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PubMed1989

Thoracoscopy: a review of 121 consecutive surgical procedures.

The records of 121 patients who underwent surgical thoracoscopy between 1976 and 1987 were reviewed. The indications for thoracoscopy were pleural effusion (88%), pleural thickening (7.4%), and a mass on the chest roentgenogram (15%). All procedures were performed under general anesthesia with a rigid thoracoscope and 91 patients (75%) were diagnosed as having a malignant process. Although thoracotomy was undertaken in 20 patients (16.5%), no patient with benign disease underwent diagnostic thoracotomy. Thoracoscopy had a 98.9% sensitivity and a 93.3% specificity in this series. One patient died of a myocardial infarction after the procedure, and 11 patients (9.1%) had other, predominantly respiratory, complications. We confirm that surgical thoracoscopy is a useful procedure in the diagnosis of pleural processes.

Diagnostic Techniques, Surgical↗
PubMed1993

The role of thoracoscopy in thoracic trauma.

The advent of video-assisted thoracic surgical procedures has caused many thoracic surgeons to reevaluate their approach to the management of diseases of the chest. The management of traumatic thoracic injuries is an area in which thoracoscopic techniques may have significant impact. The current role of thoracoscopy in the diagnosis and therapy of thoracic trauma continues to evolve. This review considers the currently accepted diagnostic and therapeutic applications of thoracoscopy in the management of these patients. The technique of thoracoscopy as it applies to the trauma patient is also discussed, as well as the future and expanding applications of thoracoscopy in this setting.

Anesthesia, General↗
PubMed1996

Selective lung ventilation during thoracoscopy: effects of insufflation on hemodynamics.

BACKGROUND: Positive-pressure insufflation during thoracoscopy has been advocated by some authors to facilitate exposure of the intrathoracic structures by expediting collapse of the lung. We hypothesized that insufflation during thoracoscopy may result in hemodynamic compromise despite selective lung ventilation. METHODS: After placement of invasive monitoring lines, six adult swine underwent selective lung ventilation and thoracoscopy. Baseline measurements of hemodynamic indices were taken before selective lung ventilation. The right lung then was collapsed; data were obtained at insufflation pressures up to 10 mm Hg and were compared with baseline values using Student's t test. RESULTS: Cardiac index, mean arterial pressure, and left ventricular stroke work index decreased, whereas pulmonary artery and central venous pressures increased (p < 0.05) at insufflation pressures of 5 mm Hg and greater. CONCLUSIONS: Positive-pressure insufflation during thoracoscopy resulted in significant hemodynamic compromise despite the use of selective lung ventilation. Conversion to thoracotomy may be an alternative if positive-pressure insufflation is necessary to perform the thoracoscopic procedure.

Animals↗
PubMed1981

Thoracoscopy for intrathoracic tumors.

The technique of thoracoscopy has been performed on 49 occasions in 45 patients for the diagnosis or staging of intrathoracic tumors. The patients ranged from 8 months to 68 years old. Eight procedures were performed for pleural disease, 16 for mediastinal masses, 22 for parenchymal lesions, and 3 for intrathoracic staging. Seventeen patients had had previous invasive procedures performed without a pathological diagnosis being established. In 28 thoracoscopy procedures, a positive diagnosis for malignancy was obtained; in 6 instances, areas of unsuspected tumor involvement were identified. A correct diagnosis was obtained by thoracoscopy in 45 procedures for a 92% overall accuracy rate. There was no clinically significant morbidity in this series and no procedure-related mortality. Thoracoscopy, performed under stellate ganglion block and regional anesthesia, has proved to be a very attractive method of diagnosing intrathoracic neoplasia with very low morbidity.

Adolescent↗
PubMed1978

Thoracoscopy: a useful tool in the diagnosis of thoracic disease.

