagnosed as low-grade leiomyosarcoma. Since no residual tumor cells were proven in the resected margins histologically, further resection was not performed. At present, she is alive and well with no sign of recurrence of leiomyosarcoma two years and one month after operation. Thoracoscopic surgery is worth trying for accurate diagnosis of and effective treatment for a chest lesion without apparent invasion of the chest wall on the preoperative CT images.

Biopsy↗
PubMed2002

The cardiopulmonary effects of single-lung ventilation and carbon dioxide insufflation during thoracoscopic internal mammary artery harvesting.

BACKGROUND: Thoracoscopic internal mammary artery harvesting has become an integral part of minimally invasive coronary artery bypass operations. The technique involves the use of single-lung ventilation and carbon dioxide insufflation to maximize exposure and facilitate rapid dissection. The hemodynamic and pulmonary effects of this technique have not been extensively studied. METHODS: Seventy-five consecutive patients undergoing a minimally invasive coronary artery bypass operation were prospectively studied intra-operatively. Sixty-six left and nine right thoracoscopic IMA harvests were performed in patients with ejection fractions ranging from 12 to 70%. Carbon dioxide insufflation was utilized in the range of 8 to 12mm Hg and the effects on cardiovascular and pulmonary performance were recorded to disk every sixty seconds. RESULTS: Carbon dioxide insufflation in combination with single-lung ventilation increases central venous pressure and pulmonary artery pressure. At higher levels of insufflation pressure, negative effects are seen on systemic blood pressure, cardiac output and left ventricular stroke work. These effects can be aggravated by hypovolemia and a poor preoperative left ventricular ejection fraction. CONCLUSIONS: Single-lung ventilation and carbon dioxide insufflation greatly enhances the technical ease of thoracoscopic internal mammary artery harvest. While safe in the majority of patients, CO2 insufflation should be used cautiously in hypovolemic patients and patients with poor left ventricular function.

Adult↗
PubMed2002

[Castleman lymphoma originated from the posterior mediastinum resected thoracoscopically: report of a case].

We report thoracoscopic resection of Castleman lymphoma originated from the posterior mediastinum. The patient was a 19-year-old woman, who was pointed out to show an abnormal shadow in the left upper lung in the chest X-ray photograph. It was diagnosed as a blood-rich posterior mediastinal tumor by dynamic MRI, and thoracoscopic surgery was performed. The tumor was adjacent to the vertebral body of the fourth thoracic vertebra. Although operation involved 2 hours and 40 minutes and 670 ml of bleeding due to a strong adhesion between the tumor and the intercostal muscle and considerable bleeding from the tumor itself, it was successfully removed under thoracoscopy. The tumor was elastic and hard, and 50 x 45 x 25 mm in size. The histopathological diagnosis was a Castleman lymphoma, hyaline vascular type. The postoperative course was satisfactory, and the patient was discharged from the hospital on the 7th postoperative day. Castleman lymphoma originated from the posterior mediastinum tends to bleed considerably during its resection. If a blood-rich posterior mediastinal tumor was found preoperatively, thoracoscopic operation must be advanced carefully keeping this disease in mind.

Adult↗
PubMedDate not supplied

Primary thoracoscopic evaluation of pleural effusion with local anesthesia: an alternative approach.

OBJECTIVE: The development of a thoracoscopically assisted technique to be performed with the patient under local anesthesia for both diagnostic and therapeutic purposes when treating pleural effusions and empyemas in high-risk surgical patients. METHODS: Twenty patients with pleural effusion or empyema who were also determined to be at high risk for complications following a thoracotomy, pleural biopsy, general anesthesia, or all of these, underwent placement of a thoracoscope while under local anesthesia followed by thoracic fluid drainage, pleural biopsy, and pleurodesis as required. Patients were retrospectively evaluated for a variety of factors including personal history, pre-existing medical conditions, and pre- and postoperative course. RESULTS: The average age of the patients was 59 years (18 to 89) with a 55% male/45% female sex distribution. Patients had this procedure as a consequence of malignancy (50%), empyema (30%), spontaneous pneumothorax (10%), bronchiectasis (50%), or heart failure (5%). The average duration of the procedure was 62 minutes (20 to 190), with an average of 861 mL of fluid drainage, and 114 mL of estimated blood loss. The tube thoracostomy was usually removed on the sixth (0 to 13) postprocedure day. This procedure was well tolerated by the patients with the majority of pain management being achieved with patient controlled analgesia (58%). The direct complication rate was 10%, with 2 patients requiring endotracheal intubation. CONCLUSION: This novel thoracoscopic procedure represents an acceptable alternative to the traditional treatment of pleural effusions and empyema with comparable outcome parameters and morbidity. This technique may eventually become the standard of care for the treatment of pleural effusions.

