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At least 793 records · Page 44Linked to original sources
PubMed1999

Thoracoscopic reduction pneumoplasty for severe emphysema: do pleural adhesions affect outcome?

BACKGROUND: Pleural adhesions are frequently encountered in patients undergoing reduction pneumoplasty. We evaluated the impact that pleural adhesions had on the surgical technique and outcome of thoracoscopic reduction pneumoplasty. METHODS: 59 operated patients were divided into 2 groups depending on the presence (group A) or absence (group B) of pleural adhesions. RESULTS: At inter-group comparison (A versus B) a significant difference was found for mean duration of operation (128+/-55 min versus 73+/-33 min; p<0.005), morbidity (14 versus 9 patients; p<0.05), and hospital stay (14.1+/-11.8 days versus 12.0+/-7.4 days; p<0.001). Complications occurred less frequently in the last 29 patients than in the first 30 patients (11 versus 24; p<0.03). At histopathologic analysis subpleural (p<0.005) and interstitial fibrosis (p<0.001), and interstitial granulomas (p<0.012) were more frequent in group A specimens. At six months dyspnea index, six-minute-walk test, FEV1, FVC, PaO2, and prednisone and oxygen independence improved significantly in both groups. However FEV1 increased less in group A (1.20+/-0.2L vs 1.31+/-0.3L; p < 0.01). CONCLUSIONS: Pleural adhesions may be associated with increased morbidity and less improvement in FEV1 but they do not contraindicate thoracoscopic reduction pneumoplasty.

Aged↗
PubMed1993

Selective video-assisted thoracoscopic sympathectomy.

Video-assisted and thermometrically controlled thoracoscopic sympathectomy demonstrates new ways in the treatment of upper-limb hyperhidrosis. An anatomical portrayal of the sympathetic chain is possible as a result of the improved visualization and magnification of the operative area provided by the video-optic technique. The difference in temperature, registered by means of a thermometric sensor in the palm of the hand, indicates that the sympathetic nerves responsible for the hyperhidrotic segments have been severed. The number of postoperative Horner's syndromes will be reduced significantly with this method. Until now, we have successfully treated six thermometrically controlled patients. No recurrences have arisen during an 18 months observation period. Neither intraoperative nor postoperative complications were recorded. One patient complained of increased compensatory sweating of the trunk. Thermometrically controlled thoracoscopic sympathectomy is expected to improve the various forms of treatment available for sympathetic reflex dystrophies in the future.

Body Temperature↗
PubMed1993

Video-assisted thoracoscopic surgery--indications, results, complications, and contraindications.

In recent times minimally invasive surgery has secured a firm place among the therapeutic options in thoracic surgery. The experience and results gained from video-assisted surgery on 109 patients between January 1, 1992 and July 31, 1993 are critically discussed. The procedure could be completed thoracoscopically on 94 of them. A change of method was necessary nine times for technical reasons and six times for oncological reasons (two times due to metastasis, four times due to bronchial carcinoma). A total of 154 individual operations were conducted. Sixty-three patients with recurrent spontaneous pneumothorax were successfully treated. The relapse rate was 1.5%. With the exception of three rethoracotomies (one due to postoperative hemorrhaging and two to persistent fistula) no significant complications occurred. Further indications included capsulated pleural empyema (n = 1), persistent hematothorax (n = 2), pleurectomy for malignant pleural effusion (n = 2), pleural tumors (n = 3), pulmonary parenchyma (n = 2), interstitial lung diseases (n = 3), bullous emphysema (n = 2), peripheral lung nodules (n = 18), mediastinal tumors (n = 8), and sympathectomy (n = 2). The advantages of video-assisted thoracoscopic surgery for patients include cosmetic considerations, low pain, earlier postoperative mobilization, and for some indications, a shorter operation period. The significant disadvantages for the surgeon are the loss of binocular vision as well as the impossibility of intraoperative palpation.

Bronchial Neoplasms↗
PubMed1992

Thoracoscopic resection of benign schwannoma.

