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PubMed2005

[CT-guided resection of pulmonary metastases].

PURPOSE: To evaluate the feasibility and potential use of intraoperative computed tomography (IOP CT) as guidance for video-assisted thoracic surgery (VATS). MATERIAL AND METHODS: Fifteen consecutive patients with peripheral intrapulmonary nodules underwent a thoracoscopy with IOP CT. Solitary lesions were known in 6/15 patients (40 %, group II) whereas 9/15 (60 %, group I) patients had multiple lesions (n >/= 2). IOP CT was performed with the mobile CT scanner Philips Tomoscan M. Radiologists intraoperatively placed percutaneous marks of lung lesions after unsuccessful VATS by use of a lung marker set (Somatex, Teltow, Germany). VATS was performed under general anaesthesia and with double lumen endotracheal intubation for single lung ventilation. Imaging quality and imaging of pulmonary nodules were rated. RESULTS: IOP CT was evaluated as feasible combined with VATS. Thoracotomy was avoided in 5/15 patients where lesions could not be detected by VATS. A CT-guided biopsy was performed in two patients after an unsuccessful attempt of thoracoscopy. There were no documented side effects. CONCLUSION: First clinical results suggest that a combination of VATS and IOP CT is feasible. Thus, the number of open thoracoscopies might be decreased. Intrapulmonary lesions not detectable with VATS could be marked under CT -- guidance intraoperatively and then resected by thoracoscopy.

Aged↗
PubMed1992

Thoracoscopic lymph node dissection in the staging of esophageal carcinoma.

Preoperative staging in esophageal cancer is usually done by noninvasive tests. Currently, in the staging of lung cancer, when lymph nodes are identified preoperatively by CT or MRI to be greater than 1 cm, surgical staging using mediastinoscopy, Chamberlain procedures, or thoracoscopy are employed. We describe herein the use of thoracoscopy in routine preoperative staging of esophageal cancer. With the advent of newer laparoscopic techniques currently available, thoracoscopy plays an increasing role in the management of intrathoracic disease. Staging thoracoscopy as a routine preoperative invasive staging test appears to be a good diagnostic test.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Thoracoscopic surgery in childhood cancer.

PURPOSE: Recent advances in minimally invasive surgery, especially thoracoscopy, have allowed many new applications in children. The authors' purpose was to review their experience with thoracoscopic surgery in childhood cancer. They hypothesized that thoracoscopy can be efficacious, safe, and cost-effective and has the potential to change the way we care for children with cancer. PATIENTS AND METHODS: The authors reviewed their thoracoscopic experience of the past 7 years. Thoracoscopic procedures performed included biopsy and resection of masses, resection of lung nodules, biopsy of infiltrates, and lobectomy. Some resections required conversion to open thoracotomy. RESULTS: Sixty-three thoracoscopic procedures were performed on 52 children; 8 required conversion to open thoracotomy and 55 were completed by thoracoscopy alone. The overall success rate was 98.4%. There were three complications and no deaths. The mean surgery time was 1.2 hours, mean length of hospital stay was 1.9 days, and mean number of chest tube days was 0.7. CONCLUSIONS: Thoracoscopic surgery in the treatment of children with cancer can be efficacious, safe, and cost-effective. Mediastinal masses can usually be biopsied and resected by thoracoscopy alone. Conversion to open thoracotomy for a more complete resection can be safely accomplished if needed. Thoracoscopic removal of lung nodules allows more accurate staging and early initiation of chemotherapy. Thoracoscopic biopsy of lung infiltrates can be safely performed in intubated, critically ill children and changed the treatment in all of these patients. Surgery time and days in hospital were decreased compared with historical thoracotomy data.

Adolescent↗
PubMed2005

Video-assisted thoracoscopic decompression of tubercular spondylitis: clinical evaluation.

