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At least 613 records · Page 34Linked to original sources
PubMed1992

Preliminary experience with thoracoscopic surgery.

Thoracoscopic surgery was accomplished in 12 patients utilizing thoracoscopic instruments and a stapler. Five patients were treated for recurrent, spontaneous pneumothoraces, for which blebectomies were done; three patients for pulmonary nodules, for which wedge resections were done; one patient for cryptogenic pleural effusion; one patient for debridement of an empyema cavity; one patient for traumatic bronchopleural fistula; and one patient with AIDS for interstitial lung disease. All patients were done under general anesthesia in the lateral decubitus position and were prepped and draped for a standard thoracotomy. They underwent endobronchial double-lumen ventilation so that the ipsilateral lung could be deflated to create a working space. In addition, insufflation of 4 to 5 mmHg was also used. Trocars were placed using a blunt technique. The mid-axillary trocar was at about the eight intercostal space and was used for the endoscope, and then additional trocars were placed, usually on the anterior axillary line and posterior axillary line at about the fifth intercostal space. If adhesions were encountered, the lung was grasped atraumatically with a clamp or retractor used to give counteraction, and the adhesions were lysed with shears or electrocautery. After a thorough exploration of the hemithorax involved, the area of pathology was grasped with the clamp, which was used for countertraction. Through a 12 mm trocar, a stapler was introduced and fired. This staples and also transects on a 3 cm length. Several firings were usually necessary to remove the pathology, which, if malignant, was placed in a retrieval bag.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1998

Pulmonary nodules: CT-guided contrast material localization for thoracoscopic resection.

Fifteen patients underwent computed tomography (CT)-guided contrast material localization of pulmonary nodules, with barium and indigo carmine stain used in five patients, iodized oil and indigo carmine stain in five, and water-soluble contrast material and indigo carmine stain in five before fluoroscopy-assisted thoracoscopic resection. Contrast material localization was successful in all cases, and the surgeon confirmed accurate localization, CT-guided contrast material localization is simple and useful for thoracoscopic resection.

Adult↗
PubMedDate not supplied

A survey of 150 video-assisted thoracoscopic procedures in Kuwait.

OBJECTIVE: To review our experience of indications, technique, and complications as they relate to video-assisted thoracoscopic surgery (VATS) in the diagnosis and management of intrathoracic diseases. SUBJECTS AND METHODS: One hundred and fifty consecutive VATS procedures, which were performed over a 3-year period, were retrospectively evaluated. Indications included recurrent or persistent primary spontaneous pneumothorax (n = 73 patients), lung biopsies for diagnosis of diffuse lung disease (n = 33), pleural biopsies (n = 18), wedge resections of pulmonary nodules (n = 8), bilateral thoracic sympathectomy (n = 6), decortication (n = 5), mediastinal tumor biopsies (n = 5), excision of bullous emphysema (n = 1), and removal of a foreign body from the pleural cavity (n = 1). An alternative method of manipulating thoracoscopic instruments without using a trocar is described. RESULTS: Of the 150 VATS procedures, 127 (85%) were successfully performed, 6 (4%) were converted to thoracotomy and 17 (11%) had complications. The most common complication was prolonged air leak, which occurred in 9 patients. The average postoperative hospital stay was 4 days (range: 2-17). Diagnostic procedures were considered successful in 32 out of 33 lung biopsies and in all 18 patients with pleural diseases, 8 lung nodules, or 5 mediastinal tumor biopsies. The other 86 therapeutic VATS procedures were effective in 82 (95%) patients. Four (5%) patients had a recurrence of the pneumothorax after VATS. CONCLUSION: Thoracoscopy and the use of a nontrocar technique is a safe and effective method for the diagnosis and treatment of intrathoracic diseases.

Adolescent↗
PubMed1998

Exercise performance and gas exchange after bilateral video-assisted thoracoscopic lung volume reduction for severe emphysema.

