Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Thoracoscopes”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 685 records · Page 38Linked to original sources
PubMed2006

Inclusion of the transcervical approach in video-assisted thoracoscopic extended thymectomy (VATET) for myasthenia gravis: a prospective trial.

BACKGROUND: Because evidence-based data regarding the quality of video-assisted thoracoscopic thymectomy for the treatment of myasthenia gravis are lacking, a prospective trial comparing three different operative approaches was conducted to evaluate their efficacy. METHODS: This prospective study enrolled 20 consecutive patients with nonthymomatous myasthenia gravis. A series of three approaches for bilateral video-assisted thoracoscopic extended thymectomy (VATET) using the anterior chest wall-lifting method (original), the original method with a flexed-neck position (modified), and the original method with a transcervical approach (final) were prospectively performed in each patient for quantitative and pathologic evaluation of the residual thymus after each approach. RESULTS: Complete VATET required 242 +/- 48 min, with the transcervical procedure requiring 23 +/- 12 min. After the modified method, the residual thymus in the cervical region was 1.5 cm in size and weighed 0.8 g (0.8% of the entire thymus), as compared with a size of 2.2 cm and a weight of 1.3 g (3.2%) after the original method. Each value is the result of comparison with the final method. Histopathologic studies showed residual tissue in the germinal center as well as Hassall's corpuscles in more than 70% of cases. CONCLUSION: The findings show that VATET without the transcervical approach could be an immunologically incomplete treatment for myasthenia gravis. Therefore, the transcervical approach should be included in VATET procedures to ensure radicality.

Adult↗
PubMed2001

Hand-assisted thoracoscopic resection for anterior mediastinal masses.

We report three cases of anterior mediastinal disease (pericardial cyst, thymoma, and myasthenia gravis) in which we used a hand-assisted method in combination with thoracoscopic resection via an infrasternal approach in order to improve the maneuverability and safety of the operation. This technique combines the advantages of both thoracoscopic and incisional resection. It shows promise of becoming a less invasive operation that can be used to treat certain mediastinal tumors, both malignant and benign.

Humans↗
PubMed2001

Mediastinal pancreatic pseudocyst in a child. A thoracoscopic approach.

Mediastinal pancreatic pseudocyst is a rare occurrence in children and may be difficult to diagnose. Internal drainage via a cystenterostomy and a simple external drainage are two of the treatment options that are currently employed. We describe the case of an 11-year-old boy with a mediastinal pseudocyst who was treated via a thoracoscopic approach using an original pulmonary exclusion. The pseudocyst disappeared in 15 days and there has been no recurrence. No adjuvant treatment was necessary. Endoscopic retrograde cholangiopancreatography (ERCP) was useful in establishing the etiology (pancreas divisum). We believe that the thoracoscopic approach is a reproducible, simple, and safe procedure for the treatment of mediastinal pseudocysts. The technique may represent a valid alternative to cystogastrostomy.

Catheterization↗
PubMed2001

Thoracoscopic sympathectomy for palmar hyperhidrosis. Ablate or resect?

BACKGROUND: Upper thoracoscopic sympathectomy, obtained either by ablation or resection of the appropriate ganglia, is now the preferred treatment for primary palmar hyperhidrosis. Therefore, we undertook a review to compare the relative efficacy of these two techniques. METHODS: A Medline search was performed for the years 1974-99 to identify all published studies of thoracoscopic sympathectomy for hyperhidrosis. RESULTS: In all, 33 studies were identified and divided into two groups-ablation and resection. When the resection method was used, the immediate success rate was 99.76%, whereas the ablation method achieved dry hands in 95.2% of cases (p = 0.00001). Palmar sweating recurred in 0% of patients treated via resection and -4.4% treated with ablation. Ptosis was noted in 0.92% of cases after ablation and in 1.72% after resection (p = 0.017). CONCLUSIONS: Resection yields superior results, yet the majority of surgeons ablate, probably because it is easier, requires a shorter operating time, leads to fewer cases of Horner's syndrome, and because resympathectomy eventually overcomes initial failure.

Hand↗
PubMed2001

Long-term follow-up of thoracoscopic splanchnicectomy for chronic pancreatitis pain.