STUDY DESIGN: A prospective, observational study using a novel procedure of video-assisted thoracoscopy and conventional, long spinal instruments for decompression of dorsal tubercular spondylitis. OBJECTIVES: To assess the efficacy of video-assisted thoracoscopic decompression of dorsal tubercular spondylitis and compare it with the published data of classic thoracotomy procedures. SUMMARY OF BACKGROUND DATA: Surgical decompression of dorsal tubercular spine with the transpleural transthoracic method is a standard procedure. It is a major surgery with significant morbidity in terms of blood loss, intensive care unit (ICU) and hospital stay, postoperative incision pain, and chest tube insertion. A procedure that has the potential to achieve comparable recovery in patients with dorsal tubercular spondylitis but with a surgery of lesser magnitude and morbidity has immense potential. METHODS: There were 16 patients with mid-dorsal tubercular spondylitis with paraplegia/paraparesis requiring surgery who were included in the study. Every patient had a recent paradiscal disease at a single level. A soft tissue shadow was visible on plain radiographs of the spine, and conservative treatment for at least 3 weeks had shown no recovery. Patients with obvious respiratory insufficiency and likely to have significant pleural adhesions were excluded from the study. Single lung anesthesia and ipsilateral lung collapse using a double-lumen tube were administered. A 3-portal thoracoscopy approach was used, and conventional but long spinal instruments were used through an open port to decompress the spine. Patients were assessed for blood loss, duration of surgery, postoperative incision pain, duration of chest tube insertion, ICU and hospital stay, and neurologic recovery. Patients were observed for a minimum of 6 months. RESULTS: Of 16 patients, 14 (88%) had good neurologic recovery. In 1 patient, thoracoscopy was abandoned, and open thoracotomy was performed because of persistent bleeding. Another patient did not recover, and anterolateral decompression was performed 10 weeks after thoracoscopy. She recovered subsequently. Other complications included fracture of the sixth rib in 1 patient and breakage of suction tip in another. Adequate tissue biopsy for histopathologic examination could be obtained in all patients. Duration of surgery was 223 minutes (+/-56), blood loss was 497 ml (+/-302), and blood transfusion was required in 3 patients (3 U in 1 and 1 U in 2). Postoperative analgesic (tramadol) was 243 mg (+/-70) for 2-4 days (median 3), median hospital stay was 5.5 days (range 4-9), chest tube requirement was 3 days (range 2-7), and 2 patients were required to stay in the ICU for 1 day each. CONCLUSION: Video-assisted thoracoscopic decompression of tubercular dorsal spondylitis is a viable option to achieve significant neurologic recovery with less morbidity, blood requirement, and hospital stay compared to the open thoracotomy procedures.

Adolescent↗
PubMed2006

Diagnostic value of thoracoscopic pleural biopsy for pleurisy under local anaesthesia.

BACKGROUND: We find pleural effusion in clinical practice frequently. However, it is difficult to make a diagnosis definitively by thoracocentesis or closed pleural biopsy. We directly examine the thoracic cavity by thoracoscopy under local anaesthesia, carry out pleural biopsy and make a definitive pathological diagnosis in pleurisy. METHOD: A retrospective study of 138 patients who had been diagnosed by thoracoscopy in our hospital was carried out between January 1995 and January 2005. RESULTS: The patients were 114 men and 24 women, ranging in age from 21 to 85 years, with a mean of 59 years. The right side was involved in 83 patients and the left side in 55. The operations took 11-145 min, with a mean of 46 min. Thoracoscopy directly without thoracocenteses was carried out in 28 of 138 patients. Lung cancer with pleural dissemination was diagnosed in 27, malignant pleural mesothelioma in 10, tuberculous pleurisy in 32, non-specific pleurisy in 58, other tumour in 2 and pyothorax in 9 patients. The overall diagnostic efficacy was 97.1% (134/138). The diagnostic efficacy in the cases of carcinoma was 92.6% (25/27), in malignant pleural mesothelioma it was 100% (10/10) and in tuberculosis it was 93.8% (30/32). No major complications occurred during the examination. CONCLUSION: Pleural biopsy by thoracoscopy under local anaesthesia should be actively carried out in patients with pleurisy, because the technique has a high diagnostic rate and can be easily and safely carried out.

