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At least 577 records · Page 32Linked to original sources
PubMed1994

Video-assisted thoracoscopic T2 sympathectomy for hyperhidrosis palmaris.

BACKGROUND: Hyperhidrosis palmaris is a functionally and socially disabling problem. Thoracic sympathectomy of the T2 ganglion has proved to be the time-honored treatment modality. STUDY DESIGN: The results of this study demonstrate the effectiveness of video-assisted thoracoscope for treatment of hyperhidrosis palmaris. The possibility to apply different anesthetic techniques and to measure surface temperature change of the hand were documented as well. RESULTS: Eighty consecutive cases (159 procedures) of essential hyperhidrosis palmaris were treated by video-assisted thoracoscopic T2 sympathectomy between January 1991 and December 1992. The surgical results were classified as excellent (much improved, very dry) in 88.1 percent, good (improved, minimal wet) in 9.4 percent, and fair (slightly improved, still wet) in 2.5 percent of the patients. The postoperative complications included one prolonged air leakage, one hemothorax, two wound infections, and 15 cases of facial anhidrosis. There were no recurrent cases (mean follow-up, 14.5 months). Fifty-six patients had concomitant hyperhidrosis pedum. Interestingly enough, through unknown mechanism, 64.3 percent of the patients with concomitant hyperhidrosis pedum were cured after this procedure. CONCLUSIONS: Video-assisted thoracoscopy provides magnified surgical fields, which make thoracoscopic sympathectomy for hyperhidrosis palmaris an effective, safe, easy to use, and time-saving procedure. This technique is also excellent for teaching purposes and allows the assistant to participate in the operation.

Adolescent↗
PubMed1994

[Thoracoscopic resection of schwannoma: a report of two cases].

We have performed thoracoscopic resection of schwannoma without intraspinal extension in two asymptomatic cases confirmed by chest roentgenogram and computed tomography: the case 1 with the tumor as large as 4.0 x 4.0 x 3.5 cm found in the paravertebral fifth Intercostal space, the case 2 with the tumor as large as 3.2 x 2.5 x 1.8 cm found on the first rib in contact with the supreme intercostal vein. In the operation of case 1, the dilated fifth intercostal vein in contact with the tumor which could not be controlled by Endo-Clip was doubly ligated by the use of Knot-Pusher. The tumor was successfully dissected from the chest wall and proved to arise from the fifth intercostal nerve. The tumor was brought into Endo-Pouch and extracted through one of the skin incisions which was minimally enlarged to accommodate the pouched lesion. In the operation of case 2, curved forceps facilitated the procedure because the tumor located near the apex of thorax. The tumor was found to originate from sympathetic nerve and removed through the minimally enlarged incision as case 1. We conclude as the following. The benign tumor found in the mediastinum or the chest wall is amenable to thoracoscopic treatment. In thoracoscopic procedure, as the operation under thoracotomy, we must acquire skills of standard operative technique, i.e., suture or ligation, because those skills are necessary when Endo-Clip or Endo-GIA cannot be used. The skin incision should be minimally enlarged finally when the specimen is extracted to minimize operative intervention.

Adult↗
PubMed1994

[Thoracoscopic pleurodesis in spontaneous pneumothorax].