BACKGROUND: Thoracoscopic splanchnicectomy (SPL) has been reported to give excellent short-term pain relief in chronic pancreatitis. This study prospectively evaluates the long-term efficacy of SPL in pancreatitis patients. METHODS: Chronic pancreatitis patients with severe pain unrelieved by standard therapy completed a standard 10-point analogue pain scale prior to surgery and at postoperative visits. Midline and left-sided pain was treated with left SPL; right-sided pain was treated with right SPL. If pain recurred on the contralateral side, contralateral SPL was done. RESULTS: Fifteen patients underwent SPL. Eleven of them required narcotics preoperatively. Follow-up is complete and ranges from 4.2 to 6.1 years (median, 5.75). All patients had constant pain prior to surgery. Following SPL, it decreased in the short term to a mean of 3.9 attacks a month. At long-term follow-up, the mean number of attacks was 8.6 per month. Preoperatively, the mean score for worst pain within the last 2 months was 9.1. This score decreased to 3.9, but at long-term follow-up it had increased to near preoperative values (8.6). Current severity of pain decreased from 7.2 preoperatively to 2.9 at short-term follow-up, but at long-term follow-up it had increased. The degree of disability decreased from 9.1 preoperatively to 5.1 at short-term follow-up, but in the long term it increased toward preoperative values. Although eight patients were narcotic free at early follow-up, only three remained narcotic free in the long-term. CONCLUSION: Thoracoscopic SPL offers short-term relief of pain from chronic pancreatitis, but the relief is not durable in most cases. Similarly, there are short-term improvements in degree of disability, mood, and freedom from narcotic use that are not sustained in the long-term. Nevertheless, two-thirds of patients stated that they would have the surgery again.

Abdominal Pain↗
PubMed2001

Thoracoscopic surgery and conventional open thoracotomy in metastatic lung cancer.

BACKGROUND: We performed a retrospective comparison of the oncological outcome of thoracoscopic surgery for pulmonary metastasis with that of conventional open thoracotomy. METHODS: The patient population for our retrospective comparison was comprised of 45 patients undergoing pulmonary resections via video-assisted thoracoscopy (thoracoscopy group) and 55 undergoing similar resections by open thoracotomy (open group) for pulmonary metastases between 1994 and 1999. RESULTS: Solitary metastasis was resected more frequently with thoracoscopy than open thoracotomy. There were no significant intergroup differences in rates of local recurrence from the initial pulmonary resection site. The actuarial 1-year, 2-year, and 3-year survival rates were, respectively, 82.8%, 70.0%, and 62.3% in the thoracoscopy group and 93.6%, 64.6%, and 52.7% in the open group. The rates of pulmonary recurrence and survival also did not differ significantly between the two groups with solitary metastases. CONCLUSION: Thoracoscopic surgery for metastatic lung disease appears to be feasible as long as the preoperative metastatic tumor evaluation using chest computed tomography (CT) is accurate.

Actuarial Analysis↗
PubMed2001

The role of video-assisted thoracoscopic surgery in the diagnosis of the small peripheral pulmonary nodule.

BACKGROUND: The use of imaging techniques to detect small peripheral pulmonary nodules often results in a missed diagnosis. Thoracoscopy had limited application until recently, when advances in technology allowed thoracic surgeons greater visualization and mobility within the chest. METHODS: Between September 1992 and June 1997, 81 patients were treated for small peripheral pulmonary nodules by pulmonary wedge excision using video-assisted thoracoscopic techniques. The patients were 39 men and 42 women with an average age of 59.5 years. RESULTS: A definitive diagnosis was obtained in all cases. Malignancies were found in 44 patients (55%), which involved primary lung cancer in 28 patients and metastatic lesions in 16 patients. The rate of malignancy in nodules measuring 1 cm or less was 18%. There was no operative mortality or morbidity. CONCLUSIONS: We conclude that video-assisted thoracoscopic lung biopsy is a more effective and less invasive diagnostic tool for small peripheral pulmonary nodules.

Female↗
PubMed1997

Thoracoscopic partial pericardiectomy in the diagnosis and management of pericardial effusion.

