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At least 595 records · Page 33Linked to original sources
PubMed1997

[Thoracoscopic surgery for pneumothorax with bullous emphysema in an elderly patient: a case report].

Recent advances in optical and endoscopic operating instruments have made thoracoscopic surgery easier. The authors report the case of an 83-year-old patient who was referred to our hospital for right spontaneous pneumothorax associated with severe bullous emphysema. Chest X-ray films showed 40% collapse of right lung and the right spontaneous pneumothorax was treated by chest tube drainage for 3 weeks. However air leak was not decreased and subcutaneous emphysema appeared. Chest computerized tomography revealed multiple bullae. Thoracoscopic surgery was performed because of preservation of the respiratory function. The ruptured bulla was resected by using ENDO GIA and the other multiple bullae were resected similarly in order to improve the pulmonary function. A surgical drain was removed on the 14th postoperative day because of a little air leak continuing. His postoperative course was uneventful after removal of the chest drain. He was discharged on 27th postoperative day and had no shortness of breath in daily life. From our experience, thoracoscopic surgery appears to be much better than thoracotomy for spontaneous pneumothorax because of much less postoperative disability and preservation of respiratory function.

Aged↗
PubMed1996

[Thoracoscopic major pulmonary resection--pro and con].

The first reports of thoracoscopic video-assisted procedures are from 1993. The main reason for this new techniques was that they allow the performance of standard thoracic surgical procedures in a less invasive ways. The operation trauma is minimalised that could be a cause not only of postoperative pain but often also of chronic future problems. The other advantages are the shortened hospitalisation time and earlier end of disablement. On the other hand there are many objective arguments against here. Firstly, the operative technique is not standardised and thoracoscopic lobectomy and pneumonectomy are performed by many modified methods. No regular randomised studies are available that could confirm the positive contribution of thoracoscopy in these cases. It is possible to perform classic thoracotomy by very careful way saving muscles and contemporary observing the requirement of safe operation and to attain the maximally possible result. Resuming information from written and verbal reports in last 3 years we have necessary the impression that the main reason for thoracoscopic reactions was to demonstrate the technical feasibility of this operation which is entirely insufficient reason for acceptance of this technique. Authors suggest that thoracoscopy is in experienced hands and adequately equipped workplaces an accurate and safe method for the diagnosis and in some cases also for therapy of hemodynamic stabile patients with thoracic trauma.

Endoscopy↗
PubMed1997

[An approach to lobectomy under a thoracoscopic surgery].

Lobectomy under a thoracoscope is a minimally invasive surgery and full consideration must also be given to the length of access thoracotomy and the number of access ports inserted. On the other hand, securing a full visual field within a limited access and treating the pulmonary artery/vein and bronchus safely and for sure are needed. However, it would not be too much to say that the easiness of lobectomy under a thoracoscope depends on the length of access thoracotomy and the number of access ports inserted. In the experiment this time we discussed an approach to the access area in lobectomy under a thoracoscope in our cases.

Aged↗
PubMed1997

Thoracoscopic implantation of a pacemaker lead: experimental study.

We have performed five thoracoscopic pacemaker lead implantations into the porcine myocardium. A small opening, approximately 2 cm in diameter, was made thoracoscopically in the pericardium overlying the apex of the left ventricle, avoiding phrenic nerve injury. Three screw-in type or two stab-in type standard sutureless unipolar epicardial electrodes were introduced through a trocar, and then screwed or stabbed into the myocardium near the apex of the left ventricle, avoiding the coronary vessels. Hemorrhage and arrhythmia were negligible during the procedures. Electrical tests of the pacing threshold and lead impedance after implantation of the leads revealed acceptable values in each lead. We conclude that thoracoscopic implantation of pacemaker leads is feasible, and may be used as a minimally invasive option when conventional transvenous techniques are unavailable or contraindicated.

Animals↗
PubMed1997

[Relapse after video-assisted thoracoscopic surgery for spontaneous pneumothorax].

Postoperative relapse was noted in 8 (14.8%) of 54 patients who underwent video-assisted thoracoscopic surgery for spontaneous pneumothorax followed for more than one year. Five of the eight patients with relapse were among the 15 initial-stage cases. Concerning treatment, only drainage was performed in 1 patient, and thoracotomy was performed in 5 patients. Findings on additional surgery consisted of missed cystic lesions, in 2 patients, a small opening adjacent to a suture caused by an autosuture device in 1 patient, and a cyst around a suture in patients. There was no missed cystic lesion after the 15th case. In subsequent cases, there were changes at the periphery of a suture. In patients with other diseases, there were no changes observed when an autosuture device was used under thoracoscopic guidance. Therefore, the changes may be associated with hypertonus of the emphysematous lung at the periphery of the site where an autosuture device was used. Thoracoscopic surgery for spontaneous pneumothorax using an autosuture device has limitations such as the presence of a dead angle, insufficient evaluation of emphysematous changes in the collapse lung, a large volume of resected tissue, and hypertonus of the peripheral lung. These limitations may contribute to a high recurrence rate of spontaneous pneumothorax. To reduce the recurrence rate, conditions and problems in cases showing relapse should be clarified before selecting treatment including pleurodesis in individual cases.