Adult↗
PubMed2006

Fluorescence detection of pleural malignancies using 5-aminolaevulinic acid.

STUDY OBJECTIVE: Although the use of video-assisted thoracoscopy has improved the diagnostic accuracy in patients presenting with pleural diseases, not all biopsies performed are conclusive and staging of the disease is not always optimal. Fluorescence diagnosis (FD) with 5-aminolaevulinic acid (5-ALA) has been used in the diagnostic workup for various malignancies. The impact of 5-ALA-mediated FD on diagnosis and staging during video-assisted thoracoscopy was examined. DESIGN: Prospective, single-center study. SETTING: National cancer center. PATIENTS: Twenty-six patients with nonconclusive pleural effusions who were scheduled for video-assisted thoracoscopy. INTERVENTION: Eligible patients were administered 1,500 to 2,500 mg po of 5-ALA before video-assisted thoracoscopy. After conventional inspection with white light, fluorescence inspection of the pleural cavity was performed (D-LIGHT Auto Fluorescent System; Karl Storz; Tuttlingen, Germany). Biopsy specimens of both normal and abnormal sites, as determined from white light and FD inspection, were obtained for histologic examination. RESULTS: One patient was ineligible, and two patients were not evaluable because of equipment failure. One postoperative death occurred due to preexisting myocardial disease. In another patient, an empyema developed; in another patient, a postoperative infection of the lung developed. Other toxicities were minimal. A definitive diagnosis was obtained in 24 of 25 cases, with malignant mesothelioma in 15 cases, other malignancies in 5 cases, one infection, and three benign diseases. Upstaging occurred in four patients (unsuspected tumor deposits) due to FD examination. In 23 patients, a total of 111 biopsy specimens could be analyzed. When correct findings of white light and FD were compared, FD had an additional value in 21 of 111 biopsies, compared to white light with 16 of 111 biopsies. CONCLUSIONS: FD using 5-ALA in the pleural cavity is feasible with limited side effects when used in addition to white light inspection. It improved visualization of abnormal lesions and led to upstaging in 4 of 15 mesothelioma patients.

Adult↗
PubMed1993

Localization of peripheral pulmonary nodules for thoracoscopic excision: value of CT-guided wire placement.

OBJECTIVE: One of the indications for the rapidly expanding use of thoracoscopic surgery as an alternative to thoracotomy is the excision of peripheral lung nodules. Nodules judged too small or too far from the pleural surface to be seen or palpated during thoracoscopy must be localized beforehand. The purpose of this study was to evaluate the feasibility and effectiveness of percutaneous placement of spring hookwires to localize such nodules before video-assisted thoracoscopy. SUBJECTS AND METHODS: Under CT guidance, 17 nodules in 14 patients were preoperatively localized with the Kopans breast lesion localization system. Three patients who had solitary nodules had thoracoscopic resections for diagnosis because a previous transthoracic needle or transbronchial biopsy had been unsuccessful. Four patients who had lesions less than 8 mm in diameter had thoracoscopic biopsies because transthoracic fine-needle aspiration biopsy was not likely to be diagnostic. Seven patients, who had a total of 10 nodules, had therapeutic wedge resections of either limited metastases or a second bronchogenic carcinoma. Mean nodule diameter was 10 mm (range, 3-20 mm). The mean distance from nodule to costal pleura was 9 mm (range, 0-25 mm). At the end of the procedure, wire placement was confirmed by CT scanning. After thoracoscopy, the surgeons were questioned about the stability and utility of each hookwire localization. RESULTS: In all 17 procedures, a hookwire was placed successfully. In one case, the wire dislodged before thoracoscopy (after a 6-hr preoperative delay and severe bending of the wire during induction of anesthesia). In 16 of the 17 resections, the surgeon thought that thoracoscopic identification of the lesion would not have been possible without hookwire localization. Only one localization, across a major fissure, required placement of a second wire to localize a nodule. Wire-related complications included two instances of serious pain, five cases of clinically insignificant pneumothorax, and one large pneumothorax requiring drainage before a second nodule in the same lung was localized. CT scanning showed presumed local pulmonary hemorrhage in six cases without hemoptysis or hemothorax. CONCLUSION: CT-guided hookwire localization is easily and safely performed and permits thoracoscopic resection of lung nodules, which might otherwise be impossible.

