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At least 829 records · Page 46Linked to original sources
PubMed1997

Thoracoscopic vagotomy for recurrent ulcer after previous gastric operation.

BACKGROUND: Recurrent peptic ulcer after previous gastric operation is a difficult surgical problem and abdominal re-operation is associated with significant morbidity, mortality and recurrence rate. METHODS: The authors report on five patients with recurrent ulcers who, after previous gastric operation, were treated with thoracoscopic vagotomy. RESULTS: All patients tolerated the procedure well without complications, and the median hospital stay was 5 days. Endoscopy confirmed healing of the ulcers in all patients. Pre-operative and postoperative gastric acid studies showed a significant postoperative reduction in both basal and maximal acid output (P < 0.05). In a follow-up period of 18-33 months, one patient had a recurrent ulcer presenting with bleeding. Gastric biopsy revealed presence of Helicobacter pylori and repeated gastroscopy after a course of H. pylori eradication treatment showed a healed ulcer. The other four patients were asymptomatic. CONCLUSIONS: We conclude that thoracoscopic vagotomy is a simple and safe procedure for the treatment of recurrent ulcers after previous gastric operation, but the long-term results need further assessment.

Adult↗
PubMed2005

Thoracoscopic repair of esophageal atresia with tracheoesophageal fistula: anesthetic and intensive care management of a series of eight neonates.

Advances in minimally invasive techniques have made pediatric laparoscopic surgery commonplace. Thoracoscopic surgery in children however is still performed in only a few centers throughout the world. Between July 2001 and January 2004, the first eight esophageal atresia with tracheoesophageal fistula repairs were performed thoracoscopically at the Royal Hospital for Sick Children in Edinburgh. This article presents their anesthetic management, their postoperative management in the pediatric intensive care unit and reviews the complications seen in both the intraoperative and postoperative periods. Finally we discuss how our experience to date influences our perioperative management of these challenging cases.

Esophageal Atresia↗
PubMedDate not supplied

Minimally invasive coronary surgery with thoracoscopic internal mammary artery dissection: surgical technique.

BACKGROUND: We describe our technique of revascularization of the left anterior descending artery (LAD), using the left internal mammary artery (LIMA) without cardio- pulmonary bypass (CPB), by means of a 4-cm left thoracotomy and video-thoracoscopic harvesting of the LIMA. METHODS: The patient is placed in a semioblique position. The LIMA is harvested under thoracoscopic guidance. Trocars are introduced via three thoracic incisions of less than 15 mm at the level of the fourth and seventh intercostal spaces. Perforating arterial branches are cauterized or clipped. This approach allows complete dissection of the LIMA from the subclavian artery to the fifth intercostal space. A 4-cm left anterior thoracotomy is then made along the fourth or the fifth intercostal space. Rib excision is not necessary for LAD exposure. Coronary artery control is obtained with looping sutures (4/0 prolene) placed proximally and distally to the site of the anastomosis. Anastomosis is then performed with 8/0 prolene on the beating heart, under direct vision, without CPB. RESULTS: Between September 1995 and May 1996, this procedure was performed on 20 consecutive patients under age 80. There were no operative complications. The mean duration of hospitalization was six days. CONCLUSIONS: This new procedure enlarges the field of minimally invasive coronary artery bypass grafting techniques.

Dissection↗
PubMedDate not supplied

Thoracoscopic IMA takedown.

In recent years, the field of minimally invasive cardiac surgery has grown rapidly beginning with the MIDCAB operation and evolving toward totally endoscopic coronary artery bypass grafting (CABG). It promotes the goal of decreasing surgical trauma while maintaining surgical efficacy. For MIDCAB, a limited anterior thoracotomy or mediastotomy have been proposed to harvest the internal mammary artery (IMA). However, complete graft harvesting of the IMA is difficult under direct vision in these circumstances and may necessitate costal resection and important chest wall retraction. Additionally, it carries the potential risk of kinking or coronary steal syndrome. Thoracoscopic harvesting of the IMA avoids these hazards. It permits complete dissection from the subclavian artery to the sixth inter-costal space (ICS) with section of all collateral branches issuing from the IMA without any traumatic retraction. The technique of IMA takedown described herein has been used regularly by us since 1995. Our current experience shows that it is safe and reproducible after a reasonable period of training. Furthermore, in the objective of performing a totally endoscopic and/or robotic CABG, thoracoscopic IMA takedown would be a prerequisite.