Lung volume reduction surgery (LVRS) improves dyspnoea and pulmonary function in selected patients with severe emphysema. The purpose of this study was to assess the effects of LVRS on exercise performance and gas exchange in relation to changes in pulmonary function. In 40 patients (63.2+/-1.4 yrs, mean+/-SE) with severe emphysema (forced expiratory volume in one second (FEV1) 29+/-1% predicted, residual volume/total lung capacity (RV/TLC) ratio: 0.63+/-0.01) we assessed dyspnoea, pulmonary function and exercise performance before and 3 months after bilateral video-assisted thoracoscopic LVRS. The Medical Research Council dyspnoea score fell from 3.5+/-0.1 to 1.4+/-0.1 (p<0.0005); FEV1 increased by 55+/-9% to 44+/-2% pred (p<0.0005), RV/TLC decreased from 0.63+/-0.01 to 0.51+/-0.02 (p<0.0005). The diffusing capacity remained unchanged. Maximal work load during bicycle ergometry increased from 34.3+/-2.0 to 48.9+/-2.4 W (p< 0.0005), maximal oxygen uptake (V'O2max) from 10.0+/-0.4 to 12.8+/-0.3 mL x kg(-1) x min(-1) (p<0.0005). The increase in maximal ventilation during exercise (V'Emax) from 29.5+/-1.5 to 38.6+/-1.8 L x min(-1) (p<0.0005) was associated with increases in tidal volumes at isowatt and maximal exercise while corresponding breathing frequencies remained unaltered. The increases in V'O2max and V'Emax correlated with the increases in FEV1 and the decreases in RV/TLC. We conclude that the improvement in pulmonary hyperinflation and airflow obstruction after bilateral thoracoscopic lung volume reduction surgery may reduce ventilatory limitation, thereby increasing exercise capacity.

Adult↗
PubMed1992

Imaged thoracoscopic lung biopsy.

Imaged thoracoscopic surgery is a technique utilized to operate on the intrathoracic organs without making a formal thoracotomy incision. Eleven patients underwent lung biopsy with this procedure and each had markedly reduced postoperative pain. Each patient resumed preoperative activity levels within one week of discharge from the hospital. Besides thoracotomy and thoracoscopy, imaged thoracoscopic surgery provides another option for approaching the intrathoracic organs.

Adult↗
PubMed1993

Comparison of video thoracoscopic lung biopsy to open lung biopsy in the diagnosis of interstitial lung disease.

BACKGROUND: Up to one third of patients with interstitial lung disease will require a lung biopsy for diagnosis. Open lung biopsy is generally accepted as the most reliable method of biopsy and tissue diagnosis. The purpose of this study was to compare the efficacy and safety of video thoracoscopic lung biopsy, a minimally invasive technique, with open lung biopsy in the diagnosis of interstitial lung disease. METHODS: From December 1990 to January 1992, 43 patients were referred for diagnostic lung biopsy. Twenty-two consecutive patients undergoing video thoracoscopic lung biopsy (VTLB) over a 6-month period were retrospectively studied and compared with 21 consecutive patients who had undergone open lung biopsy (OLB) in the preceding 6-month period. RESULTS: VTLB (46 +/- 4 minutes) did not add to operative time when compared with OLB (38 +/- 3 min, p = 0.09). The same number of biopsies per patient were performed (VTLB, 1.9 +/- 0.1; OLB, 2.0 +/- 0.1; p = 0.48), the same amount of tissue was obtained per biopsy (VTLB, 6.69 +/- 0.82 cm3; OLB, 5.78 +/- 0.54 cm3; p = 0.36), and the diagnostic accuracy of each method was comparable (VTLB, 95 percent; OLB, 100 percent). However, patients undergoing VTLB demonstrated a significant reduction in length of pleural drainage (1.36 +/- 0.25 days) and hospital stay (2.57 +/- 0.46 days) relative to patients undergoing OLB (3.20 +/- 0.34 days, 5.71 +/- 0.63 days; p < 0.05). Complications occurred in 2/22 VTLB patients (9 percent, 0 deaths) and 4/21 OLB patients (19 percent, 1 death). CONCLUSIONS: When compared with OLB, VTLB does the following: (1) provides equivalent specimen volume; (2) achieves equal diagnostic accuracy; (3) does not add to operative time or complications; and (4) reduces the time necessary for pleural drainage and length of hospital stay. Our findings suggest that VTLB is an effective and safe alternative to OLB in the diagnosis of interstitial lung disease.