The immediate effects and long-term results are reported of thoracoscopic pleurodesis in 225 patients (158 men, 67 women) treated for persistent or recurrent spontaneous pneumothorax. The procedure was performed by combined local and neurolept analgesia with direct visual exploration of the pleural space through a rigid thoracoscope. The technique included electrocoagulation of small pleural blebs, followed by regional application of fibrin and insufflation of talc powder. The main indications were a first event which persisted more than 7 days despite chest-tube suction drainage in 27% (n = 61) or a recurrent event in 73% (n = 164). The procedure provided primary success in 96.4% of the patients. Only 8 patients (3.6%) required surgical intervention including parietal pleurectomy. Perioperative complications were pharmacologically induced respiratory failure (n = 5), generalized subcutaneous emphysema (n = 8), bleeding by cutting adhesions (n = 5) and Horner's syndrome (n = 2). However, no fatal complications occurred which could be ascribed to the procedure and all patients were discharged from the hospital after an average of 12.3 days except one who died of pulmonary embolism 5 days after thoracoscopy. Long-term follow-up over a mean period of 4.1 years revealed an ipsilateral recurrence rate of 10.2% (n = 24), 16% of the patients complained of sporadic pains at the site of insertion, 51% still had diffuse thoracic pains and 2.4% reported occasional attacks of dyspnea. Spirometric lung function tests showed normal values in 89%. The immediate and longterm results show thoracoscopic pleurodesis with fibrin and talcum to be a safe and effective method for treatment of patients with persistent or recurrent pneumothorax.

Adolescent↗
PubMed1994

Thoracoscopic laser ablation of pulmonary bullae. Radiographic selection and treatment response.

The purpose of this study was to develop objective preoperative selection methods for predicting outcome in patients undergoing thoracoscopic laser ablation of emphysematous pulmonary bullae. Initial radiographic presentation was correlated with physiologic function both before and after the operation in 24 patients entered into a prospective clinical protocol for evaluation of carbon dioxide laser treatment of emphysematous pulmonary bullae. Nineteen surviving patients underwent follow-up evaluation 1 to 3 months after the operation. Pulmonary function test results showed improvements in spirometry (forced vital capacity increased 0.82 +/- 0.125 L, forced expiratory volume in 1 second increased 0.36 +/- 0.07 L, and maximum voluntary ventilation increased 11.69 +/- 2.6 L/m; p < 0.002); airway resistance decreased by 0.9 +/- 0.35 cm of water/L per second, and specific conductance increased 0.019 +/- 0.006 L/cm H2O per second (p < 0.02). Lung volumes improved (residual volume decreased 1.25 +/- 0.23 L, p < 0.001) without significant change in resting gas exchange. Quantitative radiographic grading of extent of preoperative pulmonary bullae correlated well with response to laser treatment in patients with preoperative and postoperative studies. Patients with large bullae accompanied by crowding of adjacent lung structures, upper lobe predominance, and minimal underlying emphysema had greatest improvement in pulmonary function results with laser bullae ablation (p < 0.05). However, some patients with multiple smaller bullae and diffuse emphysema also demonstrated objective improvement after operation. Quantitative radiographic analysis of the extent of bullous disease and the degree of associated emphysema can be used to determine short-term postoperative pulmonary response and may be useful in selecting future thoracoscopic laser bullae ablation candidates. Additional follow-up will be necessary to further improve selection criteria and help define the long-term role of thoracoscopic laser treatment of bullous emphysema.

Aged↗
PubMed1993

Thoracoscopic placement of implantable cardioverter-defibrillator patch leads in sheep.

BACKGROUND: A thoracoscopic technique was developed for the placement of commercially available implantable cardioverter-defibrillator (ICD) patch leads in sheep. METHODS AND RESULTS: Small ICD patch leads (13.5 cm2, A-67) were placed thoracoscopically in sheep (n = 5) that had survived coronary artery ligation from a previous experiment. The technique used three small incisions in the left chest. After lysis of adhesions, the ICD patch lead was introduced through a mediastinoscope. The ICD patch lead was secured in the extrapericardial position with surgical clips placed in the four corners of the ICD patch lead. After 2 weeks, a median sternotomy was performed, and ICD patch leads were reexamined for positioning. Extensive fibrosis was noted to adhere the ICD patch lead to the pericardium. The surgical clips were found intact in all animals without noticeable migration of patch lead position. There was no mortality related to ICD patch lead placement, and estimated blood loss was less than 30 mL without use of cautery. CONCLUSIONS: Commercially available ICD patch leads may be reliably and safely placed with minimal patch migration in sheep using thoracoscopic techniques.

Animals↗
PubMed1993

Video-assisted thoracoscopic stapled wedge excision for indeterminate pulmonary nodules.