Adolescent↗
PubMedDate not supplied

Video assisted thoracoscopic and cardioscopic radiofrequency Maze ablation.

The authors examined the feasibility of transthoracic radio frequency Maze ablation of atrial fibrillation using video assisted thoracoscopy and cardioscopy in the experimental setting of a beating porcine heart. In six pigs under general anesthesia, the left atrium was viewed using a video assisted thoracoscopy system (VATS), and radiofrequency linear ablation of the left atrial wall was carried out using a radiofrequency ablation catheter (HAT200S:OSYPKA) inserted through a trocar port. The right atrium was also ablated in the same manner under VATS. In six other pigs, intravenous radiofrequency ablation by cardioscopic catheter device was carried out. Atrial fibrillation was provoked by acetylcholine injection plus rapid atrial pacing. The thoracoscopic visual field created for radiofrequency catheter ablation from a transthoracic approach and the cardioscopic visual field from an intravenous approach were sufficient, and safe positioning of the ablation catheter device on the atrial epicardium and endocardium, which enabled linear ablation of the atrium, was obtained. The Optimal setting for ablation was 70-80 degrees C/ 30 sec duration per each ablation. This process was monitored and documented by a video system through the thoracoscope and cardioscope, and results were confirmed by postmortem macrohistologic examination. In conclusion, the authors' results suggest the potential usefulness of the combination of transthoracic radiofrequency catheter ablation with video assisted thoracoscopic and cardioscopic linear ablation of atrial fibrillation, and the possibility that use of this system might eliminate the need for open heart Maze surgery.

Acetylcholine↗
PubMed1997

Video thoracoscopic resection of neurogenic tumor in a superior-posterior mediastinum: three case reports.

Neurogenic tumors of the thorax can originate in any neurogenic structure within the chest. Surgical resection is considered the primary treatment of such tumors and usually is performed through a thoracotomy. Recently, using a new approach, we applied the technique of video thoracoscopic surgery to resection a posterior mediastinal tumor. In this paper, we report three patients with superior-posterior mediastinal neurogenic tumors in which the approach to the tumor is technically difficult. Cases 1 and 2 were a 26-year-old man and a 50-year-old asymptomatic man, respectively, and case 3 was a 45-year-old asymptomatic woman. The sizes of the three tumors were 3.0 x 2.5 x 1.8 cm (case 1), 6.0 x 4.0 x 2.0 cm (case 2), and 3.0 x 2.0 x 2.0 cm (case 3). In one case (case 2), minithoracotomy was added to video thoracoscopic surgery for adhesion to the spinal artery and intraspinal extension. A standard thoracotomy was avoided in all three cases. All patients had uncomplicated postoperative courses. Video thoracoscopic resection of a neurogenic tumor in the superior-posterior mediastinum may be a safe and useful approach with improved cosmetic results.

Adult↗
PubMedDate not supplied

Thoracoscopic esophageal surgery.

Thoracoscopic surgery has been utilized for both esophageal benign lesions and malignant lesions. Resection of submucosal and mural benign lesions, as well as Heller Myotomy, are prime indications for the procedure. Resection of or staging procedures have been performed by various centers around the world for esophageal carcinoma. Resection of epiphrenic diverticula and performance of antireflux endoscopic surgical procedures are indications for the VATS procedure. Transthoracic thoracoscopic vagectomy has been performed for a number of years. Avoidance of perforation of the esophageal mucosa and subsequent leakage are prime concerns of thoracoscopic video assisted surgery on the esophagus.

Endoscopy↗
PubMed1998

[A case report of video-assisted thoracoscopic resection for a pericardial cyst].

We report here a case of a pericardial cyst resected by video-assisted thoracoscopic surgery. The patient was a 38-year-old male who was incidentally pointed out as having an abnormal shadow close to the superior vena cava on a chest X-ray film. A pericardial cyst was suspected after magnetic resonance imaging showed low intensity in T1 weighted image and high intensity in T2 weighted image. Video-assisted thoracoscopic surgery was carried out under a general anesthesia. The cyst, sized 2 x 2 cm, was recognized between the superior vena cava and right atrium. The cyst was resected successfully and surgery took only 30 minutes. Postoperative course was uneventful and the pathological diagnosis was pericardial cyst. We think video-assisted thoracoscopic surgery is a useful method for the final diagnosis and treatment of pericardial cyst.

