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At least 883 records · Page 49Linked to original sources
PubMed2004

Video-assisted thoracoscopy in thoracic injury: early or delayed indication?

The aim of this study was to evaluate the diagnostic role and therapeutic effectiveness of videothoracoscopy in chest trauma. Between 1st January 1993 and 30th September 2003, 112 traumatized patients underwent a videothoracoscopy. The origin of trauma was different: 60 road accidents, 42 accidental falls, 7 knife wounds and 3 firearm wounds. Seventy-six patients presented hemothorax, 21 hemopneumothorax, 10 suspected diaphragmatic injury and 5 pericardium effusion. All patients were hemodynamically stable and conscious. In suspected diaphragmatic rupture patients, videothoracoscopy confirmed the presence of 4 lesions with diameter from 7 to 10cm. The etiopathogenetic causes in the other clinical patterns were: 20 lung lacerations, 17 apical adhesion lacerations, 11 diaphragmatic lesions, 16 wall bleedings and 38 vessel lesions. Ninety patients (80.3%) were treated with video assisted thoracic surgery. The remaining procedures were : 17 drainage tube insertions, 4 thoracotomies and 1 laparotomy. Videothoracoscopy made the use of the primary intention drainage tube obsolete in stable traumatized patients with hemothorax or hemopneumothorax. It is a safe technique that allows the diagnostic and surgical management of the lesions.

Accidental Falls↗
PubMed2005

Use of the Arndt wire-guided endobronchial blocker to facilitate one-lung ventilation for pediatric empyema during video-assisted thoracoscopy.

BACKGROUND: Video-assisted thoracoscopic surgery (VATS) has emerged as an innovative and popular procedure for the management of postpneumonic empyema in children refractory to a medical response. One-lung ventilation is required during VATS. In this study, we evaluated the efficacy of intraoperative wire-guided endobronchial blockade (WEB) for achieving 1-lung ventilation during a thoracoscopic procedure for pediatric empyema. METHODS: Eighteen patients undergoing a VATS approach for evacuation of an empyema cavity were studied. We used a new device, a bronchial blocker tube, to establish 1-lung ventilation. Intraoperative oxygenation, ventilation, and hemodynamics, as well as the duration of the operation during 1-lung ventilation were recorded. The number of unsuccessful placement attempts, number of malpositionings of the device, and the number of secondary dislodgements of the device after turning the patient into the lateral position were also counted. The quality of lung deflation and inflation was rated by the surgeon under direct visualization as either excellent, fair, or poor. RESULTS: The mean operative time was 80+/-10.8 (range, 50 approximately 120) min. The mean peak inspiratory pressure under 1-lung ventilation was 28.7+/-3.6 cm H2O, and no desaturation was noted. A number of unsuccessful placement attempts were required in 1 patient (1/18) for left-sided VATS. No malpositioning or secondary dislodgement of the device was noted. The quality of lung deflation was judged as being excellent in all patients. CONCLUSIONS: VATS can safely and effectively be performed in children with a proper anesthetic technique. With the development and clinical use of this new device, the bronchial blocker tube proved to be effective and easy to use for establishing 1-lung ventilation in a pediatric population.

Adolescent↗
PubMed1990

[Surgical thoracoscopy].

UNLABELLED: Thoracoscopic adhesiolysis since 1913 (Jacobaeus). Thoracoscopic targets: Sympathetic system, vagus system, lymphatic system, lung. INDICATIONS: Arterial circulation disturbances, posttraumatic reflexdystrophy ("Sudeck"), Hyperhidrosis syndromes, erythrodermy syndromes; pain syndromes: causalgiform, splanchnicotomy for chronic pancreatitis. For peptic jejunal ulcer thoracoscopic splanchnico-vagotomy. For bronchial asthma selective vagotomy of bronchial rami. Operative techniques. Hemostasis: low-frequency thermocoagulation, unipolar and bipolar high-frequency coagulation, with thermostabilisation. Videoendoscopy with minicameras. Electronic frame freezing for colour slides.

Electrocoagulation↗
PubMedDate not supplied

Operative thoracoscopy for recurring pneumothorax.