Adult↗
PubMed2002

[Thoracoscopic pericardial fenestration for persistent pericardial effusion after radiotherapy for esophageal cancer; report of a case].

We performed thoracoscopic pericardial fenestration for persistent pericardial effusion after radiotherapy for esophageal cancer. An 85-year-old man who had radiation therapy (70.2 Gy) for esophageal cancer was admitted for shortness of breath. Chest computed tomography showed a pericardial effusion. During the 6 months prior to this admission, the patient had undergone percutaneous pericardial drainage 3 times for cardiac tamponade. We performed thoracoscopic partial pericardiectomy with creation of a pleuropericardial window via one access port. Histopathologically, no malignant cells were found in either the resected pericardium or the pericardial effusion. Therefore, we believe the persistent pericardial effusion was secondary to radiotherapy. There was no recurrence of the pericardial effusion for 7 months postoperatively. In summary, thoracoscopic pericardial fenestration is useful in both the diagnosis and treatment of persistent pericardial effusion.

Aged↗
PubMed2002

[Electronic fiberesophagoscopy in video-assisted thoracoscopic surgery for benign esophageal diseases].

OBJECTIVE: To evaluate the effect of electronic fiberesophagoscopy in video-assisted thoracoscopic surgery for benign esophageal diseases. METHODS: We determined the position of lesion, separated the lesion from the esophageal wall, resected the lesion and protected the esophageal mucosa during the process of video-assisted thoracoscopic surgery for benign esophageal diseases. RESULTS: Thirty-six patients with benign esophageal disease underwent the operation successfully and recovered uneventfully. There was no operative death or severe perioperative complications such as esophago pleural fistula. Two patients were changed to undergo thoracotomy. CONCLUSIONS: Electronic fiberesophagoscopy is an essential equipment in video-assisted thoracoscopic surgery for benign esophageal diseases. It should be adopted as a routine equipment to ensure the accuracy, safety, reliability and convenience of this kind of operations.

Adolescent↗
PubMed2003

Video-assisted thoracoscopic lung biopsy in the diagnosis of diffuse interstitial lung disease. A prospective study.

AIM: Video-assisted thoracoscopic lung biopsy is commonly performed for diagnosis of diffuse interstitial lung disease. This study reports our experience with this technique in terms of diagnostic accuracy, complications and appropriate site for biopsy. METHODS: A prospective non-randomized study. SETTING: Thoracic Surgery Department, Chest Diseases Hospital, Kuwait. PATIENTS AND INTERVENTION: 79 consecutive patients undergoing thoracoscopic lung biopsy for diffuse interstitial lung disease from January 1995 to December 2001. Patients were divided into 2 groups; 34 patients with single biopsy from lingula or right middle lobe (RML) and 45 with 2 biopsies from other sites. MEASURES: comparison of operative and postoperative data, diagnostic accuracy, and complications between the two groups. RESULTS: The mean age of the patients was 38.9 years (range 15-75 years). There was no difference in the groups in operative time, 24 hours postoperative pleural drainage, chest tube drainage days, and hospital stay. Histologic diagnosis was achieved in 76/79 patients (96%). The diagnostic yield of each group was comparable (32/34 from lingula/RML; 44/45 other sites), (p=0.3). Postoperative complications occurred in 4/34 of patients with single biopsy from lingula or RML and 4/45 patients with 2 biopsies from other sites (p=0.6). There was 1 death in this series. CONCLUSIONS: Video-assisted thoracoscopic lung biopsy is an effective procedure. Single lung biopsy from lingula or RML compared to other anatomic sites has an equivalent diagnostic yield.

Adolescent↗
PubMed2003

[A device to prevent an air-leakage after a thoracoscopic surgery for spontaneous pneumothorax].