Adult↗
PubMed1998

[Surgical pain therapy in inoperable metastatic epigastric tumor by bilateral thoracoscopic splanchnicectomy].

Patients with unresectable supramesenteric malignancies often suffer from intractable pain. The supramesenteric viscera are supplied by the greater splanchnic nerve. Surgical options to effectively denervate the supramesenteric area are coeliac ganglionectomy, open or percutaneous coeliac ganglion block or transhiatal bilateral splanchnicotomy. The surgical minimally invasive alternative is thoracoscopic splanchnicectomy. In 7 patients pain was scored on a scale from 1 (no pain) to 10 (maximal pain) before and after surgery and weekly thereafter. Five bilateral and 2 left-sided thoracoscopic splanchnicectomies were performed. Operation time was 17 +/- 3 min for each side. The mean pain score dropped from preoperatively (under morphine sulphate medication) 7.4 +/- 0.6 to 4.9 (2.5-8.25) 1 week postoperatively (p = 0.02) and to 4.9 (2.5-6.75) 7 weeks postoperatively (p = 0.02). The relief from back pain was immediate and complete, but abdominal pain tended to recur. Six of our 7 patients and their general practitioners rated the intervention as a success. Thoracoscopic splanchnicectomy affords excellent palliation in patients with unresectable supramesenteric tumour, offering reliable pain control.

Abdominal Neoplasms↗
PubMed1997

A video-assisted thoracoscopic surgical technique for interruption of patent ductus arteriosus.

We describe herein a technique for patent ductus arteriosus (PDA) closure using a method of video-assisted thoracoscopic surgical (VATS) interruption derived from video-assisted endoscopic surgery. This technique of repair was performed on five patients with a mean age of 3 years and a mean weight of 13.7 kg during 1994 and 1995. Under general anesthesia, two 10-mm trocars and two or three 5-mm trocars were inserted through the left thoracic wall. A video camera and specially designed surgical tools including scissors, dissectors, and a clip applicator were then introduced. The ductus was dissected, and two titanium clips were applied to interrupt the ductus completely. Successful closure of the PDA by this video-assisted technique was achieved in all patients. The only complication which developed in one patient was hoarseness for 2 weeks postoperatively. The hospital stay ranged from 7 to 12 days and there were no serious complications or deaths. There results indicate that video-assisted thoracoscopic surgical interruption is a safe and effective technique for achieving closure of PDA.

Child, Preschool↗
PubMed1996

[Thoracoscopic methods in treatment of pulmonary emphysema].

Technical advances in the field of endoscopical surgery have widened the spectrum of thoracoscopic operations in the therapy of lung emphysema. Especially in patients who are severely disabled as a result of their reduced lung function, a less surgical trauma should result in better postoperative performance. Bullectomy, which was an integral part of the spectrum in thoracic surgery for a long time, should be performed in a minimally invasive way today. In the American literature, disappointing results have been published concerning laser resection of emphysematous lung tissue. As a result, this method should be abandoned. In contrast, lung volume reduction surgery in patients with diffuse emphysema has caused significant improvement in lung function. The initial approach to this method was a median sternotomy. However, recent experiences in several centers have demonstrated the feasibility and efficiency of a thoracoscopic procedure.

Endoscopes↗
PubMed1997

Thoracoscopic decortication in infants and children.

BACKGROUND: The treatment of pediatric empyemas remains controversial. While thoracentesis and tube thoracostomy appear adequate for relatively benign organisms, virulent bacteria cause thick fibrinous pleural peels entrapping the lung. Open thoracotomies have been effectively used for decortication but are painful. METHODS: We report the use of minimally invasive thoracoscopic decortication in 12 patients (mean age 5 years). All failed conventional management with persistent fever, increasing oxygen requirement, recurrent effusion, and pleural consolidation; 5- and 10-mm trocars were used and complete decortication was accomplished. RESULTS: Ten of 12 patients were afebrile by 72 h and discharged 4-12 days after surgery. Eleven of 12 patients had clear chest x-rays by 1 month. CONCLUSION: Thoracoscopic decortication is a safe and effective means of treating pediatric empyemas.

Adolescent↗
PubMed1992

Thoracoscopic lung biopsy.