Between June 1991 and July 1992, 118 patients (57 men and 61 women) underwent video-assisted thoracoscopy for indeterminate pulmonary nodules. Median age was 64 years (range 30 to 85 years). Thoracotomy was performed in 33 patients (28.0%) after thoracoscopy only because the nodule could not be located in 17 patients, was too large to safely resect in 5, appeared malignant in 4, and for technical reasons in 7. Eighty-five patients underwent thoracoscopic wedge excision. Twenty-one (24.7%) of these 85 patients also had thoracotomy--15 to perform formal lung resection for bronchogenic carcinoma, 3 for nondiagnostic abnormalities, 2 to locate a second nodule, and 1 for stapler malfunction. The remaining 64 patients (54.2%) had only video-assisted thoracoscopic wedge excision. A single wedge excision was performed in 56 patients, two in 6, and three in 2. Pathologic examination of these 74 nodules revealed a granuloma in 30, metastatic cancer in 25, hamartoma in 7, lymphoma in 1, and other benign lesions in 11. There were no deaths and only 4 (6.3%) complications in these 64 patients. The 64 patients treated by thoracoscopy only were compared with a similar group of 64 patients who had wedge excision via thoracotomy without prior thoracoscopy. Postoperative analgesic requirements were less in the patients treated by thoracoscopy. Median hospitalization in the thoracoscopy group was 3 days compared with 6 days in the thoracotomy group (p < 0.05). Median total charge for the thoracoscopy-only group was $12,898 as compared with $12,502 for patients undergoing wedge excision via thoracotomy. We conclude that thoracoscopic wedge excision is a safe and effective procedure in selected patients with an indeterminate pulmonary nodule. A significant number of patients (45.8%), however, required a thoracotomy to accomplish a safe operation or to ensure adequate staging and resection for malignancy. Although thoracoscopy reduces postoperative analgesia requirements and shortens hospital stay, total hospital charges were similar to charges for a wedge excision via thoracotomy.

Adult↗
PubMed1993

Mediastinal tumor and application of thoracoscopic surgery.

Thoracoscopic resection of a mediastinal tumor or cyst was done in three patients: two with neurogenic tumors and one with a bronchogenic cyst. The tumors and cyst showed evidence of a discrete plane on computed tomography of the chest. The mean operation time and estimated blood loss were 156 min and 45 g, respectively. For all three patients, the chest drain was removed within 48 h after operation, and there were no complications related to thoracoscopic surgery. The advantages of this approach are less pain, early return to normal activity, and an acceptable cosmetic appearance. Based on our experience, thoracoscopic surgery is considered the treatment of choice for certain mediastinal tumors or cyst.

Adolescent↗
PubMed1993

Laparoscopic Heller cardiomyotomy and thoracoscopic esophageal long myotomy for the treatment of primary esophageal motor disorders.

The technique of laparoscopic and thoracoscopic esophageal myotomy is described. The laparoscopic Heller procedure was performed in a patient with manometrically diagnosed achalasia and the thoracoscopic long esophageal myotomy in another with diffuse esophageal spasm. Both operations were performed in the same fashion as during open surgery, using standard laparoscopic surgical instruments. Antireflux procedures using the Dor and modified Belsey fundoplications protected patients from iatrogenic reflux. Complete relief of dysphagia in the first case and chest pain in the second has been confirmed after 2- and 4-month follow-up, respectively. Laparoscopic Heller myotomy and thoracoscopic long esophageal myotomy are technically feasible and reduce surgical trauma, hospitalization, and postoperative recovery. They offer a viable alternative for the definitive management of primary esophageal motor disorders comparable with that of open surgery.

Adult↗
PubMed1993

Thoracoscopic fundoplication.

