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At least 865 records · Page 48Linked to original sources
PubMed2005

Bilateral thoracoscopic sympathectomy for the treatment of palmar hyperhidrosis in the active duty population.

In an active duty population charged with handling weapons and heavy equipment, hyperhidrosis is a dangerous affliction. Surgical correction of hyperhidrosis is possible by transection of the thoracic sympathetic chain. Thoracoscopic sympathectomy should yield results similar to those of a standard open thoracotomy approach but with decreased recovery times, a more rapid return to duty, and improved job performance. Three active duty patients presented to the Naval Medical Center, San Diego, for evaluation of palmar hyperhidrosis. All patients underwent bilateral thoracoscopic sympathectomy for the treatment of palmar hyperhidrosis. They tolerated the procedure well without complications and were satisfied with their outcomes. They reported no further episodes of hyperhidrosis and have returned to full duty. This procedure is especially relevant for patients in the active duty population, whose job safety is affected by hyperhidrosis. Those treated can expect to return to full duty in a timely manner.

Adult↗
PubMed2001

[Treatment and results of interstitial lung diseases in video assisted thoracoscopic lung biopsy].

In order to establish treatment of interstitial lung diseases in video assisted thoracoscopic lung biopsy, we retrospectively reviewed our experiences. The present study included 7 patients with a mean age of 46.4, range from 24 to 61, who were treated at our department from 1996 through 1999. They were 5 men and 2 women. The pathologic diagnosis was nonspecific interstitial pneumonia in 3 patients who responded to steroid therapy. Three other patients had usual interstitial pneumonia. One patient had lymphocytic interstitial pneumonia. No complications occurred. The results indicate that video assisted thoracoscopic lung biopsy is an effective and safe way to diagnose interstitial lung diseases.

Adult↗
PubMed1999

[A case report of pleural empyema treated by video-assisted thoracoscopic surgery in an elder patient receiving hemodialysis].

A 79-year-old male who had the treatment of renal failure with hemodialysis was admitted to our hospital for the management of right pleural empyema. We performed thoracoscopic débridement and pleural irrigation in the management of empyema thoracis, because both chest tube drainage and antibiotic therapy had failed. Postoperatively pleural irrigation was performed for three weeks and the chest drains were removed after four weeks. He was successfully transferred to our department of internal medicine at four weeks after the operation. Thoracoscopic débridement and pleural irrigation for the elder patient with pleural empyema is safe, effective and minimally invasive surgical procedure.

Aged↗
PubMed1999

[Intrapulmonary hematoma surrounding the stapled line after video-assisted thoracoscopic bullectomy for spontaneous pneumothorax].

A 52-year-old man presented at our hospital with hemoptysis three months after undergoing a video-assisted thoracoscopic bullectomy for spontaneous pneumothorax. A chest X-ray showed a localized infiltrative shadow in the right upper lobe of the lung. The chest CT findings revealed a mass-like lesion surrounding the staple which had been used during the bullectomy. He therefore underwent a pulmonary resection including the lesion due to the continued hemoptysis that did not improve even after treatment by hemostatic agents and bronchial arterial embolization. The resected specimen revealed an intrapulmonary hematoma with severe inflammation. The late onset hematoma which was induced by the stapler may thus be a rare complication in video-assisted thoracoscopic surgery.

Endoscopy↗
PubMed1999

[Computed tomography-guided hookwire localization of small pulmonary nodules for thoracoscopic biopsy].

We performed thoracoscopic biopsies of small pulmonary nodules in 13 patients by placing hookwires adjacent to the target nodules under computed tomographic (CT) guidance. Biopsies were successfully performed in 10 of the 13 patients. Placement of individual hookwires for this purpose took from 20 to 50 minutes (30 minutes on average). Excisional biopsies of individual nodules required 20 to 60 minutes (37 minutes on average). Although pneumothorax developed in one patient, treatment was not considered necessary. This biopsy technique was unsuccessful in 3 cases, in 2 of which the hookwire became dislodged, and in 1 of which the target nodule was not contained in the resected specimen. These experiences seemed to underscore the importance of placing CT-guided hookwires more deeply into lung tissue near the target nodules. The technique appears to be useful for thoracoscopic biopsies of peripheral pulmonary nodules that otherwise would be difficult to identify by endoscopic probing forceps.

Biopsy↗
PubMed1999

[Two case reports of bilateral synchronous pneumothorax treated in a single stage bilateral thoracoscopic surgery].

We report here two cases of bilateral synchronous pneumothorax treated by video-assisted thoracoscopic surgery. The first case was a 15-year-old male and the second case was a 22-year-old male. Bilateral thoracoscopic surgery by using of endo-stapler was performed at one stage and Nd-YAG Laser ablation to both the emphysematous surroundings and multiple small blebs was added. This procedure is minimally invasive as well as effective for the treatment of bilateral synchronous pneumothorax.

