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At least 955 records · Page 53Linked to original sources
PubMed1994

Single-lumen endotracheal intubated anaesthesia for thoracoscopic sympathectomy--experience of 719 cases.

A total of 719 thoracoscopic sympathicotomies were performed at our hospital from October, 1989 to December, 1992. We have been practicing single-lumen endotracheal intubation for general anaesthesia in all of our cases. We will review our experience and discuss our anaesthetic technique and the intraoperative complications encountered as well as post-operative pain control. General anaesthesia with controlled manual ventilation assisted the surgeon well and created clear access for electro-cauterisation of the sympathetic chain. Thirty patients were randomly chosen for arterial blood gas analysis. There was no evidence of systemic hypoxaemia or clinically significant carbon dioxide retention throughout the surgery or afterwards in the recovery room. In our experience of 719 cases, single-lumen endotracheal intubated anaesthesia is safe and economic for thoracoscopic sympathicotomy.

Adolescent↗
PubMed1994

Total intravenous anaesthesia with single-lumen endotracheal intubation for thoracoscopic sympathectomy.

The aim of this paper was to discuss the stress applied to the circulatory and respiratory systems by the combination of general anaesthesia and thoracoscopic sympathectomy and to show the benefits of an intravenous anaesthetic technique together with a single-lumen endotracheal tube as a safe method of anaesthesia for this procedure. In a retrospective study, 125 cases of thoracoscopic sympathectomy were reviewed. The anaesthesia was a totally intravenous technique with propofol, alfentanil, and atracurium and a gas mixture of 40% oxygen in air. The degree of hypoxaemia during inflation of carbon dioxide into the thorax was assessed. The results showed that hypoxaemia caused no problems in any of the patients. Three patients with severe angina pectoris were also studied using the same anaesthetic technique and they showed marked haemodynamic instability throughout the procedure requiring inotropic support. Haemodynamic values obtained through a Swan-Ganz catheter in one patient showed marked changes during the procedure, but values returned to normal after the operation. Although these patients were haemodynamically unstable there was no problem with hypoxaemia.

Alfentanil↗
PubMed1994

Bilateral thoracoscopic lower sympathetic-splanchnicectomy for upper abdominal cancer pain.

Upper abdominal pain secondary to cancer may cause great disability to patients. Surgical sympathetic-splanchnicectomy, or coeliac plexus block, has been used to relieve intractable upper abdominal cancer pain from stomach, liver, gallbladder or pancreas for a long time. There are, however, intrinsic disadvantages when performing these procedures. Due to our long experience of therapeutic thoracoscopy, we recently performed bilateral thoracoscopic sympathetic-splanchnicectomy on 14 patients (eight male and six female) for relief of pain from primary or metastatic upper abdominal cancers. Most of them were satisfied with the immediate pain relief after the operation. In this new era of therapeutic endoscopy, endoscopic surgery will gradually take the place of open methods in treatment of many diseases. It can be anticipated that thoracoscopic lower sympathetic-splanchnicectomy is undoubtedly a good alternative method for management of intractable upper abdominal pain.

Abdominal Pain↗
PubMed1994

Thoracoscopically assisted esophagectomy with gastric pull-up for esophageal cancer.

Thoracoscopically assisted esophagectomy with gastric pull-up was done in a 56-year-old man with esophageal cancer. The thoracoscopic technique, including the use of intraoperative ultrasound, is discussed. The addition of thoracoscopy offers safer and more complete esophageal dissection than transhiatal blunt esophagectomy and is less invasive than conventional thoracotomy.

Adenocarcinoma↗
PubMed1995

[A case of bilateral thoracoscopic partial resection for unilateral spontaneous pneumothorax].

There is a high incidence of pneumothorax on the contralateral side in patients with unilateral spontaneous pneumothorax. This is because bullae and blebs of the lungs, the cause of this condition, are frequently present bilaterally. Recently, thoracoscopic partial lung resection has become more common and has been proven to have advantages such as less bleeding, less pain and a smaller skin incision. In view of the common occurrence of contralateral pneumothorax, bilateral simultaneous thoracoscopic partial lung resection for unilateral spontaneous pneumothorax is recommended for patients in their teens and twenties who have contralateral bullae and blebs.

Adolescent↗
PubMed1995

Laparoscopic and thoracoscopic antireflux surgery.

Despite new effective drugs, like omeprazole, reducing gastric acid output and relieving gastro-oesophageal reflux disease (GERD) symptoms in most patients, there are still clear indications for surgical treatment of this chronic disease. The main indications are failure to control symptoms by medical treatment, noncompliance to medication and development of complications. Recent developments in minimal access surgery have modified the surgical approach to the treatment of GERD. The antireflux surgical procedures can be endoscopically performed reproducing all the essential component steps of the equivalent open operations, but with all the advantages of minimal access surgery. The fundoplication procedures are mainly performed laparoscopically and the thoracoscopic approach is chosen in patients with short oesophagus, morbid obesity or other contraindications to the laparoscopic approach. The short-term results of endoscopic antireflux surgery are at least as good than after open surgery. A review on the laparoscopic and thoracoscopic antireflux procedures is presented.