Adult↗
PubMed1994

CT-guided localizations of pulmonary nodules with methylene blue injections for thoracoscopic resections.

As only peripheral subpleural lesions can be visualized at thoracoscopy, deep nonpalpable pulmonary nodules have to be identified before performing wedge resections. We evaluate the efficiency of computed tomographic (CT) guided methylene blue injections to localize these nodules before their thoracoscopic resection. Twenty-three nodules in 21 patients were preoperatively localized under CT guidance and marked with methylene blue injections. The localizations under CT guidance of the 23 nodules were successful in all cases. The surgeon confirmed accurate localization of 22 nodules. In one case, the injected methylene blue could not be identified during thoracoscopy. Complications of this technique included six cases of asymptomatic pneumothorax, four cases of local and asymptomatic pulmonary hemorrhage, and two cases of fit of coughing. Because of this technique, 22 thoracotomies could be avoided and the duration of the hospital stay was then reduced. Computed tomographic-guided localization with methylene blue injection is a simple, effective, and rapid technique enabling good thoracoscopic surgery results.

Evaluation Studies as Topic↗
PubMed1992

[Thoracoscopic use of staplers. New possibilities for minimally invasive diagnosis and therapy].

Thoracoscopic resection of peripheral lung tissue is possible by using special staplers (Endo-GIA). Main indications for using this technique are the treatment of a spontaneous pneumothorax by resection of bullous lung areas (15 patients) and the excision of macro biopsies for diagnostic reasons (13 patients). It is reported about the technique and the early outcome of these 28 thoracoscopically performed lung resections. This way minimally invasive procedure is combined with well-established surgical technique.

Biopsy↗
PubMed1994

Bilateral endoscopic splanchnicectomy through a posterior thoracoscopic approach.

The technique of bilateral total splanchnicectomy performed through a posterior thoracoscopic approach is described. The advantages of this route include excellent visual exposure of the neural anatomy of the sympathetic and avoidance of single lung anaesthesia. The procedure was performed for the relief of intractable pain in patients with advanced pancreatic cancer (n = 3) and patients suffering from chronic pancreatitis (n = 5). Persistent relief of pain until death was obtained in the patients with pancreatic cancer (2, 4, 6 months). In patients with chronic pancreatitis, the benefit to date has varied with the severity of the disease. In two patients with severe advanced disease and previous percutaneous blocks, the relief of pain lasted only 3 and 5 weeks and both patients required resection for renewed intractable pain. In three patients with minimal change disease, relief of pain has been good in the short term (maximum follow-up of 8 months). Bilateral thoracoscopic total splanchnicectomy merits further evaluation in patients with pancreatic pain. No complications including hypotension have been encountered.

Denervation↗
PubMed1994

Thoracoscopic oesophago-gastrectomy--a new technique for intra-thoracic stapling.

A new technique for performing a standard Ivor Lewis oesophagectomy avoiding the need for a conventional right thoracotomy is described. The intrathoracic dissection and the intrathoracic anastomosis, using a conventional EEA circular staple-gun, is done thoracoscopically. Eight patients with carcinoma of the gastric cardia or distal oesophagus were prepared for a palliative Ivor Lewis two-stage oesophago-gastrectomy. The details of the technique for placing the anvil of a circular staple gun in the upper oesophagus and performing the intrathoracic stapled anastomosis are described. Intrathoracic stapling under thoracoscopic video control was successful in five of the eight patients. The three other patients received 10 cm mini-thoracotomies. All patients were transferred from the intensive care unit within 24 hours and were discharged from hospital within 14 days. There were no complications and no deaths. We believe that this procedure offers many patients better palliation with reduced morbidity because the standard right thoracotomy is avoided.

