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PubMed2000

[A case of anesthetic management for re-expansion pulmonary edema of the dependent lung saved by superimposed HFJV during one lung ventilation for the thoracoscopic operation associated with bilateral pneumothorax].

A 21-year-old male with bilateral pneumothorax underwent thoracoscopic bullaectomy in the lateral decubitus position. General anesthesia was induced using thiopental 250 mg and suxamethonium 80 mg and maintained using the combination of the thoracic-epidural anesthesia with assisted spontaneous respiration. He was intubated with a tube equipped with mobile bronchial cuff. On the left bullaectomy, two lung ventilation (TLV) was applied and its course was uneventful. On the right, one lung ventilation (OLV) was done. Fifty minutes after the start of OLV of the left lung, percutaneous arterial hemoglobin saturation (SpO2) declined to 60% with PaO2 36 mmHg. Then, under super imposed HFJV (high frequency jet ventilation) added to manual assisted ventilation through the bronchial brocker, SpO2 increased rapidly to 100%. Postoperative chest X-p showed signs of re-expansion pulmonary edema (RPE) in the dependent, left lung. PaO2 after 25 minutes of hypoxic episode increased to 339.2 mmHg. About 2 hours later he was extubated uneventfully. We conclude that superimposed HFJV is very beneficial for treatment of the RPE of the dependent lung during OLV applied for thoracoscopic operation with bilateral pneumothorax.

Adult↗
PubMed1998

[Video assisted thoracoscopic surgery (VATS) for spontaneous pneumothorax].

We report our initial experience with thoracoscopic surgery in the treatment of spontaneous pneumothorax in 14 patients, mean age 30.7 years. 7 were operated following 2 episodes of spontaneous pneumothorax, 6 after their first episode, and 1 after multiple episodes. All underwent bleb resection, pleurodesis and tube thoracostomy; in 1 we converted to a limited thoracotomy (93% success rate). Only oral analgesia was required for postoperative pain control and patients were discharged 2.6 days after surgery, on average. The apparent superiority of thoracoscopic over conventional, even limited, thoracotomy seems to justify such therapy even during the first episode.

Adult↗
PubMed1999

[Video-assisted thoracoscopic surgery for diagnosis of pulmonary lesions].

23 patients (age 11-66 years) underwent video-assisted thoracoscopic biopsy for diffuse disease or peripheral nodular lesions of the lung. 12 had been previously treated for extrapulmonary malignancy and lung biopsy was done for suspicious metastases. In all cases except 1, lesions were identified and biopsied by thoracoscopy. The postoperative course was easier and shorter as compared to thoracotomy and the mean hospital stay was only 2.5 days. Thoracoscopic lung biopsy is a safe, effective and accurate diagnostic modality for diffuse lung disease and peripheral lesions. It is associated with minimal postoperative pain and discomfort, short hospital stay, early return to normal activity, and gives good cosmetic results.

Adolescent↗
PubMed2000

[Thoracoscopic resection for benign solitary fibrous tumor of the parietal pleura].

We have experienced thoracoscopic surgery for benign solitary fibrous tumor of the parietal pleura. A 46-year-old woman was admitted to our hospital because of chest abnormal shadow. Under thoracoscopy the tumor that was connected to the parietal pleura with a wide pedicle was completely resected with combined parietal resection of the pleura. Pathological diagnosis was a benign solitary fibrous tumor developed from the connective tissues under the parietal pleura. Thoracoscopic surgery is well indicated for a solitary fibrous tumor and wide excision of the tumor with combined resection of the pleura is important to prevent a local recurrence.

Female↗
PubMed1997

A preliminary report on anaesthesia for thoracoscopic oesophagectomy.