PURPOSE: In a thoracoscopic surgery for the patient with spontaneous pneumothorax, an air-leakage from the staple-line is one of the most troublesome complications. Recently we have been using a polyglycolic acid (PGA) sleeve for staple-line reinforcement. The purpose of this study was to investigate an efficacy of staple-line reinforcement in the patients who underwent thoracoscopic lung resection using an automatic stapler. OBJECTS: Last 4 years, 55 patients with primary spontaneous pneumothorax underwent thoracoscopic surgery using an automatic stapler. PGA sleeve was used in 19 patients as PGA group, fibrin glue was applied to the staple-line in 6 patients as fibrin group and no staple-line reinforcement was applied in 30 patients as no-reinforce group. We investigated the efficacy of staple-line reinforcement according to the results after surgery in these 3 groups. RESULTS: Average drainage time in PGA group, fibrin group and no-reinforce group were 2.1, 2.2 and 2.8 days, respectively. In PGA group, the drainage time after surgery tended to be short term. The relapse of pneumothorax after surgery developed in 2 patients in PGA group (10.5%) and 8 patients in non-reinforce group (26.7%). In PGA group, the relapse after surgery tended to be low rate. CONCLUSIONS: Bioabsorbable PGA sleeve could be an useful device for a staple-line reinforcement in the patients who underwent lung resection using automatic stapler.

Adolescent↗
PubMed2003

[The establishment of the styles of video-assisted thoracoscopic surgery for spontaneous pneumothorax].

Video-assisted thoracoscopic surgery (VATS) has been widely used in the treatment of a pneumothorax, but the high incidence of recurrence from spontaneous pneumothorax after VATS is an important problem. In this study, we classified the groups into two categories from the thoracoscopic observations, and discussed whether or not there was reappearance of pneumothorax. In addition, we examined whether adjunctive procedure contributes to recurrent of pneumothorax after operation or not. We concluded that there is a tendency to recurrence in the group with multiple and skip lesions in the lung, and then concluded that the cases apical covering with absorbable material sheet and the use of fibrin glue spray was thought to be effective of recurrence of pneumothorax in cases of multiple and skip lesions from the intraoperative findings through the thoracoscopes. Finally, we examined application of Foley catheter for spontaneous pneumothorax under VATS. It is possible that the application of Foley catheter to prevention against recurrence of pneumothorax is a valid method.

Adult↗
PubMed2003

[Complications of major lung resections by video-assisted thoracoscopic surgery].

Lobectomy by video-assisted thoracoscopic surgery (VATS) is gradually being performed more frequently because of advantages regarding pain and pulmonary function. Complications sometimes occur during or after VATS lobectomy. The purpose of this study was to analyze the incidence and the causes of the complications. From 1997 to 2003, 185 patients underwent VATS lobectomies. Selected diseases for this approach included primary lung cancer (n = 172), metastatic lung cancer (n = 7), benign lung tumors (n = 3) and lung sequestration (n = 3). The VATS approach was converted to open thoracotomy in 15 (8.1%) of 185 patients because of bleeding (n = 8), dense hilar adenopathy (DHA, n = 3), local extent of disease (n = 3) of intraoperative cardiac trouble (n = 1). Intraoperative complications involved injury to a blood vessel (n = 21), stapling failure (n = 15), lung injury (n = 7), nerve injury (n = 3), and others. Predictive factors for injury to pulmonary arteries was DHA (OR 37.0, p < 0.0001). Postoperative surgical death occurred in 2 patients due to pneumonia. Postoperative morbidity was 22.9%. A surgical operation without any good direct or thoracoscopic view or the use of a thoracoscopic tool without knowledge of the directions on its use should be avoided. The VATS approach should be replaced by open thoracotomy if there are DHA.

Humans↗
PubMedDate not supplied

Thoracoscopic pericardial window creation and thoracic duct ligation in neonates.