Adenocarcinoma↗
PubMed1994

[Thoracoscopic techniques in treatment of esophageal diseases].

Some malignant and benign diseases of the esophagus are generally treated through a thoracotomic approach. While this may be justified in the curative treatment of cancer, thoracotomy may be avoided for benign diseases if good functional results can be obtained through a minimally invasive approach. Long-term results with careful clinical and manometric monitoring of patients operated on for epiphrenic diverticula have to be considered to define the possible role of thoracoscopic approach to this disease since a laparoscopic approach, which includes transhiatal diverticulectomy, myotomy, and fundoplication, seems to have excellent results. As for leiomyomas thoracoscopy represents the first choice approach since it allows a complete removal of the benign tumor with a limited access. In case of malignant diseases, thoracoscopic esophagectomy has in our opinion few indications. Extent of lymphnodal dissection appears to be the major limiting factor of the technique. Moreover, high-risk patients need anyway a double-lumen intubation and a prolonged single-lung ventilation. Modifications of respiratory function after thoracoscopy have to be compared with those occurring after thoracotomy and after transhiatal esophagectomy. Studies on lymphadenectomy and on respiratory physiopathology will help in define a possible role of this approach.

Carcinoma, Squamous Cell↗
PubMed1994

[Thoracoscopic partial pneumonectomy: morbidity and length of hospitalization].

Advances in endoscopic surgical instruments and video-technology enable the safe and fast resection of lung tissue through a thoracoscope. We report our technique and the early outcome of our first 36 patients. In a series of 46 thoracoscopic lung tissue resections, performed with a 3-cm Endo-GIA or with a 6-cm Linear-Cutter, we did not observe any complications. The chest tube was removed 3.7 days following tumor resection and after 2.8 days in case of simple biopsy. Patients could be discharged home 5.3 days following tumor resection and 4.2 days following biopsy. Complaints after a follow-up period of 3 months were almost neglectable.

Adult↗
PubMed1994

[Pulmonary resection for metastatic gallbladder carcinoma by thoracoscopic surgery--report of a case].

A 58-year-old male was admitted to our hospital 11 months after undergoing a cholecystectomy and partial hepatectomy for carcinoma of the gallbladder with direct invasion of the liver at another hospital. Three round, abnormal shadows had been detected in the lungs by chest roentgenogram, but the patient had neither been diagnosed nor treated. On admission to our hospital, we confirmed three small lesions. Before operative procedure, the lung lesions were diagnosed as adenocarcinoma by transbronchial lung biopsies via fiberoptic bronchoscope and percutaneous needle biopsies. The ipsilateral lung was collapsed during one-lung anesthesia with a Unibent tube, and thoracoscopic surgery was performed using a flexible thoraco-fiberscope and reusable thoracic surgiports of our own design. A wedge resection of the pulmonary lesion was performed by intrathoracic ENDO-DIA. A well differentiated adenocarcinoma defined as a metastasis of gallbladder carcinoma was diagnosed by resected specimen. Thoracoscopic surgery appears to be a safe, effective and less morbid alternative procedure to thoracotomy for carefully selected patients with peripheral pulmonary lesions. Further evaluation and prospective studies are indicated.

Adenocarcinoma↗
PubMedDate not supplied

Thoracoscopic sympathectomy.