Thoracoscopic fundoplication and hiatoplasty were performed by a videoassisted technique in a patient with longstanding pathologic gastro-oesophageal reflux, reflux oesophagitis and hiatal hernia. Ten months later the patient was asymptomatic and had normal findings by oesophageal endoscopy and 24-hour pH-monitoring. Thoracoscopic fundoplication may be useful in patients with intra-abdominal adhesions due to previous abdominal surgery. Also obese patients with large hiatal hernias and perioesophageal adhesions may benefit from the thoracoscopic approach.

Adult↗
PubMed1993

Techniques for localization of pulmonary nodules for thoracoscopic resection.

Significant advances in surgical equipment, video monitoring, and endoscopic surgical techniques have expanded the role of thoracoscopy to include pulmonary resection. One limitation of the thoracoscopic technique is the loss of manual palpation to identify the nodule that is either too small or too deep beneath the pleural surface. We describe the techniques used in 300 thoracoscopic pulmonary resections that have aided in identification of pulmonary nodules. These techniques include careful preoperative assessment of the computed tomogram, preoperative injection of methylene blue, or a needle localizing system to identify the nodule. Intraoperative techniques include instrument palpation, digital palpation, and intraoperative ultrasonography. It should be possible to identify the majority of pulmonary nodules at the time of thoracoscopy with these localizing techniques. All nodules were successfully identified in our last 200 thoracoscopic resections.

Humans↗
PubMed1993

[An innovative thoracoscopic surgery for patient ductus arteriosus--a Japanese first case report].

A five-year-old girl with patent ductus arteriosus (PDA) was successfully treated by thoracoscopic surgery, which was the first successful case in Japan. The operation was carried out under general anesthesia with usual endotracheal intubation. Short trocars were inserted through the left intercostal spaces to introduce a flexible video thoracoscope and adequate surgical instruments. After the ductus was carefully dissected and exposed, two titanium clips which were 11 mm in length were applied to interrupt the ductus completely. The continuous heart murmur of PDA was confirmed to disappear by an esophageal stethoscope. Postoperative course was uneventful and the patient was discharged on 6 postoperative day. No residual PDA shunt was revealed by doppler echocardiogram 8 months after surgery. The advantages of thoracoscopic surgery for PDA are: less postoperative pain and discomfort, early recovery and short hospital stay, and cosmetic preservation. Availability of smaller sized surgical instruments should allow this method indicated for smaller children or newborns with PDA.

Child, Preschool↗
PubMed1993

A new video-assisted thoracoscopic surgical technique for interruption of patient ductus arteriosus in infants and children.

Classic surgical interruption of patent ductus arteriosus was partially replaced by transcatheter endovascular closure in 1971. We describe a new technique for ductus closure by video-assisted thoracoscopic surgical interruption, derived from video-assisted endoscopic surgery. With the patient under general anesthesia and intubated, two 5 mm holes were made through the left thoracic wall. A video camera and specially devised surgical tools were introduced; such as scissors, dissectors, and clip appliers. The ductus was dissected, and two titanium clips were applied, completely interrupting the ductus. Thirty-eight patients were operated on from April 1991 to April 1992. Mean age was 23.3 months (range 1.5 to 90 months) and mean weight was 9.5 kg (range 2.4 to 25 kg). Six had associated lesions not necessitating immediate surgical treatment. All had successful closure of the patent ductus with the video-assisted technique, but two needed two such procedures, one because of incomplete immediate ductus closure and one because of partial opening of the clip after 24 hours. One patient had recurrent laryngeal nerve injury and four had pneumothorax on the left side. The usual hospital stay was 2 or 3 days. There were no other complications and no deaths. Video-assisted thoracoscopic surgical interruption was a rapid, safe, and successful technique for closure of the patent ductus arteriosus. Better dissection of the ductus decreased the risk of recurrent laryngeal nerve injury and that of clip opening. In the last 26 patients, in whom a 2 mm multiperforated catheter was used for chest drainage during the first hours, no pneumothoraces occurred. Video-assisted thoracoscopic interruption of the patent ductus arteriosus is feasible in low-weight infants, whereas transcatheter endovascular closure of the ductus usually is not possible. The technique will be applied to premature infants with new instruments designed for the size of these patients.