The anaesthetic experience in three patients undergoing thoracoscopic oesophagectomy is discussed. The indications for surgery and the premorbid states are outlined. The necessity for one-lung ventilation, with its attendant cardiopulmonary effects, the difficulty of patient access and the assessment of blood loss were the main problems encountered. Pulmonary morbidity was high in the post-operative period despite the avoidance of thoracotomy. Two patients developed persistent vocal cord paralysis. In conclusion, the role of thoracoscopic oesophagectomy needs further evaluation.

Aged↗
PubMed2000

Catamenial hemoptysis: report of a case treated with thoracoscopic wedge resection.

Catamenial hemoptysis is a rare form of hemoptysis. It is a term for the condition of hemoptysis associated with menses. Few cases have been reported in the literature. Only one case, treated by video-assisted thoracoscopic wedge resection, has been described. We report the case of a 26-year-old woman who suffered from catamenial hemoptysis for 7 months and was treated successfully with a video-assisted thoracoscopic (VATS) wedge resection of the lesion. No evidence of recurrence was noted in the postoperative follow-up period of 48 months. We suggest that VATS is the good choice for single focus catamenial hemoptysis.

Adult↗
PubMed2001

[Ultrasonic diagnosis of focal damages in thoracoscopic operations].

5-year experience of developed in PAMS A.V. Vishnevsky Institute of Surgery RAMS ultrasonic examination (USE) of the lung in thoracoscopic operations for focal lung lesions (FLL) is presented. Pilot experience of ultrasonic topical and differential diagnosis of FII opens a new page in diagnosis of respiratory diseases. Over 5 years 74 USE of FLL were performed. FLL were found in 91% cases. Detailed topical diagnosis of allows to design the lung resection with the best functional result. In postoperative X-ray examination neither atelectases nor zones of stable hypoventilation were detected. Normal echographic picture of lung tissue and echosemiotics of different focal lesions are descubed. The experience of diagnosis by echographic signs of FLL shows teasibility of differentiation of hamartomas from tuberculomas and focal metastatic lesions. The payential of differential diagnosis is illustrated. Differential diagnosis supported enucleation in superficial hamartomas and resection in suspected malignant tumor or tuberculosis. Use of intraoperative USE in the majority of cases of focal lesions located both in depth of lung tissue and subpleurally warrants the success of operation in thoracoscopic variant.

Diagnosis, Differential↗
PubMed2001

Video-assisted thoracoscopic surgery for the diagnosis of patients with hilar and mediastinal lymphadenopathy.

In areas where tuberculosis (TB) is rare, cases of hilar and mediastinal lymphadenopathy are often attributed to the diagnosis of sarcoidosis or a malignant process. However, these manifestations have been only sparsely reported in countries with high rates of TB. The role of simultaneous lung biopsy in the differential diagnosis of these patients using a thoracoscopic approach is also undetermined. In this prospective study, 15 adult patients with hilar and mediastinal lymphadenopathy were evaluated using video-assisted thoracoscopy during the period from May 1995 through September 1999. Biopsy of the hilar and mediastinal lymph nodes was undertaken in all 15 patients, and a wedge biopsy of the lungs was performed whenever frozen section of the nodes disclosed granulomatous inflammation. The final diagnoses included sarcoidosis (10 patients), TB (2), metastatic small cell carcinoma (2), and reactive lymphoid hyperplasia (1). No morbidity or mortality was associated with the operation. In patients with sarcoidosis and TB, most of the lymph node biopsy specimens disclosed extensive hyaline fibrosis. Lung biopsy specimens presented small non-necrotizing granulomas with multinucleated giant cells even in the absence of demonstrable parenchymal lesions. In the two patients with TB, identification of acid-fast bacilli and growth of Mycobacterium tuberculosis occurred only in lung specimens and not in specimens from lymph nodes. Video-assisted thoracoscopic surgery is a safe, simple, and effective procedure for the diagnosis of patients with hilar and mediastinal lymphadenopathy. Our results suggest that for a better differentiation between TB and sarcoidosis, an additional lung biopsy could be undertaken to provide specimens for microscopic examination and culture.