Adult↗
PubMed2000

Thoracoscopic surgery: historical perspectives.

Recent technical advances have revolutionized the fields of surgical endoscopy, laparoscopy, thoracoscopy, and microsurgical spinal endoscopy. The authors discuss the rich history and recent evolution of these techniques. Thoracoscopy had been widely used for the treatment of pleural conditions associated with tuberculosis. It was largely abandoned in the 1950s when effective antituberculosis medications were introduced. In the 1980s the development of video-assisted endoscopic procedures in the fields of general surgery, orthopedics, and otolaryngology provided new impetus to revive thoracoscopy. As a result of these advances thoracoscopy replaced open thoracotomy in many cardiothoracic procedures. These improvements led to the application of these techniques to treat disorders of the spine. By the mid-1990s microsurgical endoscopy was being used effectively to treat thoracic disc disease, perform anterior surgical release procedures for scoliosis, resect tumors, and even to conduct complex spinal fusions and reconstructions. As technology continues to improve, there is no doubt that thoracoscopic surgery will find a permanent place in the armamentarium of techniques used to treat pathological entities of the spine.

Animals↗
PubMed2001

[The value of medical thorascopy].

OBJECTIVE: To study the practicality and feasibility for a physician to diagnose and treat pleural diseases through thoracoscopy. METHODS: To perform open thoracoscopy on 345 patients with a fibrobronchoscope or a hard thoracoscope under local anesthesia and evaluate the safety and tolerance of patients during the operation. RESULTS: (1) Determination of etiology: in 92.7% (227/245 cases) of pleural effusion cases, 75.0% (69/92) of pneumothorax cases, etiologic causes have been determined and 8 cases of pleural tumors were diagnosed. (2) Therapeutic effectiveness: the response rate of malignant pleural effusions was 78.4% (80/102 cases), the cure rate of pneumothorax was 81.5% (75/92 cases) and for empyema, the cure rate was 92.9% (26/28 cases). (3) SAFETY: during operation the ECG, SaO(2), BP, R, P of 98 patients did not show important changes. In 345 patients, 4.3% (15/345) complained a fransceis cheot stiffin. 7% (24/345) showed sinus tachycardia. CONCLUSIONS: (1) Through thoracoscopy, we can observe the whole pleural cavity and can take biopsy specimen under direct observation. It is a good method to get the etiological diagnosis in cause-underdetermined pleural diseases. (2) It is effective and practical to treat difficult pleural effusion, the obstinate pneumothorax, or one that is not suitable for thoracic surgery. (3) It is safe and simple to apply the thoracoscopy under local anesthesia.

Adolescent↗
PubMedDate not supplied

[Evaluation of the use of bovine pericardium in non-anatomical lung resections in dogs].

