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PubMedDate not supplied

Excision of a mediastinal parathyroid gland with use of video-assisted thoracoscopy, intraoperative 99mTc-sestamibi scanning, and intraoperative monitoring of intact parathyroid hormone.

OBJECTIVE: To report the complementary use of video-assisted thoracoscopic surgery (VATS) and intraoperative 99mTc-sestamibi scanning for persistent secondary hyperparathyroidism due to a mediastinal supernumerary parathyroid gland. METHODS: We describe a patient with recurrent secondary hyperparathyroidism attributable to a mediastinal parathyroid gland who underwent parathyroidectomy with use of VATS, intraoperative 99mTc-sestamibi scanning (gamma probe), and intraoperative monitoring of intact parathyroid hormone (iPTH). RESULTS: A 32-year-old man with chronic renal failure who had undergone a 4-gland parathyroidectomy with autotransplantation 14 years previously presented with symptomatic hypercalcemia. A preoperative single-photon emission computed tomographic (SPECT) sestamibi scan revealed a focus of mediastinal uptake, suggestive of an intrathymic gland. The patient underwent a cervical exploration, and the previously reimplanted parathyroid gland and the thymus were resected. iPTH levels failed to normalize, and the operation was terminated. A repeated SPECT scan again revealed an area of mediastinal uptake. Computed tomographic scan of the chest showed a mediastinal gland adjacent to the aortic arch. VATS and intra-operative sestamibi scanning aided in localization of the ectopic parathyroid gland. After removal of the hyperplastic gland, iPTH levels decreased appropriately. CONCLUSION: In reoperative parathyroidectomy involving mediastinal glands, VATS, complemented by gamma probe localization and iPTH monitoring, may be used to minimize the operative dissection needed to cure hyperparathyroidism.

Adult↗
PubMed1999

[Video-assisted thoracoscopy in treatment of pleural empyema].

The experience of treatment for 609 patients with empyema of the pleura with the use of videothoracoscopy technique has been summarized. 436 (71.6%) patients were at stage 1 of the disease, 126 (20.7%)--stage 2 and 47 (7.7%)--stage 3. All complications of intrapleural bleedings arisen in 3 (0.5%) patients, have been controlled through thoracoscope. There were no postoperative complications. Transformation of videothoracoscopic operation into the open one has been required in 11 (1.8%) patients: in 4--due to extensive destruction of the lung tissues, in 4--due to atelectasis of the lung, and in 3--because of the danger of endoscopical injury to the mediastinal organs. Feasibility of videothoracoscopic decortication of the lung and pleurectomy at stage 3 of chronic empyema of the pleura was demonstrated. 37 (78.7%) patients were cured by this method.

Chronic Disease↗
PubMed1999

[Percutaneous localization and marking of small solitary pulmonary nodules in CT imaging before video thoracoscopy surgery].

BACKGROUND: The localization of small lung nodules by palpation is not possible when videothoracoscopic surgery is performed. Transparietal fine needle biopsy is frequently not successful in small lung nodules. METHODS AND RESULTS: The authors describe their experiences with percutaneous CT controlled marking of small lung parenchyma around small lung nodules by patent blue and contrast medium mixture. The method was used in 7 patients with nodule size from 7 mm to 25 mm. In all patients the surgeon was able to localize the nodule. Operation followed localization as soon as possible, the interval was from 60 to 120 minutes. Four of 7 nodules were benign, 3 nodules were malignant. CONCLUSIONS: New method of marking of small lung nodules makes a minimal invasive operation possible. The operation stress is lower and the time of hospitalization is shorter.

Coloring Agents↗
PubMed2000

Thoracoscopy versus open lung biopsy in the diagnosis of interstitial lung disease: a randomised controlled trial.