The recent improvement of endoscopic surgical instruments allows new therapeutical application of thoracoscopy. We report a thoracoscopic resection of a benign schwannoma of the 6th intercostal nerve in a 35-year-old patient. The operative technique and extraction of the tumor from the chest is described. Postoperative morbidity was minor. We consider the thoracoscopic resection as first choice of treatment.

Adult↗
PubMed2000

Is there a place for thoracoscopic debridement in the treatment of empyema in children?

BACKGROUND: Video-assisted thoracoscopic debridement has been shown to be a safe and efficient procedure for empyema in the adult patient. Its place in the management of childhood empyema remains controversial. METHODS: Over an 18-month period, 9 children were operated upon for pleural empyema. All children were initially treated with appropriate antibiotics and chest-tube drainage. Indication for surgery were persistent clinical symptoms and loculation of pleural fluid 5 to 7 days following initial treatment. In case of a duration of the illness of less than 14 days, an initial attempt was made to debride the pleural space by thoracoscopy. RESULTS: Mean duration of the illness prior to surgery was 15 days (range: 10-23 days), and mean duration of preoperative conservative treatment 10 days (range: 5-20 days). In five of the nine patients thoracoscopy was performed. In all patients thoracoscopy failed to provide adequate clearance of the diseased pleural space because of the advanced stage of the disease. The procedure was converted to a formal thoracotomy in four patients, the fifth patient continued to deteriorate and required formal thoracotomy and decortication seven days later. CONCLUSION: This limited experience suggests that, with the current management and indications, video-assisted thoracoscopic surgery adds little benefit to the treatment of childhood empyema.

Adolescent↗
PubMed1999

Bilateral thoracoscopic splanchnicectomy in patients with chronic pancreatitis.

BACKGROUND: Intractable pain, the most prominent feature of chronic pancreatitis, causes the patient great disability, and its treatment poses a difficult problem for gastroenterologist and surgeon alike. The main goal of treatment is to provide sufficient and lasting pain relief without the use of opiates. Conservative management, including stopping alcohol consumption, dietary measures, pancreatic enzyme suppletion and analgesics, is discussed. When these measures fail, surgery is often unavoidable. Indications, effect on pain relief, morbidity and mortality of drainage and resection procedures are described. Bilateral thoracoscopic splanchnicectomy, a newly developed operation to alleviate pain irrespective of the type of anatomic abnormality, is outlined in more detail. Early encouraging results of pain relief in patients with chronic pancreatitis after thoracoscopic splanchnicectomy are presented.

Abdominal Pain↗
PubMed1998

Thoracoscopic T2-sympathetic block by clipping--a better and reversible operation for treatment of hyperhidrosis palmaris: experience with 326 cases.

Although thoracoscopic sympathectomy or sympathicotomy is the best treatment for hyperhidrosis palmaris, a new approach of clipping only without transection of T2-sympathetic trunk is just as effective. Aside from the guaranteed cure of hyperhidrosis, this new method has fewer complications and has the advantage of recovery of the sympathetic tone in the hands if the procedure is reversed by the removal of the clips. Between March 18 and September 30 of 1996, 326 patients (190 female and 136 male with a mean age of 20.5 years) underwent thoracoscopic T2-sympathetic block by clipping to treat hyperhidrosis. Good results and few complications were noted during follow up six months to one year postoperatively. Five of the 326 patients, all female, had the operation reversed because of intolerable compensatory sweating. Three recovered from the compensatory sweating within two months and had less palmar sweating than before their sympathetic block; the fourth achieved relief of compensatory sweating after nine months, and the fifth reported no improvement.

Adolescent↗
PubMed1992

Thoracoscopic lung biopsy in interstitial lung disease.

Thoracoscopic lung biopsy has been proposed as an alternative to open lung biopsy for the diagnosis of interstitial lung disease. We performed thoracoscopic lung biopsy under local anesthesia and diathermic coagulation in 33 non-immunocompromised patients with interstitial lung disease. A diagnosis was obtained in all patients. No severe complication was observed. The average time of drainage was 4 days. We confirm that this technique has advantages compared to open lung biopsy.