BACKGROUND: An effort was made to present our experience with thoracoscopy in the diagnosis and management of pericardial effusions. METHODS: Twenty-two partial pericardiectomies were performed with the thoracoscopic approach in patients with pericardial effusions, the etiology of which was uremic (n = 7), neoplastic (n = 8), idiopathic (n = 5), septicemia (n = 1), and postpericardiotomy (n = 1). All cases had grade III-IV/IV radiological cardiomegaly and ultrasonographic confirmation of the effusion. We found hemodynamic compromise in 17 patients. The operation, requiring the insertion of three trocars, enabled us to remove a large part (approximately 6 x 10 cm) of the left anterolateral side of the pericardium and aspirate the effusion contents for diagnostic and therapeutic purposes. RESULTS: In five cases we found coexisting pleural effusions. The pericardial effusion had a mean volume of 817 ml, which was serous in 11 cases, hematic in six, serohematic in four, and purulent in one. Cytology of the pericardial effusion was positive for neoplasia in four cases (one pulmonary neoplasia, two breast carcinomas, and one lymphoma). We observed conversion to grade I/IV cardiomegaly in 16 cases and a return to normality in the other six, with the absence of ultrasonographic effusion in all cases. There was no recurrence during the mean follow-up period of 20.5 months (range: 2-47). CONCLUSIONS: The thoracoscopic management of pericardial effusions is a simple and effective technique that allows us to create a large pericardial window that drains the effusion definitively, determines its etiology, and explores and treats coexisting pleural lesions, all without recurrences.

Adolescent↗
PubMed1997

Thoracoscopic enucleation of a large leiomyoma located on the left side of the esophageal wall.

Thoracoscopic enucleation through the right thorax was successfully performed for a large leiomyoma located on the left wall of the upper-middle esophagus. Using intraoperative esophagoscopy, the exact location of the tumor was identified by trans-illumination. Two sling tapes passed around teh esophagus made the procedure as easy as that for tumor located on the right wall of the esophagus. We considered that the thoracoscopic approach through the right thorax can be applied to various types of esophageal leiomyoma, even a large one located on the left side of the esophagus.

Adult↗
PubMed1998

Bilateral thoracoscopic stapled volume reduction for bullous vs diffuse emphysema.

BACKGROUND: We compared our results with bullous vs diffuse emphysema by performing a bilateral thoracoscopic stapled volume reduction technique in 15 patients (age 45-80, 10 males, five females). METHODS: Eight patients demonstrated bullous emphysema and seven patients diffuse emphysema. Lung reduction was performed with a bilateral thoracoscopic stapled technique utilizing bovine pericardium in the supine position. RESULTS: Comparison of the bullous versus diffuse groups revealed no significant differences in means for the following variables: length of air leak (7.5 vs 3.3 days); length of stay (8.1 vs 6.5 days); pre-op FEV1, (23% vs 22%); pre-op dyspnea index (3.4 vs 3.6). At 3 months the bullous subset had a highly significant improvement (p < 0.007) in FEV1 (88%) compared with the diffuse subset FEV1 (59%). CONCLUSIONS: These early results suggest that patients with bullous emphysema are at no greater risk and demonstrate a significantly greater improvement in FEV1 than patients with diffuse emphysema.

Adult↗
PubMed1999

Complications in thoracoscopic spinal surgery: a study of 90 consecutive patients.