Adolescent↗
PubMed1999

Extensor pollicis longus paralysis following thoracoscopic sympathectomy.

Thoracoscopic sympathectomy is an acceptable form of treatment for palmar hyperhidrosis. Many authors have reported favourable results. Complications range from pneumo-haemothorax, Horner's syndrome, compensatory hyperhidrosis and bleeding. Plas et al reported 2.7% of the procedures had complications requiring intervention and 9.7% had non-interventive complications. There have been isolated reports of other rare complications including false aneurysm of intercostal artery, inferior brachial plexus injury and abnormal suntanning. We report an unusual case of isolated extensor pollicis longus paralysis after a thoracoscopic sympathectomy for palmar hyperhidrosis, in a fit young male. Such complications have not been previously reported. We recognise that such isolated nerve injury is uncommon.

Adult↗
PubMed1999

[Regrowth of bullae around the staple-line is one of the causes of postoperative recurrence in thoracoscopic surgery for spontaneous pneumothorax].

Since August 1994, we have performed 65 thoracoscopic surgeries for spontaneous pneumothorax. Our operative method is partial resection of the lung with bullae using endoscopic autosuture. Three patients underwent reoperation because of persistent air leakage in one case and postoperative recurrences in two cases. In addition, we performed a second operation in one case that had undergone thoracoscopic surgery for spontaneous pneumothorax in another hospital. At the second operation, regrowth of bullae was found at the edge of staple-line in three of the 4 cases, and in one of these cases, such regrown bullae seemed to be a cause of recurrence of pneumothorax. The regrowth of the bullae was caused by incomplete resection at the initial surgery in one case. Such incomplete resection and oversight were not noticed in the review of the videotape of the initial surgeries in two cases. Reinforcement of the staple-line is necessary for prevention of recurrence of pneumothorax.

Adolescent↗
PubMed1999

[Thoracoscopic splanchnic sympathectomy in pancreatic diseases].

Thoracoscopic splanchnicsympathectomy (TSSE) was performed in 8 patients with inoperable tumors of the corpus and tail of the pancreas and in 3 patients with painful syndrome of chronic pancreatitis. Severe painful syndrome in the upper abdominal region was the main indication for ISSE. Thoracoscopic resection of the lower thoracic sympathetic ganglia and splanchnic nerves was performed. Postoperative complications were detected in 3 patients: in one case it was pneumothorax, in two--pains in the thorax due to the injury of intercostal nerve by thoracoport. There were no lethal outcomes accounted for surgical procedure. The effectiveness of the operation was evaluated by the use of descriptive and visual analogue scales of pain sensitiveness and changes of the amplitude of somatosensor provoked potentials of the brain. Favourable and satisfactory results were obtained in 9 cases.

Abdominal Pain↗
PubMed1999

Thoracoscopic surgery for intralobar pulmonary sequestration.

A 47-year-old male with intralobar pulmonary sequestration successfully treated by thoracoscopic surgery was reported. Preoperative selective angiography revealed two aberrant arteries originating from the left infraphrenic artery. Under thoracoscopy, adhesive tissues around the sequestered lung were dissected, aberrant arteries were divided and the sequestered lung was resected. We considered that preoperative detailed analysis of the aberrant artery was very important to safely perform thoracoscopic procedures for pulmonary sequestration.

Angiography, Digital Subtraction↗
PubMed1999

Video-assisted thoracoscopic surgery for spontaneous pneumothorax--a 7-year learning experience.

OBJECTIVES: To determine the effect of increasing experience of video-assisted thoracoscopic surgery (VATS) in the treatment of spontaneous pneumothorax (SP) on clinical efficacy and surgical practice. PATIENTS AND METHODS: A prospective study of 180 consecutive operations in 173 patients who underwent VATS for SP by a single surgeon during a 7 year period. RESULTS: 118 patients, mean age 32.1 years (range 13-63 years), were treated for primary spontaneous pneumothorax (PSP) while 55 patients, mean age 65.9 years (range 28-92 years), were treated for secondary spontaneous pneumothorax (SSP). All patients had VAT parietal pleurectomy combined in 162 (90%) patients with stapled bullectomy. At a current median experience of 2.0 years (range 0.4-6.8 years), 12 (6.6%) patients required reoperation for treatment failures within 12 months of surgery--9 patients within 30 days of VATS and 3 for late recurrent pneumothorax. Two patients (both with SSP) died within 30 days of surgery. When compared with PSP, VATS in SSP is characterized by an elderly, male predominance, a longer postoperative stay, a higher mortality rate and a lower rate of late recurrence. With increasing experience of the technique, there has been a significant decrease in treatment failures. In the treatment of PSP, both operating time and postoperative stay have decreased significantly with experience whilst the use of staple cartridges per patient has increased significantly with experience in both PSP and SSP. CONCLUSION: There is a demonstrable 'learning curve' effect on the clinical efficacy and surgical practice of video assisted thoracoscopic surgery for spontaneous pneumothorax.

