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PubMed2006

Thoracoscopic findings and surgical management of catamenial hemopneumothorax.

A 43-year-old woman had experienced recurrent right pneumothoraces at the beginning of her menstrual period. Thoracoscopically, multiple small fenestrations were widely found over the tendinous part of the diaphragm. Multiple purple colored nodules were seen on the visceral surface of upper lobe containing intralobar lesions, and about 100 ml blood was pooled in the thoracic space. We performed a video-assisted thoracoscopic resection of the pleural nodule suspected to be the cause of the hemothoraces. Histologically, the resected nodule had intra-alveolar hemorrhage not seen in common endometriosis. Pleurodesis with mechanical abrasion of parietal pleura and the diaphragm was performed. Chemical pleurodesis, with minocycline hydrochloride and distilled water was applied.

Adult↗
PubMed2006

[Thoracoscopic removal of bronchogenic cyst of the posterior mediastinum; report of a case].

A 15-year-old female was admitted to our hospital with an abnormal chest X-ray shadow in the left posterior mediastinum found at health screening. Magnetic resonance imaging (MRI) suggested that the cystic lesion contained a viscous liquid. The lesion was removed using a thoracoscope and diagnosed as bronchogenic cyst. Postoperative pathological evaluation was consistent with the initial diagnosis of bronchogenic cyst. This case illustrates the usefulness of thoracoscopic surgery for diagnosis and extirpation of bronchogenic cyst.

Adolescent↗
PubMed2006

[Comparative study of video-assisted thoracoscopic surgery vs thoracic tube drainage in synthetic therapy for malignant pleural effusion secondary to non-small cell lung cancer].

OBJECTIVE: To study the value of video-assisted thoracoscopic surgery (VATS) and identify its indications in synthetic therapy for malignant pleural effusion secondary to non-small cell lung cancer. METHODS: A prospective randomized single-blinded controlled clinical trial was conducted. Fifty-three patients with moderate or large amount of ipsilateral malignant pleural effusion (MPE) secondary to non-small cell lung cancer (NSCLC) were randomly divided into VATS group and tube drainage group (TD group). All patients received chemotherapy with the regimen of paclitaxel combined with paraplatin, and the response rate of MPE after therapy, difference of Karnofsky performance status (KPS) grades before and after therapy and the survival rate of the patients were compared. RESULTS: The response rate of MPE after therapy in VATS group and TD group was 92.3% and 59.3%, and the complete remission rate was 88.5% and 44.4% (P<0.05), respectively. The difference of KPS grades before and after therapy in VATS group and TD group were 30 and 20, with a mean of 33.5-/+11.3 and 24.07-/+10.5 (P<0.05), respectively. Till August of 2005 years, all patients were available for followed-up, whose median survival time was 20 months in VATS group and 15 months in TD group. The 1-, 2- and 3-year survival rate were 65.4%, 38.5% and 22.4% in VATS group and 59.3%, 25.9% and 14.8% in TD group (P>0.05), respectively. CONCLUSION: Video-assisted thoracoscopic pleurectomy can effectively control MPE and improve the quality of life for NSCLC patients with MPE, but failed to significantly improve the patients' survival rate in comparison with tube drainage. Except for grade IV, grades I, II and III according to CT findings all can be indications of VATS.

Aged↗
PubMedDate not supplied

Percutaneous localization of pulmonary nodules prior to thoracoscopic surgery by CT-guided hook-wire.

BACKGROUND: When performing thoracoscopic surgery in patients with small pulmonary nodules, intraoperative localization can be difficult and time-consuming. The percutaneous localization of suspicious intrapulmonary lesions was evaluated pre-operatively to facilitate the resection of the lesion and to avoid thoracotomy. MATERIALS AND METHODS: Thoracoscopies were performed in 13 patients with intrapulmonary nodules previously localized by CT-scan and flagged percutaneously with a hook-wire. Immediately after the procedure, the patient was transferred to the operating room and thoracoscopic pulmonary wedge resection was performed. RESULTS: All the nodules were properly identified. The time to position the wire was 20-30 min and thoracotomy could be avoided in all patients. The nodules were 0.5 cm - 6 cm in size and situated 1 cm - 4 cm subpleurally. CONCLUSION: Guide-wire identification of an intrapulmonary nodule is a safe, elegant, time-saving and reliable method. The lack of manual examination of pulmonary parenchyma in thoracoscopy is compensated for by precise pre-operative localization.