Child↗
PubMed1993

[Thoracoscopic lung biopsy in diagnosis of interstitial lung diseases].

Thoracoscopic lung biopsy is accepted to be an appropriate method in diagnosing interstitial lung diseases when lung tissue examination is needed for accurate diagnosis. In our study of 30 patients with chronic interstitial lung diseases a high sensitivity of 97% was reached similar to the yield reported from open lung biopsy techniques. The manyfold described handicap of long lasting pleural fistula after thoracoscopic biopsies could be prevented in most cases by sealing the biopsy site with a fibrin layer. Thus the mean pleural drainage-time was reduced to 3.7 +/- 1.0 days and only 3 out of the 30 patients required a prolonged drainage up to 11 days. There were only a few minor complications except in one patient who developed an etiologically unclear pulmonary edema shortly after the procedure. However the results obtained by this modified bioptic technique are encouraging and confirm again the efficacy and safety of thoracoscopic lung biopsy in diagnosing interstitial lung diseases.

Biopsy↗
PubMed1995

Thoracoscopic management of malignant pleural effusions.

Thoracoscopy has been around for decades, advocated by some, but until recently, ignored by many. Not surprisingly, its diagnostic and therapeutic efficacy in patients with suspected or proven malignant pleural effusions has withstood the test of time. Today, the potential benefits of thoracoscopy must be weighed against its cost in patients with limited life expectancy. Although diagnostic thoracoscopy requires only overnight hospitalization, pleurodesis imposes a longer hospital stay. The discomfort of an indwelling chest tube, the need for hospitalization, and the financial burden of thoracoscopic procedures compared with less-invasive means of pleural investigation and pleurodesis must be taken into account on an individual basis. Thoracoscopy should not be performed for the sake of intervention. Its indications and all diagnostic or therapeutic alternatives should always be carefully examined. Its role, however, in the diagnosis and treatment of patients with malignant pleural effusions is undeniable. The diagnostic accuracy of thoracoscopic pleural biopsy is excellent. Several studies demonstrate that thoracoscopic talc pleurodesis is more frequently successful than other methods of pleurodesis. As a staging procedure, thoracoscopy helps determine extent of disease, and possibly, prognosis in patients with metastatic pleural carcinomatosis, lung cancer, and malignant mesothelioma. As this procedure is increasingly rediscovered by our medical and surgical communities, greater clinical and experimental investigation aimed at establishing successful management strategies in patients with malignant pleural effusions will hopefully occur.

Biopsy↗
PubMed1995

[Upper thoracic sympathectomy by thoracoscopic approach. A method of choice for the treatment of palmar hyperhidrosis].

Palmar hyperhidrosis is excessive sweating beyond physiological needs in the palm without recognized etiology. Although a benign disease, it is annoying to most patients. Currently the best treatment for this condition is upper thoracic sympathectomy via many different approaches. The video-thoracoscopic approach has been recommended a a minimally invasive procedure. We report our 1-year experience with transaxillary endoscopic sympathectomy in 99 patients with palmar hyperhidrosis. Standard video-laparoscopy was used via a transaxillary approach to perform sympathectomy. The mean operating time of this operation was 12 minutes and mean hospital stay was 32 hours. The results in terms of warm and dry hands were excellent. Only one case of transitory Horner syndrome was noted. Transaxillary thoracoscopic sympathectomy for palmar hyperhidrosis is a relatively simple and effective procedure which can be performed with standard laparoscopic instruments. The advantages are, short recovery time and hospital stay along with excellent functional and cosmetic results. We are convinced that thoracoscopic sympathectomy is the procedure of choice for the treatment of palmar hyperhidrosis.

Adolescent↗
PubMed1995

Thoracoscopic bilateral splanchnicotomy for pain control in unresectable pancreatic cancer.