BACKGROUND: The literature contains few reports on negative outcomes after thoracoscopic spinal surgery. METHODS: From November 1995 to February 1998, 90 patients underwent minimally invasive spinal surgery by thoracoscopic assistance as treatment for their anterior spinal lesions. The diagnoses included 41 spinal metastases, 13 cases of scoliosis, 12 burst fractures, 10 cases of tuberculous spondylitis, 8 cases of pyogenic spondylitis, 2 thoracic disc herniations, 2 cases of ankylosing spondylitis with discitis, 1 osteoporotic compression fracture, and 1 case of thoracolumbar kyphosis. The procedures included biopsy only (3 patients); thoracic discectomy (3 patients); multilevel anterior releases, discectomy, and fusion (14 patients); corpectomy for decompression (6 patients); corpectomy and interbody fusion (32) patients; and internal instrumentation (28 patients). RESULTS: A total of 30 complications were noted in 22 patients (24.4%). Two fatal complications occurred, resulting from massive blood transfusion in one case and postoperative pneumonia in another. Other nonfatal complications included four cases of transient intercostal neuralgia, three superficial wound infections, three cases of pharyngeal pain, two cases of lung atelectasis, two cases of residual pneumothorax, two cases of subcutaneous emphysema, one inadvertent pericardial penetration due to adhesion, one chylothorax that resolved after conservative management, one vertebral screw malposition, and one graft dislodgement that needed late revision surgery. Three patients required ventilatory support for longer than 72 hours. Five patients with spinal metastases had an estimated intraoperative blood loss of more than 2,000 ml. No injury to the internal organs or spinal cord was observed. There were four conversions to open procedures due to two cases of severe pleural adhesions and two poorly tolerated one-lung ventilation. At the latest follow-up, nine patients had died as a result of cancer dissemination. CONCLUSIONS: (a) Well-selected patients and attention to details are essential to optimizing surgical results. (b) A refined technique for less invasive tumor surgery has been developed. (c) Surgeons had better experience with the standard anterior spinal approach and showed no hesitation in converting to an open procedure when necessary. A procedure failure does not mean a treatment failure.

Adolescent↗
PubMed1999

Bronchoscopic sclerotherapy combined with thoracoscopic drainage for postpneumonectomy bronchial fistula and empyema.

A postpneumonectomy bronchial fistula is a very morbid complication that often requires major surgical procedures for treatment. Since patients with postpneumonectomy bronchial fistula and empyema are physiologically compromised, corrective surgical interventions pose considerable risk. We report a case of a postpneumonectomy fistula with an associated empyema. Our patient's empyema was treated with thoracoscopic debridement and antibiotic instillation (modification of the Clagett procedure). Bronchoscopic and thoracoscopic treatment strategies that are appropriate for selected patients with postpneumonectomy bronchial fistula and empyema are discussed.

Aged↗
PubMed1999

Left thoracoscopic sympathectomy and stellate ganglionectomy for treatment of the long QT syndrome.

The long QT syndrome (LQTS) is a rare inherited cardiac disorder that may induce fatal cardiac arrhythmias. Patients diagnosed with this disorder generally have several treatment options, including beta-blockade, cardiac pacing, an implantable automatic defibrillator, or a high thoracic left sympathectomy. We report the case of a 6-year-old girl with the LQTS treated by left thoracoscopic sympathectomy and stellate ganglionectomy. The procedure was performed after an initial thorascopic attempt at another institution failed due to inadequate resection of the sympathetic chain. Operative time was 85 min and blood loss was minimal. There were no intraoperative or postoperative complications. The girl's QT interval decreased and she was discharged on the 4th postoperative day. After 9 months of follow-up, she remains asymptomatic. We conclude that the LQTS patients who fail medical treatment can be treated successfully with left thoracoscopic cervicothoracic sympathectomy. We recommend that the extent of sympathectomy for treating the LQTS be T1-T4 and either the entire stellate ganglion or at least the inferior one-third.

Child↗
PubMed2000

Anterior thoracoscopic spine release in deformity surgery: a meta-analysis and review.

Videoassisted thoracoscopic surgery (VATS) allows the surgeon to perform an anterior thoracoscopic spine release for spinal deformities. It is an alternative to open thoracotomy. Several years after its introduction the present author gives an update on the indications, surgical techniques, results, and complications of this new technology. A meta-analysis of previously published papers is organized in tables in an attempt to answer all the questions and controversies that this technique has aroused. A series of ten selected articles were available for review, comprising a total of 151 procedures. No study had any long-term follow-up. Most series were pediatric and involved a variety of etiologies (mostly neuromuscular, adolescent idiopathic scoliosis, and Scheuermann's kyphosis). The surgical technique was for most authors a convex side approach in the lateral decubitus through four or more ports in the anterior or midaxillary line. Single lung ventilation was used in most cases. Posterior surgery was carried out the same day in most cases. The total number of discs excised varied between 4 and 7, but the quality of disc excision was rarely reported. Most authors carried out a spine fusion at the time of the disc release. The total VATS procedure lasted between 2 h 30 min and 4 h, depending on the series and the surgeon's previous experience. In most series curves were in the range of 55 degrees-80 degrees, with an average of 65 . The percentage of Cobb angle correction was 55%-63% after VATS and posterior spine fusion. For kyphotic deformities only one series had significant numbers to allow conclusions to be drawn. The mean preoperative Cobb angle was 78 degrees and postoperatively the kyphosis was corrected to 44 degrees. Length of hospital stay was quite similar in most series and was around 9 days. The cost of the VATS procedure was studied in one series and was found to be 28% more expensive than thoracotomy. The total complications reported were 18%; most were pulmonary complications with prolonged ventilatory support in patients with neuromuscular pathologies. The VATS procedure has been used with success in most series for pediatric curves (average Cobb angle of 65 degrees or kyphosis of 75 degrees). No report of the surgical outcome (balance, rate of fusion, rib hump correction, cosmetic correction, pain, and patient satisfaction) was available for any series. Further prospective study including these parameters will be required to determine the real benefit of such procedures to the patient, bearing in mind that the correction of spinal deformities is the result of the surgeon's experience, skill, and the available technology.