Adolescent↗
PubMed1997

[Video-assisted thoracoscopic bullectomy for giant bullous emphysema].

Giant bullous emphysema often has serious dyspnea, and is difficult to manage. Bullectomy through thoracotomy for this disease carries a substantial morbidity and mortality. The aim of this report is to investigate the feasibility and key techniques of video-assisted thoracoscopic bullectomy for giant bullous emphysema. From December 1995 to October 1996, 6 patients with giant bullous emphysema underwent bullectomy by means of video-assisted thoracoscopy. Giant bullae occupied at least 50% of hemithorax, and 4 of which occupied more than 90%. According to Hugh-Jones dyspnea criteria: grade II in 3 cases, grade III in 2 and grade IV in 1, four bullectomies were done by video-assisted theracoscopy alone. One bullectomy and one left pneumonectomy were performed by combination of theracoscopy and a 8 cm thoracic incision. All procedures were accomplished successfully. The operating time ranged from 65 to 150 minutes. There was no blood transfusion and perioperative complications. Lung function was significantly improved in all patients after surgery (all better than grade II). Thoracoscopic bullectomy for giant bullous emphysema is a technically feasible and safety procedure, especially for group I and group II patients. However, there are still many problems to be resolved in thoracoscopy for group III and IV giant bullous emphysema.

Adult↗
PubMed2000

[A thoracoscopic resection of pulmonary metastasis from breast cancer: a case report with a 27-year disease-free interval].

A 70-year-old woman, who had undergone a right radical mastectomy for breast cancer 27 years previously, was found to have a tumor measuring 15 mm in diameter between the S5 area and the S8 area of the left lung. We suspected it to be either metastatic or primary lung cancer based on preoperatively any conclusive diagnosis. We thus performed a thoracoscopic partial lung resection and pericardial resection. The pathological diagnosis of the resected specimen was pulmonary metastasis from the previous breast cancer, since the pathological findings of the lung lesion were closely similar to those of the previous breast lesion. Using immunohistochemical methods, the tumor cells show positive staining for anti-estrogen receptor antibody. In lung tumor cases in which the patient has undergone a breast cancer resection, even more than 20 years previously, surgeons must not rule out the possibility of recurrence. Thoracoscopic surgery is considered to be most effective method for both making a definitive diagnosis and for performing curative treatment.

Aged↗
PubMed2000

[Sarcoidosis differentially diagnosed from mediastinal tumor by thoracoscopic biopsy].

A 46-year-old man presented with swallowing difficulty and dyspnea when in the supine position. Chest X-ray and computed tomographic (CT) films disclosed left pleural effusion and a tumor shadow extending invasively from superior to anterior mediastinum around the heart and large arteries. These observations called for a differential diagnosis from malignant lymphoma, invasive thymoma, and small cell carcinoma. Bronchofiberscopy and percutaneous tumor biopsy were performed, but the findings were inconclusive. Thoracoscopic biopsy yielded a diagnosis of sarcoidosis. No extrathoracic lesions were detected. Corticosteroid therapy (30 mg/day of prednisolone) was started. After 6 months of treatment (7.5 mg/day of prednisolone), the tumor shadow was reduced in size and the patient's swallowing difficulty and dyspnea subsided. This was a rare case of sarcoidosis extending invasively around the heart and large arteries, and that needed to be differentiated from mediastinal tumor. Thoracoscopic biopsy should be actively enlisted as a diagnostic procedure in difficult cases of this kind.

Biopsy↗
PubMed2000

Descending aorta-to-femoral artery bypass: preliminary experience with a thoracoscopic technique.

Descending aorta-to-femoral artery bypass is a durable procedure with excellent long-term patency rates. The operation is usually performed using a lateral thoracotomy combined with retroperitoneal tunneling of the graft. Assuming that a smaller incision would reduce the operative trauma, minimally invasive video endoscopic techniques were used to perform a thoracoscopic bypass operation. In all patients, exposure of the descending aorta was obtained using thoracoscopy. This was accomplished with a maximum of four ports. For placing the conventional side-biting aortic clamp, a 3- to 4-cm incision was necessary. Using this incision as an access port, the proximal anastomosis was sutured endoscopically. Retroperitoneal tunneling was performed using laparoscopically guided balloon dissection. Eleven consecutive patients underwent surgery. In two patients, conversion to a standard thoracotomy was necessary because of extensive intrathoracic adhesions. There were no major complications, except for one hematoma. After a mean follow-up of 9.5 months, all bypass grafts were still patent. Patients could be discharged after a mean postprocedural hospital stay of 7.4 days (range, 5-12). Thoracoscopic descending aorta-to-femoral artery bypass is an operation with excellent patency rates; however, it is a novel technique that still requires further technical improvements. Clinical studies are needed to prove the safety and efficacy of this minimally invasive technique.