During a 12-month period, 11 patients underwent diagnostic thoracoscopy for previously undiagnosed thoracic disease. In all patients, the diagnosis had been unobtainable by the usual diagnostic modalities of bronchoscopy, scalene node biopsy, mediastinoscopy, thoracentesis, or closed pleural biopsy. Thoracoscopy was diagnostic in 10 of the 11 patients. There was no morbidity or mortality. In all patients the indication for thoracoscopy was suspected malignancy. The majority of patients had recurrent pleural effusions in which routine cytological studies and tissue biopsies had been nondiagnostic. Pathological findings were mesothelioma in 3 patients, primary carcinoma of the lung in 4, congestive heart failure with pleural effusion in 1, metastatic carcinoma in 2, and inflammatory disease in 1 patient. Indications, techniques, and results are discussed. Thoracoscopy is a valuable tool in the diagnosis of thoracic disease; with it, unneccessary thoracotomy can often be avoided.

Aged↗
PubMed1996

Thoracoscopy in children.

Pediatric surgical experience with video-assisted thoracoscopy is limited. The authors report their experience with 27 thoracoscopies in 22 children. The median age was 6.1 years (range, 1 day to 16 years). The two primary indications for thoracoscopy were management of pneumothorax and mediastinal cysts. Fifteen thoracoscopies accomplished their purpose without complications. Intraoperative complications required conversion to an open operation in three patients. One bronchogenic cyst and four pneumothoraces recurred. The main complications were poor visualization, bleeding from an intercostal artery, and difficulty with suturing. Compared with open thoracotomy, anesthesia time did not differ significantly, and less pain medication was required postoperatively.

Adolescent↗
PubMed1997

Thoracotomy and thoracoscopy: postoperative pulmonary function, pain and chest wall complaints.

OBJECTIVE: Two different surgical accesses combined with standard pain management procedures are compared regarding early and intermediate pulmonary function and pain relief. METHODS: In a prospective study, 15 consecutive patients undergoing video-thoracoscopy for pulmonary wedge resection (group 1) were matched to 15 patients undergoing standard postero-lateral thoracotomy for lobectomy (group 2) according to age, gender and preoperative pulmonary function. Postoperative pain control consisted of patient controlled analgesia in group 1 and epidural analgesia in group 2. Pain intensity was scored from 0-4. The predicted postoperative pulmonary function (FVC and FEV 1) after lobectomies was calculated from the preoperative value according to the extent of resection. A clinical measurement was obtained after a mean follow-up time of 4.2 months. RESULTS: The ratios of postoperative measured to predicted values of FVC and FEV1 for group 1 compared with group 2 were 0.64 +/- 0.15 and 0.65 +/- 0.14 compared with 0.60 +/- 0.19 and 0.59 +/- 0.13, resp. (both n.s.) at the first day postoperative; 0.92 +/- 0.18 and 0.95 /- 0.17 compared with 0.76 +/- 0.20 (P < 0.05) and 0.83 +/- 0.23 (n.s.), resp. at hospital discharge; 0.98 +/- 0.10 and 0.94 +/- 0.14 compared with 1.01 +/- 0.17 (n.s.) and 1.10 +/- 0.17 (P < 0.05), resp. at follow-up. Pain intensity score one day after surgery ranged from 0.4 (resting position) to 1.6 (coughing) for group 1, and from 0.3 to 1.2 for group 2. Thirty-six percent of the thoracoscopy patients and 33% of the thoracotomy group complained of persistent pain or discomfort on the site of the operation after 3-18 months. CONCLUSION: Post-thoracotomy pain can be effectively controlled with epidural analgesia and pain intensity is no higher than in patients after thoracoscopy who are managed with patient controlled analgesia. FVC is slightly more decreased after thoracotomy during the early postoperative period. FVC and FEV 1 approach the predicted values after four months in both groups. The rate of persistent pain is similar after thoracoscopy and thoracotomy.

Adult↗
PubMed1992

Thoracoscopy in children: an initial experience with an evolving technique.

