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PubMed2006

[Robotically and video-assisted thoracoscopic interruption of patent ductus arteriosus].

Over the past decade, video-assisted thoracoscopic techniques have been used in the pediatric population. Recently, the computer-enhanced robotic system has been applied to video-assisted thoracoscopic interruption of patent ductus arteriosus (VATS-PDA). We focused on the utility of a voice-controlled robotic arm (automated endoscope system for optimal positioning: AESOP 3000) in VATS-PDA. Thirteen infants weighing 4.2 approximately 12.6 (mean 6.6) kg underwent robotically assisted VATS-PDA. Robotically assisted VATS-PDA is comparable with closure by means of the conventional video-assisted thoracoscopic technique.

Child, Preschool↗
PubMed2006

[Practice and education in thoracoscopic surgery].

There are 2 vectors in training in thoracoscopic surgery. One is a paradigm in which training is patterned on education in laparoscopic surgery centered on young surgeons, and the other is a paradigm in which introduction of thoracoscopic surgery is promoted among thoracic surgeons who are already active on the front line. Although the demand, degree of need, and content of each of these paradigms differ, the ultimate goal is the same. Thus, it is important to prepare a system that combines safer operations and less invasive surgical techniques, and haste is being made to prepare a society-initiated program. Publication of thoracoscopic surgery techniques that overcomes the barriers of university and school and support of technical standards are desirable, and we think that achieving this will be linked to the standardization of techniques.

General Surgery↗
PubMed2006

[Minimally invasive thoracotomy for the lung resection; without thoracoscopic procedure].

Video-assisted thoracoscopic surgery (VATS) is though to be a minimally invasive surgical procedure of lung resection. But there are some problems still remained about training, cost efficacy and oncological principles. Minimally invasive thoracotomy without thoracoscopic procedure was reviewed in this paper. In case of standard posterolateral thoracotomy with cutting ribs, it brings less postoperative pain and less dislocation of the ribs that fixes the ribs with bioabsorbable poly-L-lactide (PLLA) pins. Muscle sparing thoracotomy is available in broadly peeling off the muscle of trapezius and latissimus dorsi subcutaneously. But sometime much exudate collects subcutaneous wound in postoperative period so that some trouble or complication often occurs in the management of postoperative course. In case of axilloanterior thoracotomy we have proper view which is almost the same as standard posterolateral thoracotomy without cutting thoracic muscles. Skin incision runs from the axillar to the lateral margin of the breast and the 4th or 5th intercostal thoracotomy is performed through thoracodorsal muscle being pressed laterally, anterior serratus muscle being split. There is no need to cut the ribs, and good for the upper or middle lobectomy and the upper mediastinal dissection. Axilloanterior thoracotomy is minimally invasive than standard posterolateral thoracotomy and is useful for the surgery of upper or middle lobe lung cancer. In the procedure of thoracotomy operating with or without thoracoscope is not to be concerned. Important is to perform operation smoothly in adequate time for patients ease.

Humans↗
PubMed2006

[Thoracoscopic surgery and postoperative respiratory complications].

In minimally invasive surgery in a thoracic surgery, thoracoscopic surgery already has been recognized as effective procedure for benign disease of the lung and the mediastinum. On the other hand, induction of thoracoscopic surgery to lung cancer surgical treatment raises various problems. We reviewed clinical outcome about 'low invasiveness and a postoperative respiratory complication of thoracoscopic surgery' mainly on surgical treatment for lung cancer. Furthermore, in recent years there is a problem of surgical treatment for lung cancer that we developed for emphysema, interstitial pneumonia with increase of elderly patients. As for stage IA patients who underwent a lobectomy with mediastinal lymphadenectomy, we reviewed what kind of influence on postoperative complications and long-term prognosis with the change of thoracotomy methods.

Aged↗
PubMed2006

[Thoracoscopic approach for esophageal malignancies].