Adult↗
PubMed2006

[Thoracoscopic surgery for pneumothorax].

It is difficult to tell clearly what a therapy for pneumothorax is because it is not enough just to cut away the bullae. The patients should be treated mentally, physically and less invasively. The 4 anxieties should be solved for pneumothorax patients. Four anxieties for symptom, the normal side of lung, the effect after therapy and surgery. In thoracoscopic surgery on pneumothorax, to cut away just the bullous change does not mean to prevent the postoperative recurrence. Added treatments need beside resection of bullae because bullae often tend to regenerate near the suture line soon after thoracoscopic surgery. The covering method is the most effective in some added treatments. It is a method of covering regenerative oxidized cellulose mesh and fibrin glue on the suture line. Classification of air leakage level that was designed in Pneumothorax Research Center is clinically useful. This classification forms from level 1 to 4 according to air leakage volume and pressure level. It is important to resolve the mechanism on postoperative regeneration of bullae at this point in order to ask for better surgery. Female pneumothorax and less than 15-year-old pneumothorax should be researched because they cause frequently postoperative recurrence.

Adolescent↗
PubMed2006

[Video-assisted thoracoscopic debridement for acute empyema; a low invasive surgery for acute empyema].

BACKGROUND: Recent study reported that thoracoscopic surgery for acute empyema can achieve good results. We performed video-assisted thoracoscopic debridement (VD) in cases diagnosed as having acute empyema when conservative therapies such as administration of antibiotics or continuous thoracic drainage were not successful. METHODS: Two to 4 access ports were inserted into the empyema lumen, and surgery were conducted only under monitoring vision. After removing as much pus, coating, fibrin walls and peel as possible, a chest tube was set in the lumen for drainage. Thirty cases treated in our hospital were reviewed with respect to selected parameters. RESULTS: The interval from onset to surgical treatment was 41.0 +/- 21.0 days. All cases were considered in either fibrinopurulent phase or early organizing phase. Pathogenic bacteria were identified in 8 cases. Surgical duration was 93.1 +/- 26.6 minutes. Hospitalization period was 26.3 +/- 36.4 days. Twenty-seven cases showed improvement after the first VD procedure, while 3 cases required repeat procedures. CONCLUSIONS: VD may achieve good results not only in the fiburinopulurent phase but also in the early organization phase. VD is both low invasive and highly effective for acute empyema.

Acute Disease↗
PubMedDate not supplied

[Video-assisted thoracoscopic biopsy in the diagnosis of idiopathic interstitial lung disease].

Surgical lung biopsy is indicated in the diagnosis of idiopathic interstitial lung disease in more than 30% of patients. Our study analyses the technical evolution of the surgery during recent years in our department and the results of thoracoscopic lung biopsy. We retrospectively analysed 31 consecutive patients who underwent thoracoscopic lung biopsy from Jan. 1 2000 to Dec. 31 2004; 16 were male and 15 female with a mean age of 58.17 +/- 11.84 years. From September 1991 to December 1999 we performed another 40 lung biopsies. The SPSS software package was used to process the data. All patients but one underwent bronchial lavage and transbronchial biopsy preoperatively, without obtaining a correct diagnosis. Surgical biopsy findings were diagnostic in all patients. The conversion rate to thoracotomy was 20.7%. The mean operative time was 67.9 +/- 16.7 minutes and a mean number of 2.4 +/- 0.8 wedge lung biopsies were performed. The mean chest drain duration and hospital stay were 6.0 +/- 4.7 days and 7.9 +/- 4.7 days, respectively. The perioperative minor complication rate was 6.9% and the mortality rate 0%. Our results confirm that thoracoscopy has a diagnostic accuracy of 100% with low complication and mortality rates. These results compare well with those of open lung biopsy.

Aged↗
PubMed2006

[Thoracoscopic repair of peritoneopleual communication with a giant diaphragmatic bullae in a patient with liver cirrhosis; report of a case].