Progress in instrumentation and techniques developed for laparoscopic surgery have paved the way for a resurgent interest in thoracoscopic procedures. Traditional thoracoscopy was limited by access, restricted visualization, and surgical devices. Recent cases provided an opportunity to successfully perform thoracoscopic pulmonary wedge excisions using state-of-the-art technology and instruments adapted from laparoscopy. These preliminary cases provided an opportunity to modify and adapt these techniques to thoracic procedures. Video thoracoscopy is rapidly evolving in both methods and instrumentation.

Adult↗
PubMed1993

Role of mechanical stapling devices in thoracoscopic pulmonary resection.

For its first 80 years, thoracoscopy was primarily reserved for the evaluation and treatment of pleural disease. Extension of thoracoscopic techniques to management of parenchymal lung disease remained limited until the availability of endostaplers and adaption of video-assisted techniques through minimal access incisions. The widespread acceptance of mechanical staplers in open lung resections during the previous two decades has facilitated conversion to closed methods in the past 2 years. A variety of techniques for mechanical stapling in thoracoscopy are discussed. The impact of mechanical stapling in 300 consecutive thoracoscopic pulmonary resections is presented.

Humans↗
PubMed1993

Endoscopic subtotal oesophagectomy for cancer using the right thoracoscopic approach.

The technique of right thoracoscopic oesophagectomy and our experience with this approach are reviewed. The procedure enables resection of middle and lower third tumours with lymphadenectomy which is equivalent to that achieved by the standard McKeown operation. Thoracoscopic inspection with biopsy detects small pleural deposits which are missed by the standard preoperative tests including CT scanning. The initial experience with endoscopic oesophagectomy has been favourable in terms of recovery and time spent in the intensive care unit, although the procedure takes significantly longer than the equivalent open dissection of the thoracic oesophagus.

Aged↗
PubMed2004

Thoracoscopic closure of the patent arterial duct.

Video assisted thoracoscopic surgery for closure of the persistently patent arterial duct is an effective answer to the modern effort of seeking repair of congenital cardiac malformations with minimally invasive techniques. Between June, 1994, and December, 2002, 150 consecutive patients with an echocardiographic diagnosis of isolated patency of the arterial duct were referred to our Institution for video assisted thoracoscopic closure. The median age at the time of operation was 45 months, with a range from 3 to 161 months, and mean weight was 18 kg, with a range from 4.2 to 73 kg. Video assisted closure was possible in 139 patients (93%). The mean operative time was 37 min, with a range from 14 to 89 min. In the remaining 11 patients (7%), seen early in our experience, we converted to a mini-thoracotomy to achieve closure. In no instance did we encounter major haemorrhage requiring blood transfusion, and there were no hospital deaths. The mean period of stay in hospital was less than 24 h in 61 patients, less than 48 h in 88 patients seen earlier in our experience, and 21 days in 1 patient because of a persistent chylothorax. Other complications included palsy of the left recurrent laryngeal nerve in 1 patient, with partial regression at 6 months follow-up. We conclude that closure of the arterial duct by video-assisted thoroscopy combines the advantages of safe and complete extraluminal occlusion with an excellent clinical and aesthetic result, minimal postoperative pain, and short stay in hospital at low cost.

Cardiac Surgical Procedures↗
PubMed1996

Endofinger for tactile localization of pulmonary nodules during thoracoscopic resection.

To localize a deeply situated small pulmonary nodule during thoracoscopic resection, we developed as instrument a so-called "endofinger" for tactile localization of the nodule, and examined its usefulness. An attempt was made in 26 patients, using endofinger palpation under thoracoscopy, to localize twenty-six pulmonary nodules, each of which was less than 20 mm in diameter (mean 12.2 mm) and situated apart from the pleural surface. An endofinger comprises an extended "finger' section connected with a sleeve section. The sleeve section fits with a large contract area over the surgeon's forefinger, effectively lengthening it. The surgeon uses an endofinger in each hand and palpates a pulmonary nodule with the endofinger from two directions simultaneously. Surgeons could feel the hardness of nodules with a high degree of sensitivity. The sense of touch of the endofinger is much better than that of a simple bar, due to the large contact area of the sleeve section with the real finger. With the endofinger palpation 22 of 26 nodules were localized and their margins confirmed. All of 19 nodules larger than 10 mm in size had their locality confirmed by endofinger palpation. Four of 7 nodules smaller than 10 mm in size could not be localized, however. The endofinger is a useful instrument for tactile localization of pulmonary nodules under thoracoscopic surgery, especially for nodules larger than 10 mm. The method is simple, low-cost, time-saving, and has no complications.

Adult↗