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PubMed1996

Mediastinoscopy vs thoracoscopy for mediastinal biopsy. Results of a prospective nonrandomized study.

OBJECTIVE: To assess the results and the morbidity of thoracoscopy compared with conventional mediastinoscopy for the approach of mediastinal solid masses and lymph nodes, we have performed a prospective study about the respective yields, complication rates, and the length of hospital stay for patients. MATERIAL AND METHODS: We have included 114 patients in the study. The criteria of inclusion were the accessibility of the lymph nodes and/or mass to cervical mediastinoscopy through CT scan view. There were 2 groups: 52 patients underwent a mediastinoscopy (group M) and 62 underwent a thoracoscopy (group T). RESULTS: There were 3 failures in group M (5.7%) and 5 failures in group T (8.1%) (not significant; NS). In group M, the three procedures were converted to anterior mediastinotomy (two cases) and to thoracoscopy (one case). In group T, the five procedures were converted to anterior mediastinotomy (two cases), mediastinoscopy (two cases), and thoracotomy (one case). The diagnostic yield was 94.3% in group M and 91.9% in group T (NS). After conversion, a diagnosis was reached in all patients in group M (100%) and in all but 1 patient in group T (98.3%) (NS). There was no intraoperative complication in group M, while 2 complications occurred in group T (3.2%) (p < 0.05). The overall morbidity was zero in group M and 4.8% in group T (p < 0.05). CONCLUSION: The diagnostic yield of mediastinoscopy is comparable to thoracoscopy. Complication rate and hospital stay of patients undergoing mediastinoscopy are significantly inferior. Thoracoscopy should be indicated only for lesions that are not within the reach of the mediastinoscope or when multiple biopsy specimens are necessary.

Biopsy↗
PubMed1997

Thoracoscopy in children and adolescents.

STUDY OBJECTIVES: Present the feature characteristics of the use and findings of thoracoscopy in children and adolescents. DESIGN: From February 1983 to February 1996, 77 thoracoscopic procedures were done on patients ranging in ages from 5 months to 18 years (mean, 9.8 years). Two-thirds (66.2%) were male. They were divided into three groups (1, 2, and 3) based on age (up to 2, from 2 to 8, and older than 8 years), predominance of certain diseases in these ages, and the size of the instruments utilized. They were operated on using general anesthesia with Carlens' mediastinoscope routinely used in 64 (83%) and videothoracoscopy in 13 (17%). The chief indication for therapeutic thoracoscopy was treatment of empyema, while for diagnostic thoracoscopy it was pleural biopsy and diagnosis of pleural effusions. RESULTS: In group 1, thoracoscopy was solely for the treatment of pleural disorders. In group 2, it was for the treatment of pleuropulmonary diseases. Group 3 behaved almost like adults, with broad diagnostic and therapeutic indications for thoracoscopic procedure. CONCLUSIONS: Thoracoscopy, which is a useful diagnostic and therapeutic procedure, has secured an important place in pediatric surgical practice.

Adolescent↗
PubMed2001

Thoracoscopy talc poudrage : a 15-year experience.

OBJECTIVES: To review our experience with thoracoscopy and talc poudrage during the previous 15 years with regards to efficacy, side effects, morbidity, and mortality. METHODS: Six hundred fourteen consecutive patients (58.6% female; mean age, 54.5 years) underwent thoracoscopy with talc poudrage from August 1983 to May 1999. Of these, 457 patients had malignant pleural effusions, 108 patients had benign pleural effusions, and 49 patients had spontaneous pneumothorax. RESULTS: Sixty-four patients were excluded from evaluation for efficacy: 30 patients (4.9%) because the lung did not expand at the time of the procedure and 34 patients (5.5%) because they died within 30 days of the thoracoscopy. All exclusions were in the malignant group. The overall success rate of the 393 patients with malignant pleural effusions was 93.4%, while the overall success for the 108 patients with benign effusions was 97%, although 7 patients (7%) with benign effusions required a second thoracoscopy. The success rate with pneumothorax was 100%. Major morbidity included empyema in 4%, reexpansion pulmonary edema in 2.2%, and respiratory failure 1.3%. CONCLUSION: Thoracoscopy with talc poudrage is effective in producing a pleurodesis in malignant and benign pleural effusion and in spontaneous pneumothorax. However, it should be noted that the insufflation of talc has a systemic distribution associated with a low rate of morbidity and perhaps does induce ARDS, which is sometimes fatal in a small percentage of patients. Because of these side effects, the search for a better agent should be continued.