Current status and problems of thoracoscopic esophagectomy with mediastinal lymph node dissection for esophageal cancer are described. In the initial period at introduced this technique, many authors have concluded that postoperative morbidity after this procedure did not reduce compared with conventional technique. However, we clarified that this technique can be reduced the rate of postoperative pneumonia basis of series consisting a large number of experience, and conserve the respiratory function after surgery. Thoracoscopic approach for mediastinum can show the detailed anatomy and contribute to the improvement of safety of esophageal surgery. The establishment of a training system for this technique is important to achieve the standardization of thoracoscopic esophagectomy.

Esophageal Neoplasms↗
PubMed2006

Leiomyoma of the oesophagus managed by thoracoscopic enucleation.

The authors document two patients with oesophageal leiomyoma. In the first patient, a 41-year-old man, enucleation of the oesophageal leiomyoma was initially attempted by a thoracoscopic approach, but because of adherence of the tumour to the oesophageal mucosa, enucleation was completed by thoracotomy. Thoracoscopic enucleation was successfully performed in the second patient, a 62-year-old man. This paper includes a literature review on the pathology, diagnosis and surgical approach in the management of oesophageal leiomyoma. In conclusion, prudent use of thoracoscopic approach in the enucleation of oesophageal leiomyoma could potentially result in shorter hospital stay, decreased postoperative pain and reduced requirement for postoperative analgesia.

Adult↗
PubMed2006

[Long-term effects of video-assisted thoracoscopic thymectomy for myasthenia gravis: 5-year follow-up of 18 cases].

OBJECTIVE: To evaluate the long-term effects of video-assisted thoracoscopic thymectomy for myasthenia gravis (MG). METHODS: Eighteen MG patients, 7 males and 11 females, aged 33.4 +/- 9.4 (19 - 48), underwent video-assisted thoracoscopic thymectomy by the same surgical group from November 2001 to May 2005. Right side access was used in 14 of them, left side approach was used in 2, and bilateral approach in 1 of them. The thymus and fatty tissue in the front mediastinum were resected. The medical records were reviewed and telephone survey was conducted to understand the effects. The mean follow-up time was 26.4 +/- 10.9 months. RESULTS: VATS was successfully conducted except in 1 case. The bleeding volume was less than 50 ml. The average chest tube drainage time was 2.1 +/- 1.2 days, and the mean hospitalization day was 6.3 +/- 3.1 days. Three of the 18 patients needed temporary mechanical ventilation less than 72 hours, and 2 needed reintubation due to either myasthenic or cholinergic crises. Nine of the 18 patients achieved complete relief (50%) and 6 of them (33.3%) had their symptoms greatly improved, and the symptoms of one case remained stable (5.6%), and the overall effective rate was 83.3%. CONCLUSION: Video-assisted thoracoscopic thymectomy is a safe and effective method for treatment of myasthenia gravis with satisfactory long-term outcomes.

Adult↗
PubMed1979

[The value of thoracoscopic sympathectomy in the treatment of Raynaud's syndrome].

On the basis of a follow-up period lasting at least 6 years concerning 23 patients, in whom on account of a Raynaud-syndrome a thoracoscopic sympathicotomy in the region Th 2-5 was carried out in most cases bilaterally in two sessions, in comparison with the sympathicectomy performed in major surgery can be established:no mortality, no serious complications, duration of stay in hospital 5-7 days, no absolute healing. In a follow-up period of the same length in an approach of major surgery absolute healings are possible, but only in 35%. This gain is loaded by a longer stay in hospital of at least 10 days and a mortality of 4.3% as well as by a complication rate of 6-41%, to which in 8-13% of the cases a Horner-syndrome comes. Therefore, before an approach in major surgery a thoracoscopic intervention is to be tried. The thoracoscopic operators should strive for a sympathectomy with destroy of the ganglia Th 2 and 3 instead for a sympathicotomy.

Humans↗
PubMed1995

Thoracoscopic resection of a localized visceropleural mesothelioma.

Herein we present a case report of a 46-year-old man with a localized visceropleural mesothelioma detected incidentally during a health examination. The patient underwent a thoracoscopic resection, and his postoperative course was uneventful. A thoracoscopic resection of peripheral localized nodules can be easily performed using thoracoscopic techniques, and this method should not be considered inferior to thoracotomy in terms of curability.