Coronary Artery Bypass↗
PubMed2005

Bilateral thoracoscopic cervical sympathectomy for the treatment of recurrent polymorphic ventricular tachycardia.

Congenital long QT syndrome (LQTS) is a disorder of prolonged cardiac repolarisation, manifest by a prolonged QT interval and characterised by recurrent presyncope/syncope, polymorphic ventricular tachycardia (PMVT), or sudden cardiac death. A 46 year old woman with no family history of sudden death or deafness presented with recurrent syncope. Physical examination and electrolytes were normal and a 12 lead ECG showed a corrected QT interval of 458 ms. A monitored syncopal episode documented PMVT. Despite potassium and magnesium supplements, beta blockade, implantation of a single then dual chamber implantable cardioverter defibrillator (ICD), amiodarone, nicorandil, and mexiletine, the patient continued to experience arrhythmia storms, receiving more than 700 ICD discharges over seven months. She was ultimately treated successfully with bilateral thoracoscopic cervicothoracic sympathectomies. This is the first reported bilateral thoracoscopic treatment of a patient with LQTS and symptomatic life threatening ventricular tachyarrhythmias refractory to current pharmacological and pacing techniques.

Electrocardiography↗
PubMed2004

Spinal cord feeding arteries at MR angiography for thoracoscopic spinal surgery: feasibility study and implications for surgical approach.

PURPOSE: To prospectively investigate the feasibility of contrast material-enhanced magnetic resonance (MR) angiography for visualization of the spinal vasculature in patients referred for video-assisted thoracoscopic surgical treatment of a thoracic herniated disk and to prospectively assess the influence of preoperative imaging of the spinal vasculature on the choice of surgical approach. MATERIALS AND METHODS: Eight patients (three men and five women; mean age, 58 years; range, 42-83 years) with a thoracic herniated disk underwent contrast-enhanced MR angiography of the thoracoabdominal aorta and posterior branches. Imaging was performed with three-dimensional first-pass contrast-enhanced MR angiographic technique and a triple dose of gadolinium-based contrast agent. Images were analyzed by two observers in consensus to localize the Adamkiewicz artery (AKA) and its connections to the aorta and the anterior spinal artery (ASA). This information was used to determine any change in surgical approach. RESULTS: In all eight patients, the AKA, the ASA, and the connections with the aorta were identified. The AKA originated between T9 and L2 in all patients and derived from the left side of the aorta in 75% (six of eight) of the patients. In three patients in whom the AKA was observed on the left side, the surgical approach was changed to the right side to preserve spinal cord integrity. CONCLUSION: Preoperative imaging of the AKA is feasible with contrast-enhanced MR angiography. Contrast-enhanced MR angiography can be used to image the main feeding arteries of the spinal cord in patients undergoing thoracoscopic spinal surgery, and results can be used to change the side of surgical approach.

Adult↗
PubMedDate not supplied

Serum concentration of D-dimers as a marker of the activation of the fibrinolytic system in patients undergoing bronchoscopic and thoracoscopic investigations.

BACKGROUND: Hypercoagulability is common even after minimally invasive surgical techniques and is pathogenetically linked to postoperative thrombotic and cardiac complications. The activation of the coagulation and fibrinolytic systems after bronchoscopic and thoracoscopic investigations has not yet been elucidated. OBJECTIVE: The aim of our study was to evaluate whether bronchoscopic and thoracoscopic investigations activate the fibrinolytic system. METHODS: This study assessed cross-linked fibrinogen degradation products (D-dimer) in 120 patients after bronchoscopy with and without biopsies and/or bronchoalveolar lavage and after thoracoscopy with biopsies of the parietal pleura. RESULTS: Both bronchoscopy and thoracoscopy induced a minor but significant increase in D-dimers in most patients, reversible mostly within 24 h. In rare cases, distinct increases lasting at least 24 h occurred. CONCLUSIONS: The slight and temporary increase in serum D-dimers induced by bronchoscopy and thoracoscopy is nonsignificant in most patients; however, in some cases, the coagulation/fibrinolytic systems may become markedly activated.