Recent technological innovations have improved our ability to perform thoracoscopy in children. Video imaging improves thoracoscopic visualization and enhances the role of the surgical assistant. The placement of multiple access ports improves the thoracoscopic manipulation of tissue. The laser permits the application of thermal energy to intrathoracic tissue for hemostasis without the risk of cardiac fibrillation. The endoscopic stapler allows hemostatic, airtight lung resection which obviates the need for routine tube thoracostomy. Our initial experience with these innovations applied to thoracoscopy was successful in 9 of 12 patients, ages 5 months to 17 years. For diagnostic cases, adequate tissue for histologic evaluation was always obtained. Complications of successful thoracoscopy included suspected air embolus on establishing the initial pneumothorax and persistent air leak requiring tube thoracostomy after resection of a bronchogenic cyst. There were no perioperative deaths. We performed biopsy of mediastinal masses or nodes, and lung, drainage of loculated pleural effusions, and excision of bronchogenic cysts. Thoracoscopy provides a safe, effective alternative to thoracotomy in children and will continue to be enhanced by improving technology.

Adolescent↗
PubMed1996

A prospective evaluation of an endoscopic ultrasonic probe to detect intraparenchymal malignancy at pediatric thoracoscopy.

Thoracoscopy has been proposed as the procedure of choice for the evaluation of focal, suspected malignant pulmonary lesions in children. One drawback with this approach, however, is the concern that intraparenchymal lesions may go undetected. We prospectively evaluated the ability of an endoscopic ultrasonic probe to detect intraparenchymal nodules. The handheld probe contains a piezoelectric ultrasound emitter and receiver that operates at 7.5 MHz. The axial resolution of the probe is 1.1 cm. Two different probe tips were used. One is a forward viewing tip and the other is angled at 45 degrees relative to the axis of the probe shaft. Both probes image 90 degrees sectors. Twelve thoracoscopies on nine patients were performed using the ultrasound probe. Of seven patients with confirmed metastatic disease, six had thoracoscopy converted to open thoracotomy to assure that no lesion had been missed. The probe was able to accurately assess surrounding bronchovascular structures and the presence and location of previously placed surgical clips. Although deep structures were readily visualized with the probe, lesions within 1.5 cm of the surface of the lung were poorly visualized. No complications occurred. This ultrasound system allows for the distinction of dense lesions from the surrounding pulmonary parenchyma except for those lying near the surface of the lung, which are usually easy to see directly. Furthermore, the images define the broncho vascular structures adjacent to the lesion. This device may enhance thoracoscopy by facilitating the detection of, and ability to resect, pulmonary intraparenchymal lesions.

Endoscopes↗
PubMed2006

[Early postoperative complications of thoracoscopy versus thoracotomy in pediatric idiopathic scoliosis].

INTRODUCTION: Thoracoscopic surgery has been used for anterior release, discectomy, and fusion in severe scoliosis or kyphosis. The indications of thoracoscopy for the treatment of pediatric spinal deformity are similar to those of thoracotomy-based spinal surgery. OBJECTIVE: We designed a comparative study to observe the immediate complications in the postoperative period after thoracoscopy or thoracotomy for scoliosis in the pediatric population. MATERIAL AND METHODS: The postsurgical complications of 63 interventions for idiopathic scoliosis over a 10-year period were analyzed. Conventional thoracotomy was used in 37 interventions (59 %) and thoracoscopy was used in 26 (41 %). RESULTS: In patients treated with the thoracolumbar endoscopic procedure, oral nutrition was resumed earlier, the mean length of hospital stay was lower, and debit drainage or requirement of surgical drainage were lower. CONCLUSIONS: Fewer immediate postsurgical complications were observed in scoliosis surgery when thoracoscopy was used.

Adolescent↗
PubMed2004

Fluorescein-enhanced autofluorescence thoracoscopy in primary spontaneous pneumothorax.

The exact site of air leakage in a patient with primary spontaneous pneumothorax is difficult to determine and locate. In particular, the role of rupture of emphysema-like changes (blebs and bullae) versus that of enhanced porosity of lung parenchyma in the pathophysiology of primary spontaneous pneumothorax remains unclear. This is the first description of a patient with recurrent primary spontaneous pneumothorax in whom inhalation of aerosolized fluorescein followed by autofluorescence thoracoscopy allowed in vivo localization of various lung areas of extensive subpleural fluorescein accumulation which were not, or only partly, visibly abnormal during normal white light thoracoscopy. No air leak was present at the time of thoracoscopy. No emphysema-like changes were seen. Our findings suggest substantial areas of parenchymal abnormality that remain unnoticed by white light thoracoscopic inspection of the parenchymal surface. In this respect, fluorescein-enhanced autofluorescence thoracoscopy may become an exciting tool in the study of the pathophysiology of primary spontaneous pneumothorax, and could prove useful in clinical practice in determining the sites of surgical staple resection whenever this treatment modality is considered.