Female↗
PubMed2005

Detection of hypoventilation during thoracoscopy: combined cutaneous carbon dioxide tension and oximetry monitoring with a new digital sensor.

BACKGROUND: Changes in Paco(2) have not been described during thoracoscopy under sedation-assisted local anesthesia. We hypothesized that hypoventilation might occur secondary to administration of sedatives and decreased ventilation in one lung. AIM: Prospectively measure cutaneous carbon dioxide tension (Pcco(2)) in addition to pulse oximetric saturation (Spo(2)) using a new combined digital sensor to examine the occurrence of hypoventilation during thoracoscopy under sedation-assisted local anesthesia. SETTING: University hospital. METHODS: Following validation studies, Pcco(2) was prospectively measured in 16 consecutive patients undergoing thoracoscopy under sedation-assisted local anesthesia using a combined digital earlobe sensor measuring Spo(2) (percentage) and Pcco(2) (millimeters of mercury). All patients received supplemental oxygen. Routine BP monitoring and Spo(2) was continued. Patients received IV hydrocodone, 5 mg, and intermittent boluses or IV midazolam and pethidine. RESULTS: Mean baseline Pcco(2) measurement was 39.1 +/- 7.2 mm Hg (+/- SD) [range, 27.5 to 50.5 mm Hg], and peak measurement during the procedure was 52.3 +/- 10.3 mm Hg (range, 37.2 to 77 mm Hg) [p < 0.001]. Median and mean changes in Pcco(2) measurement from baseline were 13.0 mm Hg and 13.2 +/- 5.3 mm Hg (range, 5.5 to 27.8 mm Hg), respectively. Mean fall in Spo(2) during the procedure was 4.6 +/- 3.2% (range, 1 to 14%). CONCLUSIONS: Thoracoscopy performed under sedation-assisted local anesthesia is associated with significant hypoventilation. Combined measurement of Spo(2) and Pcco(2) during thoracoscopy is a novel approach in the monitoring of ventilation, enhancing patient safety, and might allow to guide the administration of sedation in a better way.

Adult↗
PubMedDate not supplied

[Diagnostic thoracoscopy].

Diagnostic thoracoscopy in patients with pleural effusion of unclear origin mostly provides the correct diagnosis. Results from published reports of previous researches are not uniform. In 47 male and 20 female patients with pleural effusion of unknown etiology, after receiving negative results obtained from cytological finding of pleural effusion and percutaneous needle biopsy, thoracoscopy with biopsy of one or both pleurae was performed. Procedure was done in local anesthesia using Stortz rigid thoracoscope. In 37 patients with malignant disease (primary or metastatic) diagnosis was confirmed histopathologically in 31 patient (81.12%). In 27 patients with inflammatory pleural disease diagnosis was confirmed histopathologically in 22 patients (81.4%). Among 11 patients with specific pleural effusions, tuberculosis was confirmed in 10 (90.91%). Normal finding in cases of spontaneous pneumothorax and pulmonary embolism was taken as a positive result. Total number of positive findings was 55 (82.10%). In one patient, the third spontaneous pneumothorax was the indication for thoracoscopy, and after numerous bullae were seen during the procedure, talcum powder pleurodesis was done. In four patients low intensity subcutaneous emphysema occurred one day after thoracoscopy. It can be concluded that thoracoscopy in local anesthesia out of the operating room is good and practical method for solving the unclear pleural effusions, with neglectable rate of complications.

Adult↗
PubMedDate not supplied

[Video thoracoscopy in the diagnosis of pleural effusions].