Endoscopy↗
PubMed1995

[Epidural injection for postoperative pain relief after thoracoscopic surgery].

For the pain relief after thoracoscopic surgery, the epidural injection of buprenorphine was performed in 46 cases. In 28 cases, intermittent injection was performed before awaking from anesthesia. The effect was excellent in 6 cases, who were free from pain without any more injection after returning to the ward, and good in 27 cases, who sometimes felt dull pain and had another analgetics (intermittent epidural injection in 16 cases, intermittent epidural injection and another medication in 5 cases). In 18 cases, continuous injection was performed. The effect was excellent in 9 cases and good in 9 cases. It was concluded that the epidural injection had effective analgesic effect after thoracoscopic surgery, both in intermittent injection group and continuous injection group. For limited medication, the intermittent epidural injection was considered the first choice after thoracoscopic surgery.

Analgesia, Epidural↗
PubMed1995

[Partial resection of the lung under thoracoscopic guidance using endo GIA to treat giant bulla: a case report].

A 47-year-old male was admitted because of an abnormal shadow on chest X-ray. Computed tomography showed a giant bulla in the right lung. The giant bulla was resected under thoracoscopic guidance using endoscopic GIA by three puncture technique. The thoracoscope was inserted through the 5th intercostal space in the mid-axillar line. The forceps was inserted through the 5th intercostal space below the inferior angle of the right scapula. The Endo GIA was inserted through the 3rd intercostal space in the anterior axillar line. The residual lung expansion was good enough. The chest drain was removed 5 days after operation thoracoscopic surgery with Endo GIA can be useful in treatment of patients with emphysematous giant bulla.

Humans↗
PubMed1995

[Thoracoscopic surgery--experiences with a practical training course using an animal models].

Various thoracoscopic procedures have recently become an established method in thoracic surgery. However, a systematic teaching program is lacking. We present our experience with a 1-day training course, using anaesthetized pigs. Thoracoscopic operations, such as pericardial fenestration, wedge resection of the lung, subaortic and mediastinal lymph node dissection and pleurectomy have been exercised in groups of two. 7-12 months following the teaching course 40% of the participants had performed more than ten diagnostic or therapeutic thoracoscopic interventions in clinical situations. We conclude that our course helps participants to successfully apply this technique in clinical practice.

Animals↗
PubMed1993

Comparison of insufflated talc under thoracoscopic guidance with standard tetracycline and bleomycin pleurodesis for control of malignant pleural effusions.

The standard palliation of malignant pleural effusions involves tube thoracostomy drainage with chemical pleurodesis. The insufflation of intrapleural talc under thoracoscopic guidance (n = 39) was evaluated against documented controls that consisted of patients (n = 85) who participated in a randomized study with tube thoracostomy drainage followed by either bleomycin or tetracycline sclerosis. Under local anesthesia, which was supplemented by intravenous sedation, patients in the talc group underwent complete pleural fluid evacuation. The talc was then insufflated evenly on the entire pleural surface under thoracoscopic guidance. Of the patients in the talc group who survived their disease process, 97% had a successful pleurodesis at 30 days and 95% at 90 days. In comparison, the bleomycin group demonstrated a success rate of 64% at 30 days and 70% at 90 days (p = 0.003 and p = 0.047 versus the talc group). The tetracycline group had successful pleurodesis in only 33% at 30 days and 47% at 90 days (p < 0.001 and p < 0.001 versus the talc group). There were only two patients in the talc group in whom pleurodesis was not successful, and both were subsequently found to have extraluminal compression of the right lower lobe bronchus, which prevented lung reexpansion. These data demonstrate that the insufflation of talc into the pleural cavity under thoracoscopic guidance is a safe and efficacious procedure in the control of malignant pleural effusions.

Adult↗
PubMed1994

Thoracoscopic vagotomy for peptic ulcer disease--report of two cases.