Adult↗
PubMed2001

[Assisted thoracoscopic resection of huge mediastinal neurogenic tumor with Horner syndrome and superior vena cava syndrome].

A 51-year-old female suffering from right shoulder pain had chest radiography, which showed the huge round shadow (10 x 8.5 x 8.0 cm) on the right upper lung field. Horner syndrome and superior vena cava syndrome were presented. Thoracoscopic appearance showed that the tumor with complete smooth capsulation was neurogenic. After that added ideal thoracotomy (compatible with location and length) was performed, from which tumor was carried out and made a pathologic diagnosis of neurilemoma originated from thoracic sympathetic nerve. Harmonic Scalpel, an ultrasonically activated surgical device was effective in such a case of using near by nerve and small vessels. After operation, superior vena cava syndrome except for Horner syndrome was improved. It is important that we should consider less invasive and safe approach with combination of thoracoscopic and thoracotomic procedures even in case of huge tumor.

Female↗
PubMed2001

[Successful thoracoscopic resection of pulmonary arterio-venous fistula].

A 65-year-old female was admitted for further examination of an abnormal shadow on a chest roentgenogram. Chest computed tomography revealed a lobular nodule with blood vessels, which was diagnosed as pulmonary arterio-venous fistula (PAVF). Thoracoscopic resection was performed under general anesthesia. The fistula was situated directly below the pleura of the left lower lobe. Partial resection of the left lung including the PAVF was performed with an autosuture device dedicated to endoscopic surgery (Endo GIA II). The patient was discharged from our hospital 3 days after surgery without major complications. Mild hypoxemia was corrected after the surgery. Thoracoscopic resection is considered to be safe and useful for a solitary PAVF existing a peripheral field of the lung.

Aged↗
PubMed2001

A survey on anesthesia for thoracoscopic sympathetic surgery in treatment of hyperhidrosis palmaris in Taiwan.

Thoracoscopic approach to sympathetic surgery has gained its popularity and emerged as the main stream in the treatment of hyperhidrosis palmaris in Taiwan. Different kinds of anesthesia have been practiced and reported in these surgeries. We made a survey of anesthetic methods in twelve medical centers and regional hospitals of the island. It was found out that the choice of the anesthesia was mainly dependent on the mutual trust and the full communication between the anesthesiologist and the surgeon, both based on their skills and the operative methods chosen by the surgeon. Single-lumen endotracheal tube with general inhalation anesthesia is practiced in most of the hospitals surveyed. Sevoflurane and desflurane are the choices of the inhalational anesthetic agents. In short, the anesthesiologists tend to practice the type of anesthesia that is simple but safe enough to secure the airway of the patient throughout the thoracoscopic sympathetic surgery.

Anesthesia↗
PubMed2001

[Three cases of emergency video-assisted thoracoscopic surgery for spontaneous hemopneumothorax].

We experienced 3 cases of video-assisted thoracoscopic surgery for spontaneous hemopneumothorax. All the patients had received emergent operations because of massive intrathoracic bleeding. At the operation, a 3 cm-minithoracotomy and 2 trocar ports were fashioned. In the head up position, massive blood clots in the apex in the thoracic cavity was removed by using grasping forceps and the source of bleeding point was detected easily. The bleeding was successfully stopped. It was difficult to remove massive blood clots from trocar port by suction, however it was easy to remove massive blood clots from a 3 cm-minithoracotomy window by using a large grasping forceps. Post operative course was satisfactory and the all patients discharged within 2 weeks after admission. We concluded that the spontaneous hemopneumothorax may be a good indication for video-assisted thoracoscopic surgery.

Adolescent↗
PubMed2002

[Thoracoscopic esophagectomy for esophageal cancer. Personal experience].