BACKGROUND: At present video thoracoscopy is a primary diagnostic procedure in the diagnosis of pleural diseases, particularly when pleural effusions have unknown origin. METHODS: In this article the personal experience is reported about 20 patients in which video thoracoscopy was very important in the diagnosis of pleural effusions. RESULTS: Thoracoscopy permits to explore the thoracic cavity and to do a lot of biopsies. Video thoracoscopy, made it possible to diagnose 10 cases of malignant mesothelioma, 2 cases of pleural metastases (renal mts and mammary mts) and 8 cases of inflammatory diseases. CONCLUSIONS: At last, is laid on the contribution of video thoracoscopy to determine the stage of malignant mesothelioma.

Adult↗
PubMed2000

[Endoscopic approach to pulmonary diseases: Clinical utility of medical thoracoscopy in diagnosis of pleural diseases].

Thoracoscopy is useful for diagnosis of a number of lung diseases. We report our recent experience of medical thoracoscopy performed under local anesthesia in 142 cases. Of 124 patients with pleural effusion, 46 had pleuritis carcinomatosa, 11 had pleuritis tuberculosa, and 10 had malignant mesothelioma. We evaluated the utility of thoracoscopic observation and pleural biopsy in these three diseases. Almost of patients with malignant pleural effusion initially undiagnosed by the cytology of pleural effusion were diagnosed by thoracoscopy. Especially in malignant mesothelioma, thoracoscopy allowed accurate diagnosis. No serious complication was observed. Since medical thoracoscopy under local anesthesia is a rapid, easy, safe, and well-tolerated procedure with an excellent diagnostic yield, it is recommended as a diagnostic procedure for cases with pleural effusion.

Adult↗
PubMed1992

[What is the role of thoracoscopy in the preoperative staging of non-small cell bronchial cancer?].

It is of paramount importance to clearly separate the non small cell bronchogenic cancers involving the chest wall or the diaphragm (T3) and those metastasizing to the pleura (T4). In both events, surgery is either technically demanding or contraindicated. What is the contribution of thoracoscopy to diagnosis? Very few authors have used thoracoscopy in a restricted number of cases and with varying results to confirm tumoral extent to the chest wall. We are of opinion that this approach is only warranted in patients at major operative risk, in order to prevent an unprofitable thoracotomy. Concomitant pleural effusion as indication for thoracoscopy should be discussed with respect to the following data: 1) Among all bronchogenic cancers, 10% present with a concomitant pleural effusion detected on chest radiograms, 60% of which are metastatic. The significance of effusions disclosed by CT scan has not yet been established. 2) Pleural involvement inconsistently produces an effusion; the prevalence compiled from thoracotomies is varying according to the authors. 3) The sensitivity of thoracoscopy for the positive diagnosis of malignant effusions is about 95%. The concomitant pleural effusion is predictive of poor prognosis, but does not preclude operability. Cytology of thoracentesis specimens and pleural needle biopsy are the consistent first steps towards diagnosis; thoracoscopy should be restricted to the failures of these techniques.

Carcinoma, Non-Small-Cell Lung↗
PubMed1992

[Thoracoscopy: diagnostic and therapeutic use].

From 1986 to 1989, we performed 74 thoracoscopies in 70 patients (37 persisting or relapsing pneumothoraces, 30 chronic pleural effusions, 3 primary pleural tumors, 2 chylothoraces, 1 empyema, 1 persisting bronchopleural fistula). 29 supplementary diagnoses were established by thoracoscopy: 11 carcinomas, 4 cases of pleural tuberculosis, 12 of nonspecific pleurisy, 1 pleural fibroma, and 1 hamartoma. Pleurodesis was done with talc under thoracoscopy with success in 32/34 cases of pneumothorax (94%) and in 19/20 patient with chronic pleural effusion (95%). Talc was also successful in 2 instances of chylothorax and the bronchopleural fistula. The empyema was successfully treated by drainage under thoracoscopy and local instillation of streptokinase. Altogether, we recorded 3 deaths in the 30 days following thoracoscopy in 3 plurimetastatic patients. No other major complication was observed. The procedure is a well tolerated tool for diagnosis and treatment of pleural diseases. The indication should however be established with care in debilitated plurimetastatic patients.