Hepatic hydrothorax is defined as pleural effusion in patients with a cirrhotic liver. The pleural effusion occurs due to ascites flowing to the pleural cavity through a diaphragmatic communication. Recent literature has described the usefulness of a thoracoscopic repair and has shown that it can control pleural effusion very efficaciously. The patient was a 65-year-old woman who complained of dyspnea and was admitted to our hospital. A chest X-ray revealed marked right pleural effusion. We injected indigo carmine intraperitoneally and observed indigo carmine-colored pleural effusion; thus peritoneopleural communication was validated. After the failure of thoracic drainage and pleurodesis with minocycline hydrochloride, thoracoscopic surgery was performed 5 weeks after hospitalization. Obvious bulla formation was observed on the diaphragm, which was immediately resected with linear staplers. The postoperative course was excellent without any recurrence of pleural effusion.

Aged↗
PubMed2006

[Anesthetic management for left ventricular epicardial lead implantation with minimally invasive thoracoscopic guidance].

Medical treatment for left ventricular (LV) systolic dysfunction and congestive heart failure has improved quality of life for patients but mortality rates have remained unaffected. For a subgroup of such patients with interventricular conduction delays and ventricular contraction dyssynchrony, cardiac resynchronization by placement of a LV epicardial lead is a new approach to management. We report 3 cases in which such electrodes were implanted under the guidance of minimally invasive thoracoscopy. In the first 2 cases it was decided to place the LV electrode using thoracoscopic guidance because of complications or technical difficulties in the percutaneous procedure. In the third case thoracoscopy was used because of deterioration of the patient's condition after implantation of a double-chamber pacemaker and shifting of the lead to the right ventricle. The literature on the anesthetic management of such patients is scarce. Although sedation with general anesthesia and single-lung ventilation is indicated for percutaneous procedures, that technique also proved adequate for the thoracoscopic procedures.

Aged↗
PubMed1992

[Thoracoscopic laser coagulation shrinkage of blebs in the treatment of spontaneous pneumothorax].

As a thoracoscopic treatment for spontaneous pneumothorax, electrocautery has been mainly used. But contact type electrocautery has a risk of perforation of blebs. We adopted carbon monoxide laser (wave length 5.4 microns) and good coagulation shrinkage of blebs could be obtained by non-contact irradiation. CO laser was delivered by As-S glass fiber and power of fiber tip was 2-4 W. Compared with Nd-YAG laser (wavelength 1.06 microns), CO laser showed lower risk of perforation of blebs. Thoracoscopic CO laser coagulation shrinkage of blebs proved to be a important method of treatment for patient of spontaneous pneumothorax.

Humans↗
PubMed1990

[Experience with thoracoscopic pleurodesis in the treatment of idiopathic spontaneous pneumothorax].

Between January 1987 and December 1988 thoracoscopic pleurodesis has been used as a standard treatment for idiopathic spontaneous pneumothorax. Bullae were electrocoagulated, and visceral and parietal pleurae were cauterized. Chemical pleurodesis with 50% glucose-solution was added. 34 procedures were performed on 32 patients. The average hospital stay was 8 +/- 2 days. One patient suffered from postoperative Horner-syndrome. No other complications occurred. Patients were re-evaluated 11 +/- 8 months after the operation. Recurrence was found in four patients within 30 days. These patients underwent pleurectomy. Another patient had recurrence after two months. He was again and successfully treated by thoracoscopic pleurodesis. Our data show improvement of the results as compared with simple chemical pleurodesis.

Adolescent↗
PubMed1990

[A case of postoperative chylothorax successfully treated by thoracoscopic fibrin gluing].

Chylothorax was complicated on the 10th postoperative day in a 66-year-old male who underwent left pneumonectomy with mediastinal lymph node dissection for squamous cell carcinoma of the lung. After the leakage point was determined by lymphangiogram and CT, fibrin gluing was performed via flexible fiberoptic thoracoscope. By this procedure the chylous fistulas were completely controlled. Application of fibrin glue through thoracoscope appeared very useful for the treatment of postoperative chylothorax.

Aged↗
PubMed1985

[Results, complications and controlled after-care in thoracoscopic pleural and lung biopsy].