UNLABELLED: In this study we assessed the usefulness, healing, as well as the integration to lung tissue of glutaraldehyde preserved at 0.5% bovine pericardium GPBP and lyophilized (GPBPL), after reinforced resection of lung tissue in dogs by thoracotomy or thoracoscopy. MATERIAL AND METHODS: GPBP and GPBPL were prepared and used to reinforce the suture line of lung resection in 30 mongrel dogs: Group I (n = 6): The GPBP were fixed on the lung with 4-0 polypropylene by thoracotomy. Group II (n = 6): The resection and fixed of the GPBP were performed with an linear stapler by thoracotomy. Group III (n = 6): The resection and fixed of the GPBPL were performed with an linear stapler by thoracotomy. Group IV (n = 6): The resection and fixed of the GPBP strips were performed with a linear stapler by thoracoscopy. Group V: The resection and fixed of the GPBPL strips were performed with a linear stapler by thoracoscopy. Clinico-radiological evaluation was done until euthanasia of all animals at week 8 postop. Progressive insufflation up to 40 cm H2O of airway pressure was done to evaluated resistance of the heal in the suture line reinforced. Macroscopic, and microscopic examination of the GPBP, GPBPL and lung were evaluated. RESULTS: All animals survived the surgical procedure and study time (8 weeks). No airleaks were evident at any time during the study including the insufflation test. Macroscopic examination of the GPBP and GPBPL showed good adaptation to the lung tissue. Microscopically all animals presented good healing with deposition of fibrotic tissue layer on the GPBP and GPBPL. CONCLUSION: GPBP and GPBPL are an adequate materials to reinforce lung staple line, when resection of lung tissue was performed in dogs by thoracotomy or thoracoscopy.

Airway Resistance↗
PubMed1985

[Yield of the thoracoscopic biopsy in experimental pulmonary infections in the immunosuppressed rabbit].

Using thoracoscopy lung biopsy we investigated the bacteriological diagnostic yield in immunodepressed and/or infected NZ rabbits. 84 rabbits were used: 18 controls, 30 immunodepressed rabbits and 36 rabbits immunodepressed and then infected with Aspergillus fumigatus. Candida albicans or B.C.G. The thoracoscopy technique was the one we designed for humans, the instruments were adapted to the size of animals. Thoracoscopy biopsy results were compared to those of surgical biopsies made in the same animals. The results of both techniques were similar: indeed, the sensitivity of thoracoscopy biopsy was 88.9% in immunodepressed rabbits (versus 100% with surgical biopsies), 86% in the group of rabbits infected with B.C.G. (versus 86%), 90.1% in rabbits infected with Aspergillus fumigatus (versus 100%) and 88.9% in rabbits infected with Candida albicans (versus 100%). The indications for thoracoscopic lung biopsy in immunodepressed patients with infectious lung diseases are drawn from these experimental data, from our experience and the known mortality and morbidity of surgical lung biopsy.

Animals↗
PubMed1994

Video assisted thoracic surgery: our experience with 102 patients.

UNLABELLED: Recent advances in optics, video systems and endoscopic operating instruments have made thoracoscopy easier and more accurate. From May 1992 until December 1993 we performed 102 Video Assisted Thoracic Surgical Procedure (VATS) for diagnosis and treatment. Twenty patients underwent thoracoscopy, twelve had pleurodesis. Seventy operative thoracoscopies included pulmonary wedge resection, dorsal sympathectomy, management of empyema, pleural tumor, bullectomy, pericardial window, anterior release for kyphoscoliosis and resection of posterior mediastinal cyst. In most cases of parenchyma resection, it was necessary to use three ports: one for video-endoscopy and two for preparation instruments and stapler. The average operation time was 58 minutes and average hospital stay was 3.5 days. Four patients died within 30 days after the procedure due to multi-organ failure, end-stage malignant disease and post pneumonectomy pulmonary edema, unrelated to the VATS itself. One patient had thoracotomy due to uncontrolled bleeding. No wound infection or other postoperative complication except intercostal neuralgia after dorsal sympathectomy was noticed. Localization of the target lesion deep within the parenchyma of the lung still poses a problem. We used a small incision (2 cm long), placing a finger to directly palpate the lung and locate the lesion, or made a mini thoracotomy. Conversion to thoracotomy was performed when malignancy was demonstrated at frozen section. CONCLUSIONS: 1) Thoracoscopy is a minimally invasive surgical technique causing a low morbidity rate and attaining a high diagnostic accuracy. 2) Postoperative recovery is brief and uneventful. New techniques of imaging are needed to locate the target lesion.

Adolescent↗
PubMed1993

[Malignant mesothelioma: study of prognostic factors in a series of 188 cases].