OBJECTIVE: We describe 2 newborn infants with persistent pericardial effusion treated with thoracoscopic pericardial window and thoracic duct ligation. METHODS: Patient 1 was a premature female newborn who presented with severe cardiac anomalies, including dextrocardia. She was treated with pulmonary artery handing and pacemaker placement for complete cardiac block. Postoperatively, she developed pericarditis with persistent symptomatic pericardial effusion. She did not improve despite pericardial drain placement. She was treated with a thoracoscopic pericardial window. Patient 2 was a newborn male who presented with cardiac tamponade secondary to congenital chylopericardium. He did not respond to pericardial drain placement or medical management with fasting, total parenteral nutrition, and octreotide. He was treated with thoracoscopic pericardial window and thoracic duct ligation. RESULTS: Patient 1 improved rapidly. The pericardial effusion disappeared. The chest tube was removed 5 days following surgery. She died 6 weeks later of a cardiac arrhythmia secondary to pacemaker failure. The pericardial effusion had resolved. Patient 2 responded to the pericardial window and thoracic duct ligation. He was discharged 10 days following the procedure. CONCLUSIONS: Thoracoscopy provides an excellent approach to the pericardium. Pericardial windows and biopsy can be safely performed with this approach. The thoracic duct can be easily identified and ligated even in small babies. Recovery can be fast with minimal postoperative discomfort. Cosmetic results are excellent and length of hospitalization is minimized.

Fatal Outcome↗
PubMed2003

[Anterior thoracoscopic approach of thoracic spine in adolescent idiopathic scoliosis].

The use of anterior surgical techniques for the treatment of adolescent idiopathic scoliosis (AIS) has increased recently and anterior discectomy, anterior release and fusion, instrumentation of the thoracic scoliosis can be performed through a thoracoscopic approach. The thoracoscopic approach has several advantages: small surgical trauma, early return to work, reduced postoperative pain and improved postoperative respiratory functions. Although the thoracoscopic approach still has some shortcomings currently, it will be widely accepted with further development of this technique and instrumentations in the future.

Adolescent↗
PubMed2003

Thoracoscopic lobectomy using robotic technology.

BACKGROUND: While robotic technology is gaining popularity in cardiac surgery, it also is being used to facilitate thoracoscopic procedures, such as insertion of phrenic pacemakers and resection of mediastinal masses. This report describes the use of robotic technology in performing thoracoscopic lobectomy. METHODS: One patient underwent a left lower lobectomy with the da Vinci robotic surgical system (Intuitive Surgical, Mountain View, CA, USA). With 3 1-cm port incisions and a 4-cm minithoracotomy in the left chest, visualization of the pertinent anatomy was excellent. Standard lymph node dissection was performed. The specimen was removed through the 4-cm minithoracotomy incision. RESULTS: Pathologic examination revealed mucinous adenocarcinoma. The margins of the specimen were negative, and there was no vascular or bronchial invasion. The patient's postoperative course was uneventful, and he was discharged to home on postoperative day 5. CONCLUSION: Robotic technology enhances visualization and instrument dexterity during thoracoscopic intrathoracic procedures. This technology can be used to facilitate development of minimally invasive thoracic approaches.

Adenocarcinoma, Mucinous↗
PubMed2003

Favorable outcome of parapneumonic empyema in children managed by primary video-assisted thoracoscopic debridement.

BACKGROUND AND PURPOSE: The appropriate type of intervention for the treatment of empyema in children remains controversial. This study analyzed whether video-assisted thoracoscopic debridement (VATD) as first-line treatment is effective in the management of pediatric parapneumonic empyema. METHODS: We retrospectively reviewed the medical and microbiological records of pediatric patients with parapneumonic empyema diagnosed at a medical center from January 1995 to December 2002. The 55 patients included in this study were initially treated with either tube thoracostomy drainage (TTD group [n = 37]) or video-assisted thoracoscopic debridement (VATD group [n = 18]). RESULTS: A comparative analysis found no significant difference in patient characteristics between these 2 groups. Patients in the VATD group had a significantly shorter duration of fever (18.9 +/- 1.7 vs 26.9 +/- 1.3 days), chest tube placement (5.3 +/- 0.7 vs 15.2 +/- 2.0 days), antibiotic therapy after the procedure (12.2 +/- 1.0 vs 26.3 +/- 2.8 days), and hospital stay (21.5 +/- 2.1 vs 33.2 +/- 2.8 days). No additional procedures were required in the VATD group, whereas 65% (24/37) of patients in the TTD group underwent salvage VATD. CONCLUSION: Primary management using video-assisted thoracoscopic decortication was more effective and reduced the duration of illness in pediatric patients with parapneumonic empyema.

Adolescent↗