Thoracoscopic vagotomy is a well-established technique in the management of recurrent peptic ulceration after previous abdominal vagotomy. The procedure allows an easy approach to the vagus nerves without having to dissect through dense adhesions from previous surgery. With thoracic vagotomy, the main morbidity is postoperative pain from the thoracotomy incision and rib spreading. Advances in endoscopic camera systems and instrumentation allow thoracic vagotomy to be safely and effectively accomplished by thoracoscopic surgery techniques, with reduced postoperative pain. We describe our experiences with thoracoscopic vagotomy in two cases of recurrent peptic ulceration.

Adult↗
PubMed1995

[CT-guided wire marking of peripheral pulmonary coin lesions--value for thoracoscopic resection].

Thoracoscopic identification of small and deep seated peripheral lung lesions may be difficult. To facilitate resection in such cases, a technique of CT-guided transthoracic hook wire localisation has been developed. We used this technique for localization of 12 peripheral lung lesions in 11 patients. In all cases the hook wire was correctly placed within or just beside the nodule and subsequent thoracoscopic resection was fast and easily accomplished in all. The described localization technique has a low complication rate and can be recommended for patients with small peripheral lung nodules subjected to thoracoscopic surgery.

Adenocarcinoma↗
PubMed1995

Early thoracoscopic debridement and drainage as definite treatment for pleural empyema.

OBJECTIVE: To report our experience with early thoracoscopic debridement and drainage in the treatment of pleural empyema in the fibrinopurulent or early organising phase. DESIGN: Prospective open study. SETTING: District hospital, Germany. SUBJECTS: 10 Patients operated on between August 1991 and April 1993. INTERVENTIONS: Double lumen intubation, followed by thoracoscopic opening of the empyema, evacuation of all pus under vision, debridement of the lung, irrigation of the thoracic cavity and insertion of a chest drain. MAIN OUTCOME MEASURES: Morbidity and mortality. RESULTS: Cultures taken during the operation grew no pathogens in five cases; Streptococcus pneumoniae, and haemolytic streptococci (once in combination with Staphylococcus aureus), were cultured in two cases each; and Mycobacterium tuberculosis in one. Chest drains were removed a mean of 8.5 days after operation. All patients were well without signs of infection 1-21 months later, and in no case was conversion to open operation necessary. CONCLUSION: Early thoracoscopic debridement and drainage is a safe and effective alternative to open treatment of patients with pleural empyema in the fibrinopurulent or early organising phase.

Adult↗
PubMed1995

[Thoracoscopic surgery of lung cancer].

Thoracoscopic surgery is a dream that was realized by the remarkable progress achieved in the video equipment system and the development of advanced surgical tools, in particular the endoscopic stapler. The main reasons for the rapid and wide introduction of thoracoscopic surgery are that patient injury is much less than with the traditional chest operation, there is no need for blood transfusion, the physical and mental loads on the patient are much less, and recovery from surgery is much faster. When performed by a skilled surgeon, it is a safe surgical operation, and this surgical technique may become applicable to about one-half of thoracic surgery. The application of robotics and the use of artificial satellites in the sector of thoracoscopic surgery may be possible in the future.

Female↗
PubMed1994

[A case of thoracoscopic pulmonary lobectomy for lung cancer].

A case of thoracoscopic right lower pulmonary lobectomy is reported. A 79-year-old man was admitted to our hospital after the accidental finding of a right pulmonary growth. A computed tomography (CT) scan of the thorax confirmed the presence of a neoplasm, 2.5 cm in diameter, at the posterior-basal segment of the right lower lobe. Considering the general condition of the patient and the characteristics of the lesion, we decided to perform a assess the possibility of a thoracoscopic lobectomy instead of the traditional posterolateral approach. The pulmonary artery was dissected with the new endoscopic cherry dissector, and ligated with the polyester suture material and Endo Clip then dived with Endo scissors. The lower pulmonary vein was dissected with this endoscopic cherry dissector and divided with Endo GIA 30 clamping the new thoracoscopic De Bakey type vascular clamp. The specimen was extracted through the minimal thoracotomy (15 cm). The postoperative course was uneventful with minimal postoperative pain, and the patient was discharged after complete surgical recovery with excellent functional and cosmetic results.

Aged↗