Report on 546 transthoracic forceps biopsies from pleura and lung, selected under thoracoscopic observation. After inducing a diagnostic pneumothorax the biopsy is performed in general anaesthesia with a forceps introduced beside the thoracoscope. In 60%, the endoscopic-bioptic examination resulted in a definitive diagnosis. In the remaining cases too, the results of biopsy were usefull for further diagnostic and clinical conclusions. The number of complications is small. Main risks are bleeding, tension pneumothorax, and cutaneous emphysema. In diseases of pleura and in cases of disseminated small-size lung processes, the method permits in a high proportion a corroborated diagnosis.

Aftercare↗
PubMed1986

[Thoracoscopic talc poudrage in pleurisies of blood diseases].

A total of 20 patients aged 50.5 +/- 4.5 years with 24 chronic pleural effusions associated with lymphomas underwent 24 thoracoscopic talc poudrages. Effusions were serofibrinous (32%), hemorrhagic (41%), or chylous (27%). The mean volume of pleural liquid evacuated by repeated thoracenteses before thoracoscopy was 5.2 +/- 0.6 l. Thoracoscopic biopsies confirmed a lymphomatous infiltration of the pleura in 95.5% of cases. A definitive pleural symphysis was obtained in all cases but 2 (92% positive results): in 1 case, a further single thoracentesis of 400 ml was necessary, and in the 2nd case the patient died within 6 days from an acute evolution of her Hodgkin's disease. The mean drainage time was 4.8 +/- 0.2 days. Overall results are thus identical to those obtained in solid tumor-related pleural effusions (91% positive results).

Adolescent↗
PubMed1981

[The metrology of mineral fibres in thoracoscopic lung and pleural biopsies. Preliminary results (author's transl)].

Metrology of mineral fibres by electron microscopy was carried out in thoracoscopy specimens ("normal" parietal pleura, pleural plaque, tumour, lung) obtained from different sites in 19 patients: 9 exposed to asbestos and 10 non-exposed controls. With regard to results concerning the parietal pleura, the differences in exposure of the patients (as revealed by history) were not reflected by metrological characteristics (nature and number of fibres, size, topographical distribution) and it was impossible to distinguish the exposed cases from the controls. The number of fibres ("non-measurable presence" being 130.10(3) fibres/g) did not differ significantly between the two "exposed" and "non-exposed" groups. By contrast, the number of fibres found in lung biopsies was in general very high in exposed patients (up to 379.10(3) fibres/g.) In 3 non-exposed patients, there was no asbestos in the lung. Broadly speaking, metrological data were similar to those previously obtained in other cases and using surgical or autopsy specimens. This reinforces the validity of the method of metrology in thoracoscopic specimens and confirms the complexity and difficulties of assessment of pleural involvement. The advantages of study of early pleural specimens obtained under thoracoscopic control in comparison with surgical or autopsy specimens remains to be determined in a larger number of cases. The safety of the method should be emphasized, no complications having been seen in this series.

Asbestos↗
PubMed1994

Thoracoscopic versus open supraclavicular upper dorsal sympathectomy: a prospective randomised trial.

The purpose of the present study was to compare the short term results of the "open" supraclavicular approach with the thoracoscopic access for T2-T4 sympathetic ganglionectomy in patients with palmar hyperhidrosis. Patients were randomly allocated into two groups of 12 each, and were operated on: one by the open supraclavicular access; the other by the transthoracoscopic approach. The effect on palmar perspiration, operative data, postoperative complications and patients's satisfaction on short term follow up were examined. All operations achieved dry hands. Only two significant differences were observed: longer anaesthesia and poorer patient satisfaction in the thoracoscopic group one week after surgery (probably because a higher proportion of cases developed prolonged postoperative chest pain). Both techniques similarly achieve dry hands. The open method is not longer or more difficult, is possibly associated with less morbidity, and gives a higher subjective satisfaction.

Adolescent↗
PubMed1994

Thoracoscopic surgery of palmar hyperhidrosis.

New thoracoscopic methods have been reported to minimise the operative trauma after surgical treatment of primary hyperhidrosis of the palms. We therefore began with this minimally invasive technique for sympathetic ablation in 1990. Our first 81 patients presented here confirm earlier results of excellent effects, few complications and mild side-effects when treating palmar hyperhidrosis with thoracoscopic sympathectomy.

Adolescent↗