Abdominal pain is the most common symptom of unresectable pancreatic carcinoma. The pancreas receives sympathetic and parasympathetic nerve fibers. The latter, which are the sensitive ones, reach the pancreas through the greater and lesser splanchnic nerve and the celiac ganglion. The greater splanchnic nerve originates from the thoracic ganglia T5-T8 and the lesser splanchnic nerve from T9-T11. The splanchnic nerves are composed of white nerve branches which stem from the ganglia, situated in the intercostal spaces, in the dorsal subpleural region, so they are easily visible through the pleura. The surgical treatment of pain in unresectable pancreatic carcinomas includes abdominal resection of splanchnic nerves, abdominal celiac and superior mesenteric ganglionectomy or thoracic resection of post-ganglionic splanchnic branches. Only recently monolateral thoracoscopic splanchnicotomy in association with vagotomy has been recommended. Because only the bilateral resection of splanchnic nerves ensures total control of pancreatic pain, the Authors have tried an original technique of bilateral thoracoscopic splanchnicotomy. The operation is performed in sequence on the two sides, with the patient lying, on the contralateral side. The lung is excluded and three 10 mm thoracic trocars are inserted: one in the 7th space on the median axillary line (for the optic), one in the 6th space on the posterior axillary line and one in the 5th space on the anterior axillary line. The pleura is opened medially to the sympathetic trunk, at the level of the 5th intercostal space and splanchnicotomy is performed downward up to the 11th intercostal space. The drains, placed through the previously-prepared opening at the level of the 7th intercostal space, are removed on 1 post-operative day. A bilateral thoracoscopic splanchnicotomy should be recommended as treatment of choice of pancreatic pain in unresectable pancreatic carcinoma, because is well tolerated by patients and ensures excellent results in terms of pain control.

Abdominal Pain↗
PubMed1996

Thoracoscopic management of empyema in children.

The appropriate management of empyema in children is controversial. Traditional surgical approaches have included thoracotomy and open drainage, decortication, and thoracoplasty. While generally effective, these procedures can be associated with considerable morbidity. We have sought to assess the utility of video-assisted thoracoscopic adhesiolysis and pleural debridement for the treatment of empyema in children. Nine children with postpneumonic empyema unsuccessfully managed with a single attempt at closed tube thoracostomy underwent thoracoscopic drainage during the past 2 years. The empyema was successfully treated with this technique in seven patients with no further interventions being required. Procedures performed early in the fibrinopurulent stage were technically easier. The average time before chest tube removal was 8.5 days. An immunocompromised patient required a subsequent open decortication and a patient with a coagulopathy required two subsequent open procedures for drainage of a recurrent hemothorax. We conclude from this experience that video-assisted thoracoscopic adhesiolysis and pleural debridement can be successfully performed in children. Benefits include good visualization of the entire thoracic cavity for more effective debridement and efficient drainage, and subjectively diminished postoperative pain and associated morbidity.

Adolescent↗
PubMed1996

[Thoracoscopic enucleation for sclerosing hemangioma of the lung--a case report].

A 30-year-old female with sclerosing hemangioma of the lung (SHL) was managed by thoracoscopic enucleation. Under the left lateral decubitus position, four small skin incisions were made. The tumor, approximately 2.5 cm in diameter, was just under the pleura at the right S5, and was clearly demarcated without adhesions to mediastinal pleura. Because the tumor located near the hilum, a partial resection by intrathoracic Endo-GIA could not be performed. So the tumor was enucleated bluntly with an electrode knife being tugged by a tractive thread. After it was diagnosed as SHL by intraoperative imprint cytology, the stump was closed with running suture of 3-0 nylon. The patient was discharged on the 10th postoperative day without complication. No recurrence was found during a follow-up period of six months after the operation. Immunohistochemical findings suggested that the tumor cells were derived from type II pneumocytes. Thoracoscopic surgery appears to be a good indication for SHL which commonly occurs in young or middle-aged women and which is difficult to be diagnosed preoperatively. Thoracoscopic enucleation is considered to be a one of the safe methods especially for SHL which can not be resected by Endo-GIA.

Adult↗