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PubMedDate not supplied

Training in thoracoscopy in the Asia-Pacific.

Video-assisted thoracoscopic surgery should be within the armamentarium of every thoracic surgeon today. Rapid expansion in this field has led to an unprecedented demand from practising surgeons to acquire the new skills. Five levels of training can be described: (1) didactic lectures; (2) demonstration of procedures; (3) practice on simulators; (4) animal surgery; (5) preceptorship. The first four are usually provided in training courses or workshops, while the last requires proctering or attachment to a training centre. The ultimate goal is to integrate all these into the surgical residency programs. Developments in the virtual reality module may revolutionise training in the future.

Asia↗
PubMed1997

[Closure of patent ductus arteriosus in thoracoscopy: analysis of the experience in the Gaslini Institute of Genoa].

In 1993, Laborde et al described a new surgical approach for closure of the patent ductus arteriosus (PDA), using a videoassisted technique. For the first time, videosurgery was utilized in pediatric cardiovascular surgery. The advantages of this new method are that it is minimally invasive (thoracotomy is replaced by three small holes), it reduces postoperative pain, recovery is more rapid with a shorter hospital stay and convalescence, and last but not least, it offers better aesthetic results. Between July 1994 and June 1996, we utilized the videoassisted thoracoscopic technique described by Laborde in 23 patients with PDA (age: 8 m-12 yrs, mean 45.2 m +/- 37.8; weight: 5.3-32 kg, mean 23 kg +/- 10.3). In two patients, we converted the procedure to standard thoracotomy due to anatomic problems. Echo-doppler evaluation, performed in the operating room shortly after the procedure, confirmed the complete closure of the PDA in all patients. There was neither morbidity nor mortality. The average hospital stay was four days. At a mean follow-up interval of 7.2 months (range 1-13 months), all patients showed excellent cosmetic results. We conclude that thoracoscopic closure of PDA is a valuable therapeutic option that can be used as an alternative to open-chest surgery and interventional cardiology.

Adolescent↗
PubMedDate not supplied

Complications and contraindications of thoracoscopy.

In many instances surgical intervention in the chest has been replaced by the minimally invasive thoracoscopic or VATS approach. With such a technique there are disadvantages, complications and contraindications that develop or exist. Disadvantages include the loss of tactile sensation and the cost of the procedural equipment. Absolute contraindications include a fused lung, markedly unstable patient, shock or cardiac arrest, and an individual unable to tolerate partial or complete unilateral collapse of the lung. Lesser contraindications include the patient with bleeding tendencies or under anticoagulant therapy. The few major complications we have seen include prolonged air leak, pulmonary atelectasis and respiratory failure, the "down" lung syndrome or retained secretions. Technical complications including inability to locate the lesion because of its small size, penetration of the lung or inadequate resection of a tumor with subsequent seeding of the tract through the pleural and chest wall have been reported. Major bleeding has not occurred in our institution. Mortality has been seen only in the preterminal malignancy patient.

Anesthesia, Local↗
PubMed1997

[Minimally invasive myocardial bypass surgery using video-assisted thoracoscopy].

PURPOSE: In order to associate the major benefits of the coronary artery bypass graft (CABG) with a less aggressive procedure minimally invasive coronary artery bypass graft (MICABG) has been utilized. The aim of the work is to report our initial experience with this technical approach, using video assisted thoracic surgery (VATS) to facilitate the operation. METHODS: Twenty-six patients, 19 males with ages from 44 to 83 years old, and having isolated lesion of the anterior descending artery were operated upon. Left anterior minithoracotomy of 8-10 cm was performed at the fourth intercostal space. Through this incision the optical device for VATS as well as the surgical instruments were placed in order to provide the complete left internal mammary artery (LIMA) dissection. Bypass circulation was not used and cardiac rate was decreased with the use of intravenous betablockers. For LIMA--anterior descending artery anastomosis, proximal and distal tourniquets were used and 1.5 mg/kg of heparin was intravenously administered. RESULTS: All patients presented satisfactory postoperative evolution, being discharged from the hospital at 72 h after surgery in the majority of the cases. There were delay in two patients healing of incisions and 25 patients have remained asymptomatic, with a mean in postoperative follow-up of four months. One patient died in the second postoperative month due to stroke. CONCLUSION: MICABG makes the surgery possible with better esthetic effect, lower cost and enables faster recovery than the conventional one. The use of VATS through the thoracotomy itself, allows the LIMA dissection without other incisions. It also permitted more ample dissection of the LIMA when compared to minithoracotomy without VATS.

Adult↗
PubMed1997

[Thoracic sympathectomy using thoracoscopy].

In the years 1996-1997 9 dorsal sympathectomies (DS) were performed in the authors Department using VATS technique. There were 6 right dorsal sympathectomies and 3 left DS in the group of 7 patients. Indication for dorsal sympathectomies was idiopathic hyperhidrosis in 4 cases and vascular disorders in 3 cases. Operating time for the single procedure was 30'. Chest drain was never used. There were no major complications (Horner's syndrome-one patient, intercostal neuralgia, which disappeared in a few days-2 patients). Patients left hospital the day after operation (only those with fingers ulceration stayed longer). The results of dorsal sympathectomies in patients with hyperhydorsis were excellent, less impressive in those suffered from vasospastic and vascular disorders.

Adult↗
PubMed1997

[Splanchnicectomy using thoracoscopy].

A technique of thoracic splanchnicectomy under video thoracoscopic control is reported. This simple and non aggressive procedure is indicated for very painful forms of pancreatic cancer and for some cases of chronic pancreatitis. It should relieve pain for a longer period than splanchnic nerve injection or radiotherapy.

Aged↗
PubMed1998

[Treatment of scoliosis in the adolescent by anterior release and vertebral arthrodesis under thoracoscopy. Preliminary results].

PURPOSE OF THIS STUDY: The purpose was to evaluate short term results of thoracoscopic anterior release and fusion in adolescent scoliosis. MATERIAL AND METHODS: An independent observer reviewed retrospectively hospital files and X-rays of 8 consecutive patients. The average follow-up was 14 months. The mean age at the time of surgery was 12 years old, all patients were skeletally immature. The surgical technique consisted in a thoracoscopic release and fusion of the discs space followed in the same time by a posterior instrumentation and fusion. Six cases were done in the prone position, two in the lateral decubitus. RESULTS: The release could be done in 7 cases. In one case a severe bronchospasm prevented from doing discectomy. Four levels in average could be released and fused. The thoracoscopic time was 240 mn in average and the total surgical time 430 mn. The bleeding of the thoracoscopic procedure was minimal (less than 200 cc) in all but one case (2000 cc). The duration of the chest tube was 4.4 days. At last follow up the cosmetic advantage was obvious. The angular correction of the Cobb angle was 63 per cent (similar to our isolated posterior instrumentation). The radiologic aspect of the anterior fusion seemed to be less satisfactory than the ones of classic thoracotomies (although we did not observe any non union). DISCUSSION: Our experience and these results moderate the initial enthusiasm of these new techniques reported in literature. Our current indications are therefore patients at risk of crankshaft, and complementary anterior fusion of dysplasic spines. As to the major curves we still recommend the anterior release through a formal thoracotomy which allows a more complete disc excision on more levels and a more abundant graft, with a shorter surgical time, with an associated morbidity which does not seem superior.

Adolescent↗