Adult↗
PubMed1981

Emergency thoracoscopy: a logical approach to chest trauma management.

Expeditious surgical management in serious chest trauma improves survival rates. However, guidelines for emergency thoracotomy that depend on the initial amount of blood loss or continuing blood loss are imprecise and frequently require a period of observation. In an attempt to improve prethoracotomy diagnosis emergency thoracoscopy was used in the operating room in 36 patients who presented with hemothoraces. A diagnostic thoracoscope was inserted through the previously placed incisions for chest tubes. The procedure was well tolerated under local anesthesia and in most patients took less than 15 minutes to complete. No complications resulted from thoracoscopy. When the information obtained did not indicate further operations, the thoracoscope was withdrawn and chest tubes were reinserted through the same incisions. The method provided anatomic definition of the injuries in 35 of 36 patients and allowed the determination of whether blood loss was continuing. Management was altered as a result of thoracoscopy in 16 patients (44.4%). An unnecessary thoracotomy was avoided in 16 patients who had greater than 1,500 ml of blood in the thoracic cavity on admission and allowed a more rapid thoracotomy in one patient. Four patients had wounds located close to the diaphragm and laparotomy was avoided when the diaphragm was found free of injury. Bleeding from lacerated intercostal vessels was stopped with diathermy during thoracoscopy in two of three patients. In addition, 15 patients had 200 ml or more of clotted blood removed. The usefulness of removal of clotted blood remains to be proved but it is hoped that the incidence of empyema will be reduced. Emergency thoracoscopy has proved a valuable diagnostic and therapeutic measure in patients sustaining penetrating chest trauma.

Adolescent↗
PubMed1981

Diagnostic thoracoscopy.

During a 5-year period, diagnostic thoracoscopy was attempted in 566 patients and successfully performed in 556. No deaths due to thoracoscopy occurred and complications were few. In patients with malignant disease of the pleura, positive biopsies were obtained in 95 of 137 patients (69%). A positive culture for tubercle bacilli was obtained from pleural biopsy in 27 of 36 patients (75%) with bacteriologically confirmed pleural tuberculosis. Thoracoscopy improved the diagnostic accuracy in these conditions. In patients with benign tumours as well as anatomical abnormalities thoracoscopy was diagnostic. In other conditions thoracoscopy was rarely able to give a positive diagnosis, but it proved very helpful in ruling out malignant disease and tuberculosis. The number of false positive was small, about 3% in this series.

Adolescent↗
PubMed1995

Video-assisted thoracoscopy in the management of recurrent spontaneous pneumothorax.

OBJECTIVE: To present our experience of video-assisted thoracoscopy in the treatment of recurrent spontaneous pneumothorax, and to compare the results with those of a historical control group treated by lateral thoracotomy. DESIGN: Prospective evaluation with historical controls. SETTING: Teaching hospital, Italy. SUBJECTS: 41 Patients with recurrent spontaneous pneumothorax, 20 of whom were treated by video-assisted thoracoscopy and 21 of whom underwent lateral thoracotomy (historical control group). MAIN OUTCOME MEASURES: Duration of chest drainage, length of hospital stay, amount of narcotic analgesia required, postoperative complications, and recurrence during follow up. RESULTS: The mean (range) duration of chest drainage in the group who underwent video-assisted thoracoscopy was 5 days (4-7) compared with 7 days (4-13) in the control group; the corresponding figures for length of hospital stay were 6 days (4-8) compared with 10 days (5-16). 3 Patients (15%) in the thoracoscopy group required parenteral narcotic analgesia compared with 14 (66%) in the control group, and 2 (10%) developed minor complications compared with 5 (24%). The mean length of follow up was 9 months (range 1-18) compared with 26 months (19-34), and no patient in either group developed a recurrence. CONCLUSION: Our early results of treating recurrent spontaneous pneumothorax with video-assisted thoracoscopy have been encouraging, and we have adopted it in preference to lateral thoracotomy.