Adult↗
PubMed1996

Thoracoscopic sympathicolysis for essential hyperhidrosis: immediate and one year follow-up results in 35 patients and review of the literature.

Various treatments for essential hyperhidrosis are available. The aim of this study is to present our experience with a simplified thoracoscopic sympathicolysis technique in this disorder, and to confront our results with data in the literature, 35 consecutive patients (11 male, 24 female, age 12-44 years) with essential hyperhidrosis, refractory to "conventional" medical treatment presenting between August 1993 and May 1994 were studied. Bilateral D2-D3 sympathicolysis was performed using a simplified one-time bilateral thoracoscopic procedure under general anaesthesia. Clinical scores, complications and side effects were recorded one week, one month and one year after the intervention. Severe hyperhidrosis was present in the hands in 100%, axillae in 66% and soles of the feet in 86% of patients. In one patient, only a unilateral intervention was possible due to pleural adhesions. In the other 34 patients, palmar hyperhidrosis was completely and permanently relieved in 100% of cases. Axillar hyperhidrosis was significantly improved after one year in 91% of patients, 52% of which showed a complete disappearance of hyperhidrosis. Side effects and complications were minimal. There were no permanent pleural, neurological (Horner) or other sequellae. Patient satisfaction was invariably very high. These findings compare favourably with historical data in the literature.

Adolescent↗
PubMed2004

The management of esophageal cancer with situs inversus totalis by simultaneous hand-assisted laparoscopic gastric mobilization and thoracoscopic esophagectomy.

Situs inversus is a rare disorder. We present a case of esophageal cancer with situs inversus totalis, which was successfully managed by laparoscopic gastric mobilization and thoracoscopic esophagectomy. A 57-year-old man presented to our hospital with intermittent epigastric and retrosternal pains. X-ray and computed tomography demonstrated situs inversus totalis. Upper gastrointestinal endoscopy and barium swallow showed esophageal cancer of the lower thoracic esophagus. After neoadjuvant chemotherapy, he underwent surgical intervention. Under general anesthesia, laparoscopic gastric mobilization using hand-assisted laparoscopic surgery technique was performed. The locations of the port sites were all the mirror image of the regular fashion, and the right hand of the surgeon was inserted into the peritoneal cavity. Reconstruction of the digestive tract using a gastric tube via the retrosternal route was then achieved. Finally, thoracoscopic esophagectomy with the patient in the right decubitus position was successfully completed. Postoperative recovery was uneventful.

Esophageal Neoplasms↗
PubMed2006

Thoracoscopic pericardiectomy for purulent pericarditis: experience with 21 cases.

PURPOSE: We present our experience in performing thoracoscopic pericardiectomy for purulent pericarditis in 21 children. MATERIALS AND METHODS: Pericardiectomy was carried out using one optical trocar and two operating trocars. Pleural insufflation with carbon dioxide was maintained at 2-4 mm Hg. Anterior pericardiectomy was performed from the left phrenic nerve to the right border of the sternum to free the anterior part of the heart, notably the cardiac apex and the original area of the great vessels. Purulent debris was removed prior to detaching the epicardial peel. RESULTS: This study included 21 patients. Their mean age was 8 years. The time from onset of the disease to surgery ranged from 4 to 34 days (average, 15.2 days). Operative times ranged from 50 to 180 minutes (average, 100 minutes). There were no intraoperative or postoperative complications. All symptoms of cardiac tamponade disappeared immediately postoperatively. Follow-up ranged from 4 to 15 months and showed normal clinical manifestations, echocardiographs, and chest x-rays in all children. CONCLUSION: Thoracoscopic pericardiectomy with removal of a generous amount of the pericardium is feasible and safe for purulent pericarditis.

Adolescent↗
PubMed1996

A simplified T2-T3 thoracoscopic sympathicolysis technique for the treatment of essential hyperhidrosis: short-term results in 100 patients.