Surgical sympathectomy has traditionally been achieved by 'open' surgical techniques. The transaxillary, cervical, or dorsal approaches have not been without morbidity and cosmetically have been found to be less than ideal. The main indication for sympathectomy in most units is palmar and axillary hyperhidrosis refractory to medical treatment, although it has been used with some success in troublesome causalgia. Use of sympathectomy in Raynaud's disease remains disappointing. In our unit thoracoscopic sympathectomy has been performed since 1980. A CO2 pneumothorax is initially created in the usual manner. This is followed by electrocoagulation of the sympathetic chain under direct vision using a unipolar diathermy. The lung is then reinflated under direct vision. Chest drains are not inserted. Both sides are performed at the same sitting, and the patient usually leaves hospital the following day. The functional and cosmetic results are excellent on short and long term follow-up with few side effects. Permanent Horner's syndrome has not been reported using this technique. As with all upper limb sympathectomies, patients should be warned of possible compensatory hyperhidrosis. Embracing the tenets of minimally invasive surgery, thoracoscopic sympathectomy should be considered the approach of choice for surgical sympathectomy.

Axilla↗
PubMed1994

Thoracoscopic ultrasonic localisation of lung nodules: initial results of an in-vitro and in-vivo study.

The main problem in thoracoscopic resection of lung nodules is the difficulty in localising the target. In the following we describe the use of an ultrasonographic, deflectable linear array probe of 7.5 MHz which was first tested during an in-vitro study. This study has provided useful information with respect to the US inspection of normal parenchyma and lung nodules. Initial results in clinical use in 14 patients demonstrate some limitations linked to the difficulty in manoeuvering the probe and to the remaining air in the parenchyma. However, endoscopic US is an interesting additional tool during thoracoscopic exploration of the lung.

Equipment Design↗
PubMed1993

[Video-thoracoscopic atypical lung resection].

A new era in thoracoscopy within the framework of minimal invasive thoracic surgery was introduced due to the possibilities of video-endoscopy, the development of an accordingly advanced and suitable instrumentarium as well as the production of an endoscopically applicable linear stapler. The introduction of the endo-staplers has made the thoracoscopic resection even of larger parts of lung parenchyme possible. Just as in laparoscopy a clear reduction of post-operative pain, a reduced impairment of post-operative pulmonary function, a shorter in hospital stay and an earlier return to normal activities are advantages of thoracoscopy when compared to the severely more traumatising thoracotomy. Good indications for this procedure are the spontaneous pneumothorax and the resection biopsy in the quest of finding the diagnosis of unclear pulmonary disease. For the diagnostic and should the situation arise therapeutic resection of solitary pulmonary nodules in contrast a stricter selection and handling of indications is imperative. The method however proved worthwhile under such conditions. The technique and results are reported of video thoracoscopies in 73 patients as well as 51 atypical lung resections carried out thoracoscopically with the Endo-GIA 30. A switch to open thoracotomy became necessary in 16.4%. Indications were pneumothorax (35.6%), hemothorax (1.3%), diagnostic resection of solitary nodule (42.5%), pneumopathy (11.0%), and extrapulmonary tumor (9.6%). Atypical resections were carried out only in the case of solitary nodule (51.7%), pneumothorax (39.7%), and pneumopathy (8.6%). A histological diagnosis was obtained in all cases. The average operating time for solitary nodule and pneumothorax was 1 hour, for pneumopathy 1/2 hour. Chest drains could be removed after 1.6-2.6 days. The postoperative complication rate amounted to 3.9%. There was no mortality. The introduced procedure represents a new and promising alternative in thoracic surgery.

Adult↗
PubMed1993

[Thoracoscopic operation of a tumor of the esophageal wall].

Improvements in video endoscopic technique opens a wide spreaded field of indications of thoracoscopic surgery especially in benign tumors of the esophagus. A 58-years old patient presented with dysphagia. Preoperatively a benign, intramural tumor of the esophagus wall was diagnosed. Enucleation of the tumor was performed by right videothoracoscopy. The use of thoracoscopic operative technique implies rapid disappearance of complaints and a reduced time of hospitalisation.

Deglutition Disorders↗