From 1973 to 1990, 188 patients with pleural malignant mesothelioma entered a prospective study of this disease to assess the main prognostic factors. All had undergone thoracoscopy with endoscopic description of lesions, and multiple biopsies. The diagnostic yield of thoracoscopy was 98.4%. Multivariate analysis of main clinical, histopathological, endoscopic and radiological (including CT-scan) parameters was performed according to Cox's model. The most favorable factors were: absence of weight loss at the time of diagnosis, absence of involvement of the visceral pleural, Butchart stage I and epithelial histopathological type. Thoracoscopy allowed early diagnosis of the disease and a subdivision of Butchart stage I into stage IA (with normal visceral pleura) and stage IB (with invaded visceral pleural): median survivals are 32.7 and 7 months respectively. Like CT scan, thoracoscopy is therefore necessary in the staging of malignant mesothelioma.

Adult↗
PubMed1997

[Evaluation of intrapulmonary nodules by thoracoscopic ultrasonography].

We evaluated the usefulness of thoracoscopic ultrasonography for diagnosing intrapulmonary nodules. We studied 7 patients undergoing thoracoscopic operations. Three had benign lung tumors, one had metastatic lung tumors from a renal cell cancer, and three had primary lung cancers. During thoracoscopy three benign tumors were seen as masses protruding from the visceral pleura in to the pleural space, and two primary lung cancers were seen as pleural indentations. However, the presence of one metastatic lung tumor and one primary lung cancer could not be confirmed by thoracoscopy because of the lack of pleural changes. Furthermore, intrapulmonary spread of malignant tumors in four cases could not be seen by thoracoscopy. All tumors were seen clearly and their characteristics were identified by thoracoscopic ultrasonography. Partial lung resection during thoracoscopy was successful in all patients. We found thoracoscopic ultrasonography to be useful for confirming the presence of peripheral solid nodules, and for deciding where to make incisions for partial lung resection.

Adult↗
PubMed2006

Thoracoscopic palliative treatment of malignant pleural effusions: results in 273 patients.

BACKGROUND: The aim of this study was to analyze the results of pleurodesis for malignant pleural effusion performed by surgeons. PATIENTS AND METHODS: A series of 273 patients with malignant pleural effusion underwent thoracoscopy with the aim of performing a palliative pleurodesis. There were 94 males (34.4%) and 175 females (64.1%), ranging in age from 15 to 94 years (mean age: 60.6 years). The effusion was on the right side in 136 patients (49.8%), on the left side in 110 (40.3%), and bilateral in 27 (9.9%). Thoracoscopy was performed under general anaesthesia in all patients. Pleural biopsy was performed in two thirds of the patients (70.7%). Pleurodesis was produced by instillation of 5g of sterile asbestos-free talc; the chest tube was left in place a minimum of 3 days. It was removed when fluid drainage was less than 200 ml/24 h. Patients were usually discharged the day after chest tube removal. RESULTS: There was no intraoperative mortality. Two patients (0.7%) had intraoperative complications; 17 (6.2%) underwent a bilateral pleurodesis, and 10 (3.7%) had a pericardiopleural window. In 32 patients (11.7%) no pleurodesis was done, either because the lung did not properly re-expand (5.2%), or because of suspected infection, e.g., false membranes (1.9%), or because of multiple adhesions (4.6%). Finally, only 241 patients (88.3%) had a talc poudrage at the time of thoracoscopy. Duration of postoperative pleural drainage ranged between 1 and 11 days (mean: 3.64 days). The postoperative hospital stay ranged from 2 to 21 days (mean: 7.1 days). Pleural empyema occurred in 4 patients (1.5%) and was lethal in one patient. The mean follow-up period was 8.39 (7.2 months, and 172 patients had regular follow up. In this group, there were 24 recurrences (14%), 12 of which were treated by repeat pleurodesis. The results were very good in 133 patients (77.3%), acceptable in 35 patients (20.3%), and there was a failure in 4 patients (2.4%). CONCLUSIONS: Results of surgical thoracoscopy for malignant pleural effusion are good, with low morbidity. However, in debilitated patients, bedside talc slurry may be preferable.

