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PubMed2005

[The role of video-thoracoscopy in thoracic surgery].

The widespread acceptance of minimal invasive techniques has revolutionized the practice of surgery including, thoracic surgery. Within a short period of time, video-assisted thoracic surgery (VATS) has become an acceptable approach to a wide range of thoracic procedures. The use of VATS as a diagnostic modality is now well established. For therapeutic procedures, VATS has also been generally accepted as the treatment for spontaneous pneumothorax, thoracic sympathectomy, treatment of loculated effusions and resection of simple mediastinal cysts and benign tumors. Its role in major procedures, e.g. anatomic lung resections and thymectomy, however, remain poorly defined at present although some of the existing intermediate results are encouraging. The technique continues to evolve, with further miniaturization to reduce access-induced trauma. No matter how attractive the new techniques may appear, carefully conducted clinical trials should precede the general acceptance and widespread use.

Aged↗
PubMed1996

Thoracoscopy for the Diseases of the Mediastinum Including Thymectomy for Myasthenia Gravis.

The majority of mediastinal structures and diseases can be approached thoracoscopically. Diagnostic procedures for anterior mediastinal masses, mediastinal cysts, and staging of lung cancer are well accepted. Small but increasing experience has been gained with posterior neurogenic tumors. Complete thymectomy for management of myasthenia gravis has been performed, but the efficacy of the procedure for this indication awaits longer-term results.

Journal Article↗
PubMed2005

Video-thoracoscopy and staged management of preoperative empyema in lung cancer.

The incidence of pleural empyema as a primary finding in lung cancer patients is low (0.1 to 0.3 %) and the management of those patients deemed operable consists of either infection control prior to resection, or thoracotomy and resection before infection control. We successfully resolved (in one patient) and alleviated (in a second patient) empyema-related systemic infection by video-assisted thoracic surgery (VATS), and were thus able to resect their lung tumours 14 and 21 days later, respectively.

Aged↗
PubMed1998

Thoracoscopy in the management of hemothorax and retained blood after trauma.

Retained hemothorax complicated by blood clotting in the thoracic cavity traditionally has been treated with open thoracotomy for evacuation of the hemothorax and cleaning of the thoracic cavity. Recent improvements in video technology and endoscopic surgical instruments have fostered renewed interest in video-assisted thoracoscopic surgery to diagnose and treat a variety of surgical conditions of the chest, which classically were managed exclusively by thoracotomy. Posttraumatic retained hemothorax currently is being managed at most institutions by video-assisted thoracoscopic surgery, with consistently good results.

Female↗
PubMed2002

Thoracoscopy: the preferred method for excision of mediastinal parathyroids.

Mediastinal exploration to resect ectopic parathyroid is required in approximately 2% of all cases of hyperparathyroidism. Traditionally, it has been performed through a midsternotomy or thoracotomy. A few reports about thoracoscopic resection of mediastinal parathyroid were published recently. We report here successful video-assisted thoracoscopic resection (VATS) of a mediastinal parathyroid and present a review of all previously reported cases. A 42-year-old woman presented with spontaneous fracture of the left femur and hypercalcemia. She had previously undergone cervical parathyroidectomy for primary hyperparathyroidism. A computed tomography (CT) scan of the chest and a technetium scan showed ectopic mediastinal parathyroid. The patient underwent successful thoracoscopic resection of ectopic parathyroid. A total of 26 patients were reviewed, 21 in the English literature and 5 in others. Of the 21 patients reported in the English literature, 16 had primary hyperparathyroidism (1 degrees HPT), whereas 5 had secondary hyperparathyroidism (2 degrees HPT). All but 3 patients had undergone previous cervical exploration. Ectopic mediastinal parathyroid was localized preoperatively in all by CT scans of the chest and nuclear scans. All 21 patients had successful thoracoscopic resection. All but 3 had parathyroid adenoma. Postoperatively, serum calcium (Ca ), phosphate (PO4 ), and parathormone (PTH) values returned to normal in all patients. Age and sex of the patient, type of hyperparathyroidism (1 degrees or 2 degrees ), size of the gland, its location within the anterior mediastinum, the approach used to resect it (right or left thoracoscopic), and final histopathology of the resected gland (adenoma or hyperplasia) had no bearing on the success of thoracoscopic resection. The data seem to suggest that thoracoscopic resection of mediastinal parathyroid is a less-invasive, effective, and safe procedure. Accurate preoperative anatomic localization by CT and nuclear scans of the chest is the key to success.

Adult↗
PubMed2006

The need for intraoperative parathyroid hormone monitoring during radioguided parathyroidectomy by video-assisted thoracoscopy (VATS).

PURPOSE: We report on a patient with primary hyperparathyroidism (1HPT) who had a preoperative Tc-99m sestamibi scan localizing a single parathyroid adenoma in the mediastinum. METHODS: On removal of this hyperfunctioning adenoma by radioguided video-assisted thoracoscopic surgery (VATS), intraoperative PTH levels failed to decline in the appropriate manner consistent with curative resection. This prompted the surgical team to investigate further for a second adenoma, which revealed a 2 x 1-cm mass near the inferior border of the thyroid gland on the right lateral aspect of the trachea. RESULTS: In the absence of intraoperative PTH monitoring, the operation would have been terminated after the removal of the mediastinal adenoma, leading to an incomplete surgical resection and persistent 1HPT. CONCLUSION: In our patient, curative resection was obtained and a second operation was avoided because of the use of intraoperative PTH monitoring. This case also emphasizes that although VATS was planned, in treating patients with 1HPT, one must also be prepared to perform a neck exploration.