Adult↗
PubMed1994

Efficacy and safety of thoracoscopy for diagnosis and treatment of intrathoracic disease: the University of Maryland experience.

Thoracoscopy has become an important tool in the diagnosis and management of intrathoracic disease. Between April 1991 and October 1992, 93 patients underwent thoracoscopy. Lung resection was performed on nineteen patients for diagnoses of interstitial lung disease and on seven patients for pulmonary nodules. Eleven patients underwent therapeutic lung resection for management of pneumothorax or air leaks. Sixteen patients underwent thoracoscopy for pleural disease. This was to diagnose mesothelioma (2), to lyse benign adhesions (2), to drain empyema (2), and to evacuate loculated pleural effusion (10) thoracoscopically. Nine patients underwent thoracoscopic staging for lung cancer. Thirteen patients underwent thoracoscopic staging for esophageal cancer as part of a prospective trial. Other indications for thoracoscopy included pericardiectomy (6), sympathectomy (2), and resection of mediastinal mass (4). Thoracoscopy is an excellent option for patients at high risk from standard thoracotomy and may allow procedures to be performed which would prevent the need for open thoracotomy, resulting in shorter hospital stay and less postoperative pain.

Aged↗
PubMedDate not supplied

[Malignant mesothelioma of the pleura: correlations between thoracoscopy and radiology].

The frequency of malignant pleural mesothelioma has increased greatly in the past three decades; it is a tumor of great clinical, epidemiologic and therapeutical interest. Therapy should not be started before the tumor has been correctly diagnosed and staged with thoracoscopy and computed tomography (CT) which have replaced plain chest radiography. To help optimize the combination of these techniques, the authors report on their experience in 37 patients examined with conventional radiology and then with thoracoscopy. In 26 patients with CT findings of malignant pleural mesothelioma, the authors compared thoracoscopy and CT findings in the assessment of neoplastic spread to the parietal (stage IA) and/or visceral (stage IB) pleura. CT appears to be the technique of choice after plain chest radiography: if the suspected malignant pleural mesothelioma is classified as stage II, III or IV, thoracoscopy should be used only for histologic confirmation. Conversely, in stages IA and IB, thoracoscopy--besides histology--should be used to confirm malignant spread to the visceral pleura.

Adult↗
PubMed1996

[Utility of thoracoscopy for diagnosis of pulmonary diseases in clinical pulmonary medicine].

Thoracoscopy is useful for diagnosis of a number of lung diseases. We report our recent experience with thoracoscopy in 86 patients and with video-assisted thoracic surgery in 105 patients. In 70 patients with pleural effusion, thoracoscopic pleural biopsy was done under local anesthesia. All malignant pleural effusions that were not diagnosed by cytologic examination of pleural effusion fluid were diagnosed by thoracoscopy. Especially in malignant mesothelioma, thoracoscopy yielded correct diagnoses. No complication was observed. In 45 patients with a solitary pulmonary nodular lesion and in 27 patients with diffuse interstitial lung diseases, thoracoscopic lung biopsy was done with an "endo-stapler", under general anesthesia. The diagnostic accuracy of this procedure was excellent. Plasma neutrophil elastase and IL-6 levels were measured after surgery as markers of the invasiveness of the procedure. The results indicated that thoracoscopic lung biopsy is relatively safe and non-invasive. Thoracoscopy has become an indispensable tool in the daily practice of pulmonology.

Adult↗
PubMed1996

[The diagnostic value of thoracoscopy in pleural mesothelioma].

OBJECTIVE: To analyse the diagnostic value of thoracoscopy in pleural mesothelioma. METHODS: The image features under thoracoscopy and the histology of 32 patients with pleural mesothelioma were reported. And the diagnostic rate of thoracoscopy was compared with those of chest X-ray, CT, effusion fluid cytology, tomography and the percutaneous needle pleural biopsy. RESULTS: The diagnostic rate of thoracoscopy in pleural mesothelioma was 100%, and the histologic subtypes were the benign fibrous (5 cases), epithelial (9 cases), fibrosarcoma (12 cases) and the mixed (6 cases). The positive rates of chest X-ray, tomography, pleurography, CT, effusion fluid cytology and the percutaneous needle pleural biopsy were 13%, 33%, 38%, 61%, 15% and 24% respectively. CONCLUSION: Thoracoscopy was found to be the best method for diagnosing pleural mesothelioma, by which all pleural lesions could be observed and biopsied directly.