Antifibrinolytic Agents↗
PubMedDate not supplied

A case of pulmonary intravascular lymphomatosis diagnosed by thoracoscopic lung biopsy.

Intravascular lymphomatosis with primary pulmonary lesion is an extremely rare disease. Although the major clinical symptoms include fever, cough, dyspnea and loss of body weight, these are not diagnostic. Chest radiograph findings are also nonspecific and include bilateral reticular shadow, reticulonodular shadow, ground-glass opacity or wedge-shaped subpleural opacities. Therefore, the antemortem diagnosis is relatively difficult. It is considered that intravascular lymphomatosis is a high-grade malignant lymphoma. However, it has been shown recently that a good response and long-term survival may possibly be obtained through systemic combination chemotherapy. We report a case of intravascular lymphomatosis with primary pulmonary lesion where an early diagnosis was obtained through thoracoscopic lung biopsy and subsequent systemic chemotherapy proved to be quite effective. Because the clinical symptoms or chest radiograph findings are usually nonspecific, it was thought that thoracoscopic lung biopsy could be a useful procedure for early and reliable diagnosis of primary pulmonary intravascular lymphomatosis and that it might contribute to an improved prognosis.

Aged↗
PubMed2006

Endoscope-assisted thoracoscopic technique for esophageal bronchogenic cyst which presented elevated CA125.

A 26-year-old male was admitted to our hospital with a complaint of mild dysphagia. Preoperative examinations revealed a cystic lesion at the lower esophagus, thought to be a bronchogenic cyst. The patient underwent successful thoracoscopic tumor extirpation, assisted by endoscopy, without undergoing major thoracotomy. Thoracoscopic surgery is recommended for this entity, but the muscle layer is often injured. Endoscopic ultrasonography was very useful, as it could detect damage to the proper muscle layer of the esophagus near the tumor. Thus, we could predict preoperatively that the defect in the muscle layer, which must be closed, would be caused by the surgery. Additionally, endoscopy easily facilitated the detection of the regional defect and the border of the proper muscle layer, and also could be used as a stent during wall suturing. This technique enabled us to avoid postoperative stenosis of the esophagus. Furthermore, our case presented a high level of CA125. The preoperative serum CA125 value was 93.8 U/ml and intratumoral CA125 concentration was 1,690,000 U/ml. Serum CA125 decreased to 16.5 U/ml after surgery. In this paper, we present a new strategy of the treatment for bronchogenic cyst and a review the literature.

Adult↗
PubMed2002

Cardiovascular collapse caused by carbon dioxide insufflation during one-lung anaesthesia for thoracoscopic dorsal sympathectomy.

Carbon dioxide insufflation into the pleural space during one-lung anaesthesia for thoracoscopic surgery is used in some centres to improve surgical access, even though this practice has been associated with well-described cardiovascular compromise. The present report is of a 35-year-old woman undergoing thoracoscopic left dorsal sympathectomy for hyperhidrosis. During one-lung anaesthesia the insufflation of carbon dioxide into the non-ventilated hemithorax for approximately 60 seconds, using a pressure-limited gas inflow, was accompanied by profound bradycardia and hypotension that resolved promptly with the release of the gas. Possible mechanisms for the cardiovascular collapse are discussed, and the role of carbon dioxide insufflation as a means of expediting lung collapse for procedures performed using single-lung ventilation is questioned.

Adult↗
PubMed2001

Video-assisted thoracoscopic thymectomy in juvenile myasthenia gravis.

As video-assisted thoracoscopic surgery for thymectomy has been reported to be as effective as traditional open surgical approaches in predominantly adult patients with myasthenia gravis, we applied this procedure to juvenile patients with this condition. Six patients underwent total thymectomy using the video-assisted technique (1997-98). Six patients in whom a median transsternal approach was used (1989-95) formed the comparison group. The two patient groups were similar in terms of age at thymectomy and preoperative clinical severity. There were no serious perioperative complications in either group. Minimum post-thymectomy duration of follow-up in the video-assisted thoracoscopic surgery patients was 2.3 years (mean 2.7 years), with all patients clinically improved over their baseline status. Preliminary results suggest that video-assisted thymectomies are comparably effective to transsternal procedures in treating generalized juvenile myasthenia gravis and can be safely performed in children as young as 20 months of age. In addition, video-assisted surgeries are less invasive than transsternal approaches, significantly shorten the postoperative hospital stay, and have superior cosmetic results.