Video-assisted thoracoscopic surgery has markedly changed the management of recurrent pneumothorax. Thoracotomy is no longer the routine approach for the surgical treatment of bullae, partial pleurectomy, or various methods of pleurodesis. Many surgical procedures on the lung and the pleura can be performed endoscopically as safely and easily as in open thoracic surgery. These new techniques have been assessed in 94 patients. An early analysis of the postoperative data shows that the minimally invasive procedure reduces postoperative discomfort and the length of hospital stay; the rate of recurrence is no higher than that for open pneumothorax surgery.

Equipment Design↗
PubMed1993

[Excision of mediastinal nodes using video-thoracoscopy].

A man of seventy-one years with gross respiratory failure was suspected of having a cancer of the right upper lobe with metastases to the right pretracheal and intertracheobronchial nodes. A diagnostic mediastinoscopy did not achieve a diagnosis, and a right sub-bronchial node biopsy was performed, using videothoracoscopy and this revealed the presence of tuberculosis without any further delay.

Aged↗
PubMedDate not supplied

Comparison of minimally invasive thoracoscopy versus open thoracotomy for staging lung cancer.

Minimally invasive thoracoscopic staging for lung cancer was compared with re-staging by open thoracotomy in seventeen patients to evaluate whether videoimaged thoracoscopic staging was accurate. Seventeen patients underwent thoracoscopic staging initially with a closed videoimaged technique. These same patients then underwent an open thoracotomy and re-staging with a therapeutic resection for lung cancer. All patients underwent pleural evaluation and biopsy if indicated, thoracic hilar and mediastinal lymph node sampling, and then resection of the parenchymal lesion via a wedge resection, lobectomy or pneumonectomy. There was complete TMN stage correlation between the closed videoimaged thoracoscopic and open thoracotomy techniques. This preliminary study suggests minimally invasive videoimaged thoracoscopic staging is an accurate method to assess the stage of lung cancer to guide rational management.

Biopsy↗
PubMed1996

[Problems in technical development of laparoscopy and thoracoscopy in infancy].

In neonates a new fixation of the trocars must be found since the umbilical ring is large and distensible and the abdominal wall is very thin. The pressure-controlled pneumoperitoneum is maintained by using a special "surgiflator" system which prevents high pressure peaks in the small abdominal cavity of neonates. By using a Nd:YAG laser for transection during coagulation an additional trocar can be dispensed with.

Endoscopes↗
PubMed2004

Safety and efficacy of median sternotomy versus video-assisted thoracic surgery for lung volume reduction surgery.

BACKGROUND: The National Emphysema Treatment Trial, a randomized trial comparing lung volume reduction surgery with medical therapy for severe emphysema, included randomized and nonrandomized comparisons of the median sternotomy and video-assisted thoracoscopic approaches for lung volume reduction surgery. METHODS: Lung volume reduction surgery was performed by median sternotomy only at 8 centers and video-assisted thoracoscopy only at 3 centers; 6 centers randomized the approach to lung volume reduction surgery. Mortality, morbidity, functional status, and costs were assessed. RESULTS: In the nonrandomized comparison, 359 patients received lung volume reduction surgery by median sternotomy, and 152 patients received lung volume reduction surgery by video-assisted thoracoscopy. The 90-day mortality was 5.9% for median sternotomy and 4.6% for video-assisted thoracoscopy (P =.67). Overall mortality was 0.08 deaths per person-year for median sternotomy and 0.10 deaths per person-year for video-assisted thoracoscopy (video-assisted thoracoscopy-median sternotomy risk ratio, 1.18; P =.42). Complication rates were low and not statistically different for the 2 approaches. The median hospital length of stay was longer for median sternotomy than for video-assisted thoracoscopy (10 vs 9 days; P =.01). By 30 days after surgery, 70.5% of median sternotomy patients and 80.9% of video-assisted thoracoscopy patients were living independently (P =.02). Functional outcomes were similar for median sternotomy and video-assisted thoracoscopy at 12 and 24 months. Costs for the operation and the associated hospital stay and costs in the 6 months after surgery were both less for video-assisted thoracoscopy than for median sternotomy (P <.01 in both cases). Similar results were noted for the randomized comparison. CONCLUSIONS: Morbidity and mortality were comparable after lung volume reduction surgery by video-assisted thoracoscopy or median sternotomy, as were functional results. The video-assisted thoracoscopic approach to lung volume reduction surgery allowed earlier recovery at a lower cost than median sternotomy.

Aged↗