Administration, Inhalation↗
PubMed2006

Portal site metastasis of invasive mesothelioma after diagnostic thoracoscopy in a dog.

CASE DESCRIPTION: A 10-year-old Golden Retriever evaluated because of recurrent pericardial and pleural effusion underwent thoracoscopy with biopsy of the pleura and mediastinum. CLINICAL FINDINGS: Before thoracoscopy, 5 L of serosanguinous fluid was removed from the pleural cavity via thoracocentesis. During thoracoscopic exploration, it was observed that the parietal pleura and mediastinum were covered by miliary white to tan nodules 1 to 3 mm in diameter. Biopsy specimens were obtained, and partial pericardiectomy was performed. Portal sites were closed routinely. Cytologic evaluation of the pleural fluid revealed high protein concentration and cellularity, with cellular changes consistent with an exfoliating carcinoma. Results of bacterial culture were negative. TREATMENT AND OUTCOME: Carboplatin was administered via intracavitary instillation, and prednisone was administered orally. Twenty-one days later, 1 firm, irregularly shaped 6.5 x 3-cm mass and 4 smaller masses were detected in the area of the left thoracic wall where the cannula had been inserted during thoracoscopy. Histologic analysis of tissue from the masses collected at necropsy confirmed that they were malignant tumors with similar appearance to the pleural mesothelioma and immunohistochemical staining properties identical to those of the primary tumor. CLINICAL RELEVANCE: Although thoracoscopy is associated with less postoperative pain, shorter hospitalization times, and faster patient recovery than sternotomy procedures, complications are also possible with minimally invasive endoscopic surgery. Portal site metastasis can develop from contamination of portal sites with cells on instruments or cannulas or via leakage of effusion fluid. Although rare, this potential complication should be discussed with owners prior to performing the procedure.

Animals↗
PubMed1999

[The role of thoracoscopy in traumatic diaphragmatic rupture].

The aim of this study was assess the role of thoracoscopy in the diagnosis of diaphragmatic rupture. Eight patients: six male and two female with blunt thoracic trauma underwent thoracoscopy. The chest X-ray and CT findings, pleural ultrasound indicated a diaphragmatic rupture only in three cases. Five of eight diaphragmatic injuries were confirmed by thoracoscopy. Authors suggests that thoracoscopy is a safe, accurate method for the diagnosis of diaphragmatic rupture.

Adolescent↗
PubMed2002

[Thoracoscopy in management of spontaneous pneumothorax].

OBJECTIVES: To estimate possibilities of video-assisted thoracoscopy in surgical treatment of spontaneous pneumothorax. PATIENTS AND METHODS: A retrospective analysis of 209 clinical cases of spontaneous pneumothorax, which underwent urgent thoracoscopy, is presented. RESULTS: Eighty eight patients underwent coagulation of small bullos, twenty six - parietal pleura electroscarification, 12 - mechanical pleurodesis. Four patients underwent thoracoscopic parietal pleurectomy and wedge resection. The postoperative drainage time for spontaneous pneumothorax was 3-4 days. Hospital stay - 7 days. CONCLUSIONS: Modern video-assisted thoracoscopy diagnostics and surgical treatment are inseparable parts of management of spontaneous pneumothorax. Video-assisted thoracoscopy is a safe, simple, less traumatic and effective diagnostic and treatment procedure of patients with spontaneous pneumothorax.

Data Interpretation, Statistical↗
PubMed1992

[Treatment of pericardial cyst under thoracoscopy].