BACKGROUND: Some patients with diffuse lung disease require a lung biopsy for diagnosis. This study is aimed to compare the clinical results and the efficacy of video-assisted thoracoscopic lung biopsy with the open lung biopsy method for the diagnosis of interstitial lung disease. From January 1996 to December 1998, 61 patients were referred for diagnostic lung biopsy. Thirty two patients were randomly allocated to have a thoracoscopic lung biopsy and twenty nine had an open lung biopsy. Subsequently, various factors were analyzed and compared in both groups. RESULTS: There was no difference between the groups in age and pulmonary function test. Median operative time was 45 minutes for the thoracoscopic biopsies and 60 minutes for the open biopsies (P = 0.009). Median amount of analgesia (Demerol) in the first 24 hours postoperatively was 75 mg. for thoracoscopic biopsies and 150 mg. for open biopsies (P < 0.001). Median duration of insertion of a chest tube in days and 24 hours of pleural drainage was not statistically significant between the two groups. Duration of hospital stay was significantly less for the thoracoscopic biopsy (3 days) compared with an open biopsy (5 days) (P < 0.001). The diagnostic yield of each method was comparable (thoracoscopic biopsy 31/32; open biopsy 27/29) (P = 0.3). Complications occurred in 6/29 of patients undergoing open biopsies and 3/32 patients undergoing thoracoscopic lung biopsies (p = 0.28). There were 2 deaths among patients who had an open lung biopsy. CONCLUSION: Thoracoscopic lung biopsy has some clinical advantages over open biopsy. These findings suggest that thoracoscopic lung biopsy is an acceptable alternative to open lung biopsy for the diagnosis of diffuse interstitial lung diseases.

Adult↗
PubMed2001

Video-assisted thoracoscopy thymectomy for myasthenia gravis.

Over the past 8 years, the technique of video-assisted thoracoscopic surgery (VATS) thymectomy has continued to evolve. Although the procedure has become better defined and greater experience has been gained, numerous issues still exist. Whether it is best performed through a left sided, right sided, or as a bilateral approach with or without a cervical incision, is not clear. Equivalence of outcomes compared with more standard approaches to thymectomy is still an issue. Experience still is relatively limited to a few centers, and follow-up still is relatively short. In the author's own experience, it seems that availability of the less invasive approach has allowed thymectomy to be performed earlier in the course of the disease especially in young female patients in whom cosmesis is an important issue.

Adult↗
PubMed2002

[Spanish multicenter study of video-assisted thoracoscopy surgery].

BACKGROUND: This paper reports the findings of a prospective multicenter study whose main objective was to determine the indications for video-assisted thoracoscopic surgery (VATS), as well as the techniques used, results and complications. METHODS: Seventeen chest surgery units provided data on 1,573 procedures performed over a period of two years (July 1996 to July 1998). RESULTS: Spontaneous pneumothorax (45.4%), lung biopsy (18.4%), pulmonary nodes (13.3%) and thoracic sympathectomy (5.3%) accounted for over 80% of the indications for VATS. An assistive mini-thoracotomy was required in 5.6%. A change to standard thoracotomy was needed in 167 cases (10.6%). Complications were observed in 10.8%, persistent air leakage being the most important. Spontaneous pneumo-thorax recurred in 17 cases (2.4%). Ten patients (0.6%) died. CONCLUSIONS: Technological developments have led to new applications for VATS as well as improved outcome for the most common, well established indications. It is advisable to continue to perform prospective, randomized, controlled trials to validate techniques for which little experience has accumulated.

Adult↗
PubMed2002

Stapler blebectomy and pleural abrasion by video-assisted thoracoscopy for spontaneous pneumothorax.

BACKGROUND: This study aims to evaluate the efficacy of video-assisted thoracoscopic surgery (VATS) pleurodesis in the treatment of spontaneous pneumothorax with particular reference to the postoperative period and the rate of recurrence after pleural abrasion. METHODS: One hundred and thirty-three patients who underwent VATS management of primary spontaneous pneumothorax were retrospectively reviewed. They were 113 males and 20 females with median age of 26 (range 12-37). Among these patients, 114 underwent VATS for recurrent pneumothorax and 19 for persistent air-leakage at the first episode. During surgical procedure, in 78% of cases, parenchymal blebs were identified and resected by stapler resection. All patients were submitted to pleural abrasion. RESULTS: No intra- or postoperative deaths occurred. Postoperative complications were persistent air-leak for more than 7 days in 6 patients (4.3%) bleeding in 3 patients (2.2%). The median chest-tube duration and hospital stay were 2 (range 2-11) and 3 (range 3-12) days, respectively. Median follow-up period of 53 (range 6-96) months was complete for all patients. Five episodes of recurrent pneumothorax were encountered and 4 of them, because of major entity, required re-do VATS with stapler resection and pleural abrasion: their postoperative period and residual follow-up was uneventful. CONCLUSIONS: The goal in the surgical management of spontaneous pneumothorax, which often affects "apparently healthy" young patients, is to secure the less recurrence rate with no mortality and quite null morbidity and functional impairment. VATS stapler resection and pleural abrasion is a safe procedure allowing a good management of the disease with low complication rate, short chest-drain duration, hospital stay and recurrence rate quite similar to those referred for other procedures such as pleural poudrage or limited pleurectomy.