Abdomen↗
PubMed1999

[The video-assisted thoracoscopic treatment of spontaneous pneumothorax--our experience with 42 patients].

We present our experience with video-assisted thoracoscopic surgical (VATS) treatment of spontaneous pneumothorax (SP) in 42 consecutive patients. We performed 45 video-thoracoscopic procedures during 44 hospitalisations. The most common procedures were: Endo-stapling of bullae in 12 pts, 4 ligations of bullae, 8 suturing of bullae, 27 bleb ablations and catheterizations. In all patients a parietal pleural abrasion was performed. We describe a new variation of mechanical pleurodesis for prevention of recurrences--"linear pleurotomy"--performed in 15 patients. No major complication occurred during surgery. The mean operative time was 67 minutes (range 30 to 160 min). We have 2 conversions to thoracotomy in patients with secondary SP. Two early recurrences were treated one by thoracotomy and the other by re-thoracoscopy. One case of postoperative bleeding required re-thoracoscopy. Four patients had a prolonged air-leak (more than 7 days), but recovered without additional treatment. The mean duration of intercostal drainage was 4.64 days, the mean postoperative hospital stay--6.8 days. We report 95.6% success rate after VATS treatment of SP with mean follow-up period of 21.1 months (2-49 months).

Adolescent↗
PubMed1999

Thoracoscopic approach to giant lymph node hyperplasia (Castleman's disease).

We describe the case of a thoracoscopic approach to giant lymph node hyperplasia (Castleman's disease) located in the mediastinum. In our patient the initial diagnosis was substernal goiter, but at cervical exploration the mass was found not to be continuous with the thyroid. The mass was easily identified through a lateral thoracoscopic approach and carefully removed. The postoperative course was uneventful, and the patient was discharged home on the fifth postoperative day. Histopathology revealed the features of Castleman's disease, mixed type. The prevalence, location, and pathogenesis of giant lymph node hyperplasia are described, together with the histology and clinical signs. Our report is proposed as the first case of an endoscopic approach to giant lymph node hyperplasia, which could be the best surgical approach for a mediastinal location.

Adult↗
PubMed1999

Video-assisted thoracoscopic surgery in the diagnosis and treatment of chest diseases.

Video-assisted thoracoscopic surgery (VATS) has been used recently in the diagnosis and management of thoracic diseases. In this report, VATS experience with 95 cases, focusing on indications, surgical procedures, complications, and failure rates, are reviewed. Over the past 5 years, 95 VATS procedures for diagnostic and therapeutic purposes were performed in 59 men and 36 women. The specific indications for VATS were lung biopsy for undiagnosed diffuse lung disease (48), mediastinal biopsy (12) and cyst (2), pleural effusion (10), empyema (5), pneumothorax and bullous lung disease (6), pericardial effusion (2) and cyst (2), paravertebral abscess (2), solitary pulmonary nodules (3), and thoracic trauma (3). In all patients, postoperative pain was controlled with non-narcotic analgesics and was measured according to the visual analogue scale (VAS). There was no surgical mortality. Postoperative nonfatal complications were seen in seven cases (7.5%). The overall median duration of chest tube drainage was 2.7 days and the mean postoperative hospital stay was 3 days. For diffuse lung disease, a tissue diagnosis was obtained in all the cases. Definitive diagnosis in the patients with undiagnosed pleural effusion was obtained in 90% of cases, and the overall diagnostic rate was 98.5%. The success rate of the therapeutic procedures was 100% after a mean follow-up of 12 months (range, 6-30 months). Conversion to thoracotomy was needed in six cases (6.6%). All patients scored postoperative pain <50% according to the VAS. Video-assisted thoracoscopic surgery should be considered as a procedure of choice, with exceptional results in the following chest diseases: (a) undiagnosed pleural effusions; (b) recurrent, post-traumatic, or complicated spontaneous pneumothorax; (c) stage II empyema; (d) accurate staging of lung cancer; (e) emergency traumatic injuries of the chest; (f) peripheral solitary pulmonary nodule <3 cm; and (g) lung biopsy for pulmonary diffuse disease.

Adult↗