Adolescent↗
PubMed1996

Cost-effectiveness of video-assisted thoracoscopic surgery versus conservative treatment for first time or recurrent spontaneous pneumothorax.

The aim of this study was to analyse differences in efficacy and costs in treating first time or recurrent spontaneous pneumothorax by conservative therapy (pleural drainage or observation) and video-assisted thoracoscopic surgery (VATS). Retrospectively, 112 patients treated by conservative therapy during 1985-1989 (Period 1) were compared with 97 patients treated by VATS during 1991-1994 (Period 2). Mean follow-up time in each period was more than 2 yrs. Patients in both periods had comparable clinical characteristics. Irrespective of first time or recurrent spontaneous pneumothorax at presentation, drainage and hospitalization times were longer, and complication and recurrence rates were higher in Period 1. When costs due to the waiting time before VATS were excluded, the total costs in Period 1 were higher than in Period 2. Video-assisted thoracoscopic surgery is more effective in treating patients with first time or recurrent spontaneous pneumothorax, with less morbidity and total costs compared to conservative therapy. In view of cost-effectiveness, we feel that a different management of first time or recurrent spontaneous pneumothorax is not justified.

Adult↗
PubMed1997

Comparison of video-assisted thoracoscopic talcage for recurrent primary versus persistent secondary spontaneous pneumothorax.

Thoracoscopic talcage (TT) is a safe and effective prophylactic treatment for patients suffering from recurrent primary spontaneous pneumothorax (PSP). Empirically, TT is considered equally effective in the treatment of persistent secondary spontaneous pneumothorax (SSP), although this has not yet been proved. In this study, the efficacy and safety of TT was prospectively evaluated in 28 patients (17 males and 11 females, mean age 27 +/- 8 yrs), with 31 episodes of recurrent PSP, and in 20 patients (13 males and 7 females, mean age 43 +/- 21 yrs) with persistent SSP. TT proved to be equally effective in achieving pleurodesis in both groups; there were 6.5% recurrences in the PSP group and 8.7% in the SSP group during a mean follow-up period of 18 months (p > 0.05). In the SSP group, there were significantly more prolonged postoperative air leaks (26 vs 0%; p = 0.004) and a longer postoperative chest tube drainage time (35.5 +/- 18 vs 24.9 +/- 3.2 hrs; p = 0.002) was necessary. All air leaks, however, ceased spontaneously during drainage. Duration of hospitalization was significantly longer in the SSP group (4.7 +/- 2 vs 3.2 +/- 0.5 days; p < 0.0001). Postoperative pain (90 vs 43%; p < 0.0001) and fever (65 vs 17%; p = 0.001) were more frequent in the PSP group than in the SSP group. There were no major peri- or postoperative complications in either group. We conclude that thoracoscopic talcage is as efficient and safe in achieving pleurodesis in persistent spontaneous pnuemothorax as in recurrent primary spontaneous pneumothorax.

Adult↗
PubMed1996

Port site recurrences after laparoscopic and thoracoscopic procedures in malignancy.

PURPOSE AND METHODS: A review of the literature was performed to determine the number of cases of port site recurrences (PSR) after laparoscopy or thoracoscopy. CANCERLINE and MEDLINE were searched, as were citings from retrieved and related papers. RESULTS: There have been 35 reported cases of PSR after laparoscopic colectomy for colorectal carcinoma, and 23 cases after thoracoscopic procedures for lung neoplasms. All of these have been reported since 1993. Since 1991, 12 cases have been described after laparoscopic cholecystectomy of unsuspected gallbladder carcinoma, and another case after biopsy of a known gallbladder carcinoma. Ten cases of PSR have been reported after laparoscopic procedures for ovarian lesions, often in the presence of peritoneal seeding at diagnosis. Other rare PSRs have been documented after several procedures in various malignancies. CONCLUSION: Enrollment of patients onto the ongoing intergroup study evaluating open versus laparoscopic resection of colon cancer should be encouraged. Until valid prospective data on PSR frequency are available, laparoscopic or thoracoscopic resection of malignancy off-protocol should be undertaken with circumspection.