Adolescent↗
PubMed1992

Long-term results after tetracycline pleurodesis in spontaneous pneumothorax.

From 1979 to 1988 483 patients were admitted with primary spontaneous pneumothorax. All patients underwent thoracoscopy to identify the cause of pneumothorax. Chemical pleurodesis with instillation of tetracycline was performed if cysts less than 2 cm in diameter were found. If larger cysts were identified the patient underwent thoracotomy. In 93 patients with cysts larger than 2 cm the recurrence rate after thoracotomy was 4%. In 390 patients treated with intrapleural instillation of tetracycline, the recurrence rate was 16%. Fifty percent of the recurrences occurred within 30 days. The cause of recurrence in 42 patients (69%) was cysts missed at the initial thoracoscopy. This study has demonstrated that thoracoscopy is a reliable and safe method for selection of patients for chemical pleurodesis. It is, however, necessary that the thoracoscopy is meticulous to avoid recurrence from missed cysts.

Adolescent↗
PubMed2005

Comparative study of subxiphoid versus video-thoracoscopic pericardial "window".

BACKGROUND: It remains undefined whether surgical subxiphoid drainage or thoracoscopic pericardial "window" is the optimal operative approach to pericardial effusion. We hypothesized that the true window into the pleural space created by the latter might improve the duration of freedom from recurrent effusion. METHODS: We conducted a retrospective chart review of indications, preoperative and intraoperative variables, morbidity, recurrence, and survival. RESULTS: Fifty-six patients underwent the subxiphoid procedure and 15 underwent the thoracoscopic procedure. Echocardiographic evidence of tamponade was present before 8 of 10 thoracoscopic procedures (80%) and 43 of 56 subxiphoid procedures (81%) for which descriptions of hemodynamics were available. In addition, non-pericardial procedures were performed in 10 (67%) and 18 (32%) patients, respectively (p = 0.020). Anesthesia time was longer at thoracoscopy (117.1 +/- 32.4 vs 81.1 +/- 25.5 minutes; p < 0.001). Procedural morbidity was higher after thoracoscopy (4 [27%] vs 1 [2%]; p = 0.006), but was generally minor. Hospital mortality tended to be higher after the subxiphoid procedure (7 [13%] vs 0 [0%]; p = 0.332), but none of the deaths was procedure-related. Follow-up was complete for 65 patients (92%). Recurrence occurred in 1 thoracoscopy patient (8%) and 5 subxiphoid patients (10%) (p = 1.000). Mean time to recurrence by Kaplan-Meier analysis trends were longer after thoracoscopy (36.1 vs 11.4 months; p = 0.16), and multivariate analysis identified the thoracoscopic approach as an independent predictor of freedom from recurrence (relative risk, 0.41; p = 0.014). CONCLUSIONS: Operative time and minor procedural morbidity are higher with thoracoscopic pericardial window, but long-term control of effusion seemed to be better than after subxiphoid surgical drainage.

Female↗
PubMed2007

Minimal access thoracic surgery in the pediatric population.

Thoracoscopy was initially described for use in children to obtain pulmonary biopsy samples in the immunocompromised patient. With refinements in technique, development of better instrumentation, and advances in pediatric anesthesia, there are now many diagnostic and therapeutic indications for the use of thoracoscopy in children. One of the most common indications includes pleural debridement for empyema. Many centers consider this the optimal approach for biopsy of mediastinal lesions and excision of bronchogenic or duplication cysts. The technique is useful for pleural disorders, such as spontaneous pneumothorax and chylothorax. Thoracoscopy has been used to achieve exposure for spinal diskectomy in children with thoracic scoliosis, and newer techniques are being developed in performing anatomic lobectomies, repair of esophageal atesias, and closure of diaphragmatic hernias. The role of the robot in pediatric thoracoscopy is still in the early stages of definition.

Anesthesia, Closed-Circuit↗