BACKGROUND: Esophageal surgery was recently modified by minimally-invasive approach. Personal experience with the thoracoscopic technique for esophagectomy in patients with early stage esophageal cancer is described. METHODS. From 1996 to 2000 at the Department of Thoracic Surgery of the University of Rome "La Sapienza", 10 patients, 7 male and 3 female, underwent video-thoracoscopic esophagectomy for esophageal cancer. Median age was 64 years (range 53-72). With the patient in left lateral decubitus 4 ports were positioned between the 4th and 8th intercostal space. The thoracic esophagus was mobilized in the entire length and circumference with the connective tissue and peri-esophageal nodal stations. A cervicotomy followed by a median laparotomy for tubulization of the stomach was performed. RESULTS: Nobody required conversion to thoracotomy. No complication or intraoperative death were observed. The median thoracic time was 110 minutes (range 55-165). No death within 30 days after discharge was recorded. One patient presented left vocal cord paralysis. In one case a recurrence in cervical anastomosis two months after the operation was observed. One patient died after 36 month for metastatic spread. Eight patients are alive with no evidence of disease, with median follow-up of 20 months. CONCLUSIONS: In our experience, the video-toracoscopic approach is a viable and safe option for the treatment of early stage esophageal cancer. Low incidence of complications and local recurrence should encourage a most frequent use of this procedure.

Aged↗
PubMed2002

[A case of left diaphragmatic eventration treated by thoracoscopic plication].

A 59-year-old woman was admitted to our hospital because of left diaphragmatic eventration due to a left phrenic nerve injury following surgery for recurrent thyroid cancer. She underwent plication by thoracoscopic surgery followed by marked expansion of the left lung and improvement of pulmonary function and dyspnea on exercise. Thoracoscopic plication for diaphragmatic eventration is a useful minimally invasive surgical technique.

Diaphragmatic Eventration↗
PubMed2002

A video-assisted thoracoscopic technique to encircle the four pulmonary veins: a new surgical intervention for atrial fibrillation ablation.

BACKGROUND: Atrial fibrillation (AF) is the most common of the so-called benign arrhythmias. It affects not only life expectancy but also quality of life. Until recently, surgeons have most often encountered AF in association with ischemic or valvular disease but rarely as lone atrial fibrillation (LAF). For the subset of LAF patients, a minimally invasive procedure is recommended. METHODS: Using an animal model, we have developed a video-assisted thoracoscopic approach to atrial ablation whereby the ablation is performed encircling the four pulmonary veins as through a median sternotomy. RESULTS: Fifteen animals were used, and in 5 a complete encircling of the pulmonary veins was accomplished using the thoracoscopic approach. DISCUSSION: Video-assisted thoracoscopy is a feasible and safe approach for epicardial pulmonary vein ablation. This technique offers the option of surgery to a class of patients who are resistant to medical therapy but for whom the presence of LAF contraindicates the open chest approach.

Animals↗
PubMed2003

[Thoracoscopic and video-assisted surgeries on thoracic organs of children].

Forty-seven video-surgical thoracic operations performed in children are analyzed. Age of children ranged from 4 days to 14.5 years, body weight--from 700 g to 54 kg. Two types of surgeries are singled out--thoracoscopic and video-assisted (when minithoracotomy was performed in addition to thoracoscopic technique). There were no severe complications during surgery. One child died due to non-diagnosed penumothorax on the 4th day after surgery. Problems of anesthesia and surgical technique in children are considered.

Adolescent↗
PubMed1998

Thoracoscopic sympathectomy: a case report.

Thoracoscopic sympathectomy was first described in 1951 but was not popularized until this decade. With the advent of videoendoscopic techniques and advances in minimally invasive surgery, thoracoscopic sympathectomy has been shown to be a safe and effective therapy in the treatment of various autonomically mediated disorders. Furthermore, numerous investigators have reported high rates of technical success and patient satisfacrion. These minimally invasive techniques used to resect the sympathetic ganglia significantly reduces the morbidity and mortality often associated with conventional open procedures. In addition, endoscopic techniques provide a magnified view of the surgical field and allow for precise identification of the sympathetic chain and points of resection.

Journal Article↗