Adolescent↗
PubMed2001

[Surgical treatment and comparative characteristics of the general anesthesia course in patients with myasthenia gravis operated on by traditional methods and video-thoracoscopy].

In 1995-2000 yrs 480 patients were operated on in the clinic using videothoracoscopy (VTHS). In 45 of them various forms of myasthenia were diagnosed. In 9 (20%) patients thymectomy was performed. There were no complications. The VTHS application had permitted to shorten the stationary treatment of the patients twice and to reduce the analgetics dosage in postoperative period by 2-2.5 times.

Anesthesia, General↗
PubMed2002

[Complications after operation with video-thoracoscopy application and their treatment].

Of 4715 patient, who were present in 1995-2000 yrs in the clinic, in 708 (15%) operation, using videothoracoscopy method, was performed. In 539 (76.1%) of patients the method was applied for diagnosis and in 169 (23.9%)--for treatment. After the operation 365 patients were observed, complications have occurred in 14, including the early--in 10 (2.7%) and the late--in 4 (1.1%). All the patients have survived.

Adult↗
PubMed2002

[Application of video-thoracoscopy in surgical treatment of myasthenia gravis].

In 39 patients with various forms of myasthenia operation thymectomy was performed, including those 9 (20.5%), to whom it was done using method of videothoracoscopy. There were no postoperative complications. Good cosmetic effect was noted, the duration of hospital treatment of the patients had reduced more than twice, causing economic effect.

Adult↗
PubMed2004

Diagnostic and therapeutic thoracoscopy for mediastinal disease.

OBJECTIVE AND METHODS: In order to clarify the utility of video-assisted thoracoscopic surgery (VATS) for mediastinal disease, we analyzed retrospectively 34 thoracoscopic surgical cases (seven lymph node, nine thymic, eight cystic and 10 cases with solid lesions that excluded thymic diseases) between February 1993 and July 2002. RESULTS: In lymph node disease, adequate specimens were obtained in all cases; pathologic diagnoses were three sarcoidosis, two tuberculosis, and two other tumors. In thymic disease, all cases underwent thoracoscopic partial resection of the thymus. Conversion to thoracotomy or mediansternotomy was necessary in two cases of epithelial thymic tumors. In cases of cystic diseases, complete resections of the cysts were performed in five cases. Final diagnoses of these cysts were four bronchogenic, three pericardial, and one parathyroid cyst. In solid diseases, nine tumors were completely resected. Final diagnoses of these tumors were six neurogenic, and four other tumors. CONCLUSION: VATS is an effective and reliable approach for managing mediastinal diseases. Cases of small lesions surrounded by thymic tissue, cystic lesions excluding lymphatic duct origin, and neurogenic tumors without evidence of intraspinal invasion are good indications for VATS.

Adult↗
PubMed2004

[Experience of surgical treatment of primary peripheral pulmonary cancer and of tumoral metastases by video-assisted thoracoscopy].

In clinic of thoracic surgery were operated on 2108 patients for various forms of pulmonary cancer, 218 (10.3%) of them--using videothoracoscopy (VTHS). In 141 (64.7%) patients the method of VTHS was applied for diagnostical purposes and in 55 (25.2%)--for treatment. Histological investigations of excised specimen showed planocellular cancer in 38 patients, adenocarcinoma--in 9, nonsmall cell carcinoma--in 6, anaplastic cancer--in 2. The operation cost while applying VTHS had constituted at average 648.65 US dollars, of thoracotomy--1283.5 US dollars.

Adenocarcinoma↗