Adolescent↗
PubMed1998

Thoracoscopy in undiagnosed pleural effusions.

OBJECTIVE: To review the indications and accuracy of diagnostic thoracoscopy for pleural effusions of unknown origin. DESIGN: Retrospective review of consecutive patients referred for diagnostic thoracoscopy over a 5-year period from 1 January 1989 to 31 December 1993. SETTING: Tertiary referral cardiothoracic unit. PATIENTS: Thirty-four patients referred from either medical or oncology services within a university-affiliated academic complex. INTERVENTIONS: All patients had diagnostic thoracoscopy performed under general anaesthesia. Retrospective data were collected in respect of presenting symptoms, gross findings, final pathological findings, amount of drainage, length of hospital stay and complications of the procedure. In 7 patients (21%), iodised talc was insufflated at the same time to create pleurodesis. MAIN RESULTS: Final diagnoses were: 17 (50%) malignant disease, 6 (18%) tuberculosis and 9 (26%) 'negative' pathology. In 2 (6%), further intervention was required to make a conclusive diagnosis. The diagnostic sensitivity for malignant disease was 89% and the specificity 100%. For pleural tuberculosis both the sensitivity and specificity were 100%. For 'negative' diagnoses the negative predictive value was 82%. A history of fever and sweats had a marked association (P = 0.002) with the final diagnosis of tuberculosis. No association could be identified between the gross observations at the time of thoracoscopy and the final diagnosis. The average length of hospital stay was 6.7 (range 1-25) days. There was 1 in-hospital death (3%), and 9 patients (26%) had major complications related to the procedure. CONCLUSIONS: Diagnostic thoracoscopy is a useful modality for obtaining a diagnosis in effusions of unknown origin where other methods have failed. The presence of symptoms such as fever and sweats is highly associated with a final diagnosis of tuberculosis.

Biopsy, Needle↗
PubMed1998

Evaluation of biopsy specimens obtained during thoracoscopy from lungs of clinically normal dogs.

OBJECTIVE: To determine whether lung biopsy specimens obtained during thoracoscopy, using a commercially available ligature, can provide an adequate amount of tissue for histologic evaluation and to characterize changes in the lungs and thoracic cavity that result from the procedure. ANIMALS: 6 mixed-breed dogs. PROCEDURE: All dogs underwent 2 anesthetic episodes. The first anesthetic episode was a sham procedure. During the second anesthetic episode, each dog underwent a thoracoscopic procedure to obtain a lung biopsy specimen, using a commercially available ligature. Biopsy specimens were assessed subjectively by means of histologic evaluation. Samples for arterial blood gas analysis were obtained, and thoracic radiography was performed after surgery. Dogs were evaluated daily for 14 days after thoracoscopy and then were euthanatized. Tissues were evaluated grossly and histologically. RESULTS: Excellent intraoperative visibility and biopsy specimens adequate for histologic evaluation were obtained from all dogs. Significant differences were not found between arterial blood gas values of sham- and thoracoscopy-treated dogs for samples obtained 0.25, 2, and 24 hours after extubation. Examination of thoracic radiographs obtained 2 and 24 hours after thoracoscopy revealed minimal localized pathologic changes. All dogs were clinically normal 24 hours after thoracoscopy, and major postoperative complications were not detected. Gross and histologic findings of specimens obtained during necropsy revealed changes localized to biopsy and trocar sites. CONCLUSIONS: Thoracoscopic placement of ligatures allowed procurement of lung lobe biopsy specimens from clinically normal dogs without complications. CLINICAL RELEVANCE: This procedure may provide a safe and minimally invasive means of obtaining lung biopsy specimens from clinically affected dogs.

Animals↗