A simplified one-time bilateral thoracoscopic T2-T3 sympathicolysis technique using single-lumen endotracheal intubation with high frequency jet ventilation and electrocautery destruction ("sympathicolysis") of the sympathetic ganglia was applied in 100 consecutive patients with severe essential hyperhidrosis (EH). Providing a pleural space can be created, this technique was proven simple and safe, and short-term clinical results were excellent: palmar hyperhidrosis was cured in 98% of patients, and axillar and plantar improvement was achieved in 62 and 65% of patients, respectively. Side-effects and complications were minor (compensatory hyperhidrosis) or self-limiting (pain). These data confirm the safety and efficacy of thoracoscopic sympathetic interventions for the treatment of EH, and support the evolution toward simplified methodologies.

Adolescent↗
PubMed1996

Video-assisted thoracoscopic surgery for the treatment of congenital cardiac defects in the pediatric population.

Recent technologic advances have contributed to a renewed interest in thoracoscopic surgery. In our institution, thoracoscopy through video-assisted technology has been successfully applied to congenital heart surgery. We reviewed the charts of 45 consecutive patients (ASA physical status 11-IV) who underwent video-assisted thoracoscopic surgery (VATS) for various congenital heart defects. The mean age of the patients was 2.65 yr and the mean weight was 11.78 kg. The surgical procedures included patent ductus arteriosus interruption (n = 28) and vascular ring division (n = 8), and 9 patients had miscellaneous procedures. The most commonly used anesthetic regimen consisted of isoflurane, pancuronium, fentanyl, air, and oxygen. Seven patients were managed with one-lung ventilation, the remainder by two-lung ventilation with surgical lung retraction. Intraoperative desaturation occurred in 12 patients (26.7%) but resolved quickly with brief reexpansion of the lungs. Postoperative complications included: pleural effusions (n = 3), chylothorax (n = 2), right upper lobe atelectasis (n = 1), small pneumothorax (n = 1), and vocal cord paralysis (n = 1). Seven patients (15.5%) required conversion to a thoracotomy for insufficient exposure (n = 4) or due to concern over bleeding (n = 3). This experience with VATS in pediatric patients with congenital heart disease may provide a database for comparison with others who work with the VATS technique.

Adolescent↗
PubMed1997

The effects of inhaled nitric oxide and its combination with intravenous almitrine on Pao2 during one-lung ventilation in patients undergoing thoracoscopic procedures.

UNLABELLED: The aim of this study was to assess whether hypoxemia during one-lung ventilation (OLV) can be prevented by inhaled nitric oxide (NO) (Part I) or by its combination with intravenous (IV) almitrine (Part II) in 40 patients undergoing thoracoscopic procedures. In Part I, 20 patients were divided into two groups: one received O2 (Group 1) and one received O2/NO (Group 2). In Part II, 20 patients were divided into two groups: one received O2 (Group 3) and one received O2/NO/almitrine (Group 4). In Groups 2 and 4, NO (20 ppm) was administered during the entire period of OLV, and almitrine was continuously infused (16 microg x kg(-1) x min[-1]) in Group 4. Arterial blood gases were measured during two-lung ventilation with patients in the supine position, after positioning in the lateral decubitus position, and then every 5 min for a 30-min period during OLV. During OLV, Pao2 values decreased similarly in Groups 1 and 2. After 30 min of OLV, the mean Pao2 values in Groups 1 and 2 were 132 +/- 14 mm Hg (mean +/- sem) and 149 +/- 27 mm Hg (not significant [NS]), and the Pao2 value was less than 100 mm Hg in four patients in Group 1 and five patients in Group 2. Pao2 values were greater in Group 4 than in Group 3 after 15 and 30 min of OLV. After 30 min of OLV, the mean Pao2 values were 146 +/- 16 mm Hg in Group 3 and 408 +/- 33 mm Hg in Group 4 (P < 0.001). Pao2 was less than 100 mm Hg during OLV (NS) in four patients in Group 3 and in no patient in Group 4. We conclude that NO inhalation alone has no effect on Pao2 evolution during OLV, although its combination with IV almitrine limits the decrease of Pao2 during OLV. This beneficial effect of NO/almitrine could be attributed to an improvement in ventilation-perfusion relationships. IMPLICATIONS: Decrease in oxygenation during one-lung ventilation is quite common. Our study showed that inhaled nitric oxide alone did not influence Pao2 evolution. We then tried adding intravenous almitrine to nitric oxide with amazingly good results on Pao2. This nonventilatory technique should be of great use during special thoracic acts, such as thoracoscopic procedures.