Thoracoscopic therapy was carried out on two cases of pericardial cyst. The first patient was a 24-year-old male. An abnormal shadow on a chest X-ray was pointed out at a regular checkup. Thoracoscopy was carried out under the local anesthesia and a thin-walled cyst was discovered. The cyst was punctured and serous fluid was aspirated. Then, several biopsy specimens were obtained from the cyst wall, a pathological diagnosis of the cyst was made as a pericardial cyst. One year after the thoracoscopy, no abnormal shadow is observed on chest X-ray. The second patient was a 26-year-old male. It was also discovered that he had an abnormal shadow on a chest X-ray at a regular medical checkup. Since a solid mass couldn't be completely denied, thoracoscopy was carried out in preparing for thoracotomy under the general anesthesia. The cyst observed between SVC and the azygos vein, and serous fluid was aspirated form the cyst. Following this, the cyst wall was biopsied and opened. Since no cases of malignant pericardial cysts have been reported, an operation is not usually required for these patients. We suggest that thoracoscopy is very useful tool for the final diagnosis and therapy of pericardial cyst because this method is easily carried out under local anesthesia.

Adult↗
PubMed2005

[Thoracoscopy and intraoperative upper gastrointestinal endoscopy was effective for Boerhaave syndrome; report of a case].

Boerhaave syndrome is a rare disease and needs an exact diagnosis and a proper treatment plan because of its terrible clinical course. We experienced a case of Boerhaave syndrome that thoracoscopy and intraoperative upper gastrointestinal (GI) endoscopy was very effective. Sixty-four-year-old man realized chest and back pain after vomitting. Esophageal perforation was suspected, but 64 hours had passed already when we started a surgical treatment. By the thoracoscopy and intraoperative endoscopy, lower esophageal perforation and infectious pleural effusion were found. Therefore, we selected a surgical treatment under the assistance of thoracoscopy. Secondly, a simple closure and intracostal muscle overlapping was performed with small incisional thoracotomy. Postoperative complication, such as mediastinal abscess, has not occurred. Thoracoscopy and intraoperative upper GI endoscopy was effective for an appropriate diagnosis and treatment of Boerhaave syndrome.

Endoscopy, Gastrointestinal↗
PubMed1992

Extended thoracoscopy: a biopsy method to be used in case of pleural adhesions.

Extended thoracoscopy (ET) allows several large biopsies to be taken in patients with thick adhesions of the pleura when normal thoracoscopy is impossible. Twenty patients with undiagnosed pleural effusion or thickening and two with associated pulmonary tumour close to the chest wall underwent ET because closed adhesions prevented the induction of an artificial pneumothorax. Under local anaesthesia and neuroleptanalgesia, at the site of suspected lesions on computed tomographic (CT) scan, a cutaneous incision of 3-4 cm is made on the appropriate intercostal space. After dissection with blunt scissors, the operator introduces his finger to create a space in the pleural cavity. The thoracoscope is inserted to inspect the pleura and to take several biopsies for histopathological examination. A chest tube is inserted for a few minutes after checking airtightness and haemostasis. The procedure is well-tolerated. In three cases no pleural biopsy could be taken; in three patients a false negative diagnosis was observed. A correct diagnosis was obtained in 16 out of 19 patients (84%). If performed by a pulmonologist experienced with thoracoscopy ET is a rapid, safe and efficient method to obtain biopsies in cases where normal thoracoscopy after induction of a pneumothorax is not possible. It considerably reduces the need for open thoracotomy.

Adolescent↗
PubMed1991

Expanded applications of diagnostic and therapeutic thoracoscopy.

From 1971 to 1990, 315 thoracoscopies were performed. Recent advances in optic/video systems and endoscopic operating instruments have made thoracoscopy easier and more accurate than 20 years ago. The operative mortality rate was low (1%) and the diagnostic accuracy high (99%). Thoracoscopy has been performed at an increasing frequency in recent years because of its expanded applications, especially in the areas of therapeutic or operative procedures such as carbon dioxide laser treatment of spontaneous pneumothorax or diffuse bullous emphysema, neodymium:yttrium-aluminum-garnet laser vaporization of pleural malignant tumors, and thoracoscope/laser-aided pleurectomy, pericardiectomy, or lung resection. Further technologic advancement in thoracoscopy will have a considerable impact on the future of thoracic surgery.

Aged↗