Aged↗
PubMed2006

Role of thoracoscopy in acute management of chest injury.

PURPOSE OF REVIEW: To review the literature on the use of video-assisted thoracoscopic surgery for the diagnosis and treatment of intrathoracic injuries. RECENT FINDINGS: Video-assisted thoracoscopic surgery is a relatively recent innovation. It was originally promoted for the treatment of retained hemothorax and the diagnosis of diaphragm injury. It is highly effective for the management of those problems. Recent studies have focused on video-assisted thoracoscopic surgery for treatment of chest wall bleeding, diagnosis of transmediastinal injuries, pericardial window and persistent pneumothorax. In properly selected patients, video-assisted thoracoscopic surgery is extremely efficacious in managing these problems. SUMMARY: The role of video-assisted thoracoscopic surgery in the management of acute chest injury is expanding. It is an invaluable tool for the trauma surgeon.

Contraindications↗
PubMed2006

Video-assisted thoracoscopy to treat atrial tachycardia arising from left atrial appendage.

A 17-year-old male with tachycardia-induced cardiomyopathy presented with persistent, drug-resistant atrial tachycardia (AT). An electrophysiological study suggested focal abnormal automaticity, and localized the AT origin to the left atrial appendage. Radiofrequency catheter ablation at the site of the earliest endocardial activation during AT failed. A minimally invasive, video-assisted thoracoscopic (VAT) atrial appendectomy terminated the AT and restored left ventricular contractility. The patient remained free of AT and normal left ventricular function was maintained over a 24-month follow-up period. To our knowledge, we are the first to use VAT atrial appendectomy to treat focal AT.

Adolescent↗
PubMed2006

Multiple antenatally diagnosed foregut duplication cysts excised and the value of thoracoscopy in diagnosing small concurrent cysts.

A case report of a female neonate referred with antenatally diagnosed cystic lesions within the right hemithorax and under the left hemidiaphragm is presented to highlight the ease with which these lesions can be resected in an asymptomatic post-natal infant with minimally invasive surgery. The diagnostic and cosmetic benefits of minimally invasive surgery are also demonstrated. While excising the documented thoracic cyst, another small cyst was identified adherent to the right main bronchus. An elective laparoscopic excision of the abdominal cyst was also successful. A brief review of the complications and treatment of foregut duplication cysts is detailed.

Cysts↗
PubMed2005

Videothoracoscopic resection of stage II thymoma: prospective comparison of the results between thoracoscopy and open methods.

STUDY OBJECTIVES: Although videothoracoscopic (VTS) resection of Masaoka stage I thymoma has been reported to be a less invasive method than open thoracotomy and to achieve a comparable surgical outcome, the usefulness of this method in the treatment of stage II thymoma has not yet been prospectively evaluated. We therefore compared the VTS and open (median sternotomy) methods to see whether VTS resection could be used as successfully to treat stage II thymoma disease. DESIGN, SETTING, AND PATIENTS: Patients (11 women and 11 men) with stage II thymoma were prospectively enrolled between November 1999 and September 2004. Of these, 12 patients (the VTS group) underwent tumor resection using a three-port endoscopic technique, and 10 patients (the open group) underwent tumor excision using a standard sternotomy approach. The diagnosis of all resected thymoma lesions and their stage were confirmed by histopathogic examination. MEASUREMENTS AND RESULTS: Neither group experienced mortality or any major morbidity. The difference in mean age (+/- SD) between the VTS and open groups (40.2 +/- 16.3 years and 47.7 +/- 8.5 years, p = 0.202); mean operation time (193.3 +/- 79.6 min and 207.5 +/- 85.8 min, p = 0.692); mean duration of pleural drainage (4.2 +/- 2.1 days and 4.6 +/- 2.1 days, p = 0.702); and mean duration of postoperative hospital stay (6.8 +/- 2.3 days and 8.9 +/- 4.4 days, respectively; p = 0.157) were not statistically significant. However, mean intraoperative blood loss amounts were statistically different (119.2 +/- 70.6 mL and 238.5 +/- 110.2 mL, respectively; p = 0.006). During the mean follow-up period of 33.9 +/- 19.7 months, all patients survived without sign of recurrence, and the mean survival time was not statistically significant (32.3 +/- 22.0 months and 35.8 +/- 17.5 months, respectively; p = 0.686). CONCLUSION: Using careful and skillful technique, the VTS method is an effective treatment of stage II thymoma.

Adolescent↗
PubMed1975

Differentiation between hydropneumothorax and destroyed lung by thoracoscopy with a fiberoptic bronchoscope.

In a 39-year-old man radiologic examination could not distinguish definitely between a hydropneumothorax and total destruction of one lung. Introduction of a fiberoptic bronchoscope through the opening for the chest drainage tube permitted direct inspection of the air space. A definite diagnosis of a destroyed lung was made, permitting appropriate modification of the treatment.

Adult↗