Humans↗
PubMed1998

Thoracoscopic enucleation of a submucosal bronchogenic cyst of the esophagus: report of two cases.

Thoracoscopic enucleation of a bronchogenic cyst of the esophagus was successfully performed in two cases. The first patient was a 26-year-old female complaining of dysphagia and retrosternal discomfort. The second patient was a 56-year-old female complaining of retrosternal discomfort. A close examination revealed a cystic lesion compressing the esophagus in both cases. Three trocars were employed under general anesthesia. Thoracoscopy offering excellent visualization allowed us to perform a precise anatomical dissection between the muscle layer and the mucosa. Both patients recovered uneventfully and the symptoms disappeared postoperatively. Thoracoscopic surgery is thus considered to be beneficial for the treatment of a benign esophageal tumor because of the small chest wall entry, which might positively contribute to a favorable postoperative course.

Adult↗
PubMed2002

Video-assisted thoracoscopic sympathectomy for palmar hyperhidrosis: results in 102 cases.

The purpose of this retrospective study was to evaluate the immediate and long-term outcome of video-assisted thoracoscopic sympathectomy for idiopathic palmar hyperhidrosis. Between January 1996 and December 2000, a total of 67 patients underwent 102 sympathectomy procedures with excision of the sympathetic chain between the second and fourth sympathetic ganglion. The mean duration of hospitalization was 1.7 +/- 0.6 days. Five patients were lost to follow-up. Mean duration of follow-up for the 96 sympathectomy procedures in the remaining 62 patients was 38 +/- 6.3 months. Patient outcome showed that video-assisted thoracoscopic sympathectomy is the treatment of choice for idiopathic palmar hyperhidrosis. Long-term patient satisfaction is excellent.

Adolescent↗
PubMed2005

Experience of thoracoscopic extirpation of intrapulmonary lymphangioma.

We report a 59-year-old woman who underwent thoracoscopic extirpation of the intrapulmonary cystic lymphangioma which was located in the subpleural space of the left upper lobe. A chest X-ray showed a solitary round nodule in the left pulmonary hilum. A computed tomography scan revealed a mass shadow at the interlobar region surrounding the interlobar pulmonary artery. A round nodule was recognized as low signal intensity on T1-weighted images by magnetic resonance imaging. There was biphasic signal intensity on T2-weighted images as well. Radiologically, we diagnosed this lesion as a benign cystic tumor in the lung. Thoracoscopic observation revealed a cystic lesion just beneath the visceral pleura of the upper lobe adjacent to the interlobular pulmonary artery. As this suggested a benign bronchogenic cyst, we performed extirpation of the cyst under thoracoscopy. After this operation, the cyst was diagnosed as an intrapulmonary cystic lymphangioma pathologically.

Female↗
PubMed2006

Compromised video-assisted thoracoscopic segmental resection for high-risk patients with stage I lung cancer near the lung hilum.

We performed a video-assisted thoracoscopic segmental resection without doing a mini-thoracotomy in two patients (one octogenarian and one with poor lung function) with early stage (T1-2N0) lung cancer located at the lung hilum who required preservation of their cardiopulmonary function. After 2 years of follow-up, both patients are alive without recurrence. We describe the cases and the method used for the video-assisted thoracoscopic segmental resection using an endoscopic stapler.

Aged↗