Colorectal Neoplasms↗
PubMed2006

Video-assisted thoracoscopic dissection of the brachial plexus: cadaveric study and illustrative case.

OBJECTIVE: Standard surgical approaches to the brachial plexus require an open operative technique with extensive soft tissue dissection. A transthoracic endoscopic approach using video-assisted thoracoscopic surgery (VATS) was studied as an alternative direct operative corridor to the proximal inferior brachial plexus. METHODS: VATS was used in cadaveric dissections to study the anatomic details of the brachial plexus at the thoracic apex. After placement of standard thoracoscopic ports, the thoracic apex was systematically dissected. The limitations of the VATS approach were defined before and after removal of the first rib. The technique was applied in a 22-year-old man with neurofibromatosis who presented with a large neurofibroma of the left T1 nerve root. RESULTS: The cadaveric study demonstrated that VATS allowed for a direct cephalad approach to the inferior brachial plexus. The C8 and T1 nerve roots as well as the lower trunk of the brachial plexus were safely identified and dissected. Removal of the first rib provided exposure of the entire lower trunk and proximal divisions. After the fundamental steps to the dissection were identified, the patient underwent a successful gross total resection of a left T1 neurofibroma with VATS. CONCLUSION: VATS provided an alternative surgical corridor to the proximal inferior brachial plexus and obviated the need for the extensive soft tissue dissection associated with the anterior supraclavicular and posterior subscapular approaches.

Adult↗
PubMed2003

The real impact and usefulness of video-assisted thoracoscopic surgery in the diagnosis and therapy of clinical lymphadenopathies of the mediastinum.

BACKGROUND: The aim of this study was to evaluate the impact of video-assisted thoracoscopic surgery (VATS) in the diagnosis and therapy of clinical mediastinal lymphadenopathies. METHODS: In our Institute, from 1995 to 2001, 85 patients underwent VATS biopsy: 55 subjects (group 1) for suspected lung cancer (65%) and 30 (group 2) for unknown nodes enlargement (35%). Lymphonodes were considered suspected if > 1 cm by radiological imaging. We performed 83 thoracoscopic biopsies: 33 in level 5 (39%), 24 in level 6 (29%), 19 in level 7 (22%), and 7 in level 8 (8%). RESULTS: A histological analysis of frozen sections was made in every case. Twenty subjects underwent lung resection in one-time (24%). Histology in group 1 was adenocarcinoma in 28 cases, epidermoid carcinoma in 14, microcytoma in 9, and giant-cell carcinoma in 4. Ten patients were at stage I, 10 at stage II, 33 at stage III, and two at stage IV. Histology of group 2 was lymphoma in 18 cases, sarcoidosis in eight, and focal aspecific hyperplasia in four. CONCLUSION: The usefulness of VATS allowed the pathological assessment of the presumed involved mediastinal lymph nodes in every patient and thus permitted to assure in all the cases the indicated therapeutic treatment.

Adult↗
PubMed1992

Thoracoscopic resection of a posterior mediastinal neurogenic tumor.

Advances in endoscopic instrumentation and a growing enthusiasm for minimally invasive surgical techniques have sparked renewed interest in therapeutic thoracoscopy. We report the successful thoracoscopic resection of a posterior mediastinal nerve sheath tumor. A 35-year-old asymptomatic woman was found to have a posterior mediastinal mass on chest roentgenogram. Computed tomography and magnetic resonance imaging confirmed the presence of the lesion and showed no evidence of intraspinal extension. Exploratory thoracoscopy revealed a localized lesion without intraspinal extension. Thoracoscopic resection of the lesion was then performed. The patient's postoperative course was uncomplicated and she was discharged on the fifth postoperative day. The therapeutic potential of thoracoscopy continues to be realized as experience with the technique grows.

Adult↗