Adult↗
PubMed2001

The successful management of thoracoscopic thoracic duct ligation in a compromised infant with targeted lobar deflation.

IMPLICATIONS: We describe the successful management of thoracoscopic thoracic duct ligation in a 2.5-kg compromised infant by using selective lobar-bronchial blockade. The technique reduces the risk of intraprocedural physiologic impairment, allowing the benefits of otherwise minimally invasive thoracoscopic procedures, even when the conditions of children are severely compromised.

Chylothorax↗
PubMed1993

Anesthesia for thoracoscopic laser ablation of bullous emphysema.

BACKGROUND: We describe the anesthetic management for a new surgical procedure: laser ablation of emphysematous bullae via thoracoscope. Although thoracoscopy is not new, this is the first description of a series of patients with bilateral, chronic lung disease who underwent long periods of one-lung ventilation (OLV) during thoracoscopic therapy. METHODS: Twenty-six laser ablation procedures were performed in 22 patients. The patients were elderly (mean age 63 yr) with a large incidence of coexisting cardiovascular disease. Most required chronic home oxygen therapy. Patients were monitored invasively, and hemodynamic data were recorded every 5 min. Arterial blood gas analyses were performed every 15 min. Comparisons were made between three intraoperative periods: two-lung ventilation (TLV) before thoracoscopy, OLV during thoracoscopy, and TLV after thoracoscopy. RESULTS: All patients survived the operation despite a mean OLV duration of 170 min, but several experienced serious intraoperative problems, such as hypoxemia or hypotension. Hypoxemia was treated with nondependent lung continuous positive airway pressure and dependent lung positive end-expiratory pressure. In all patients the lungs were adequately ventilated, but bronchopleural fistulae occurred upon return to TLV in every case. The resulting air leaks, often 50% of inspired tidal volume, required the use of a pressure-cycled ventilator to maintain oxygenation. Postoperative air leaks greater than 50% of inspired tidal volume usually required subsequent surgical correction, while smaller leaks resolved spontaneously. Mechanical ventilation was required for an average of 5 days. Eighty-four percent have survived at least 6 months, and nearly all survivors report symptomatic improvement. CONCLUSIONS: Ablation of bullae appears to provide symptomatic improvement, and thoracoscopy might be better tolerated than thoracotomy, especially in patients with severe bullous emphysema.

Aged↗
PubMed2000

Thoracoscopic enucleation of an esophageal leiomyoma.

A series of reports in the literature suggest that video assisted thoracoscopic resection of an esophageal leiomyoma offers distinct advantage over open approach. We describe a patient with esophageal leiomyoma who underwent surgical resection via thoracoscopic approach using four thoracic trocars. The postoperative period was uneventful and the patient was discharged on postoperative day 3.

Esophageal Neoplasms↗
PubMed1997

Thoracoscopic pericardial window and penetrating cardiac trauma.

Between September of 1991 and February of 1996, 108 patients with penetrating wounds near the heart, and with no obvious signs of cardiac injury, underwent the creation of a diagnostic thoracoscopic pericardial window to rule out cardiac injury. In 33 patients (30.6%), the procedure identified hemopericardium. Sensitivity for the procedure was 100%, specificity 96%, and accuracy 97%. There were no deaths and no complications due to the procedure. The thoracoscopic pericardial window has proved to be a precise, rapid, and safe method for the diagnosis of heart wounds in patients with no clear signs or symptoms, and it also allows the evaluation of other thoracic injuries and the evacuation of hemothorax when present. We recommend this procedure as the standard diagnostic approach for cardiac injuries in patients in stable condition.

Adolescent↗