Endoscopy↗
PubMed1995

Thoracoscopic Heller's myotomy. Treatment of achalasia by the videoendoscopic approach.

In summary, the authors believe that minimally invasive surgery has added a new dimension to the treatment of achalasia. Thoracoscopic myotomy is feasible, safe, and effective in relieving dysphagia in the great majority of individuals affected with this disease without the many problems associated with dilatation; thus, the authors offer it to patients with achalasia as the initial and preferred form of treatment. Whether an antireflux procedure should be routinely added and whether a laparoscopic rather than a thoracoscopic approach is preferred, remains unanswered questions at this time.

Cardia↗
PubMed1995

[Anesthesia for thoracoscopic laser ablation of bullae in a patient with severe bullous emphysema].

A 46-year-old male underwent laser-ablation of emphysematous bullae of the right lung via thoracoscope. For almost a year he had been bedridden because of severe dyspnea on exertion, in spite of medication and oxygen therapy. He also complained of orthopnea at rest and had suffered from body weight loss of 10 kg during the preceding year. Radiologic examination revealed emphysemotous lung with bilateral giant bullae. In spirogram, forced vital capacity in 1 second was markedly low (0.45 l, corresponding to 19% in %FVC1.0), vital capacity moderately depressed (2.41 l, 64%) and residual volume markedly elevated (5.85 l, 387%). Anesthesia was induced and maintained using the combination of thoracic-epidural anesthesia and intravenous anesthesia (midazolam and fentanyl). One lung ventilation (OLV) was used to facilitate thoracoscopic procedure. Mechanical ventilation was conducted at first with an anesthesia ventilator. As the duration of OLV was prolonged, however, the peak airway pressure increased, the tidal volume decreased and the value of percutaneous arterial hemoglobin saturation (SpO2) declined. In order to keep adequate oxygenation, brief periods of two lung ventilation (TLV) became necessary, in addition to the application of continuous positive airway pressure to the non-dependent lung. When ventilation was changed from volume-cycled ventilation to pressure-cycled and from using an anesthesia ventilator to a critical care type ventilator (Servo 900C), sufficient tidal volume was achieved with lower peak airway pressure, producing reasonable Spo2 value with much less frequent TLV. At the end of the surgery bronchopleural fistulae still persisted, with resultant air leak of about 50% of inspired tidal volume.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Epidural↗
PubMed1995

[Thoracoscopic enucleation of leiomyoma of the esophagus--report of two cases].

Thoracoscopic enucleation of leiomyoma of the esophagus was successfully performed in two cases. This paper mainly describes a 53-year-old man who experienced with a slight dysphagia and retrosternal discomfort when moving. Esophagoscopy showed a mass beneath normal mucosa located at 26 cm from the incisor of the left anterior esophagus. Endoscopic ultrasonography showed a sharply delineated low echoic mass with regular echo-pattern, measuring 4 cm along the axis. The lesion was diagnosed as leiomyoma. The operation was performed under general anesthesia, keeping the patient on the left postero-lateral position. A double-lumen endotracheal tube was utilized and the right lung was collapsed. Six trocars were inserted through right intercostal spaces for operation. The azygos vein first of all was dissected and divided by an EndoGIA. The esophagus was then mobilized lengthwise enough to rotate the left side to the right with two slings traction for better visualization of the lesion site. Intraluminal balloon-mounted esophagoscope was useful enough to expose the tumor inner side out of the esophageal wall and the tumor was easily enucleated. After resection, intact esophageal mucosa was confirmed by endoscopy and the proper muscle layer of the esophagus was closed with 2-0 Vicryl. In the 2nd case, leiomyoma located at 32 cm from the incisor of the right esophageal wall, 4 x 1.5 x 1 cm in size, was removed by the same technique using five trocars, where neither the azygos vein divided nor the esophagus mobilized. Both patients showed uneventful recovery and the symptoms disappeared after operation. Intraluminal balloon-mounted esophagoscope was useful to do this kind of thoracoscopic procedure.

Adult↗
PubMed1995

[Thoracoscopic treatment of a giant bulla: a case report].

A 38-year-old man was admitted to our hospital because of left giant bulla and pneumothorax. His chest X-rays and CT scan showed giant bulla of the left upper lobe and left pneumothorax. We performed bullectomy using the ENDOPATH ENDO LINEAR CUTTER 60 mm and 35 mm disporsable surgical stapler under thoracoscopic guidance. Clipping with end-clips and fibrin glue were effective for miner air leakage. There were no complications such as prolonged air leakage or incomplete lung re-expansion. His post operative couse was uneventful and he was discharged from the hospital on the 11th post operative day. When performed along with mini-thoracotomy, thoracoscopic operation is useful in treating patients with giant bulla.

Adult↗
PubMed1994

Treatment of bleeding peptic ulcer by bilateral truncal vagotomy via a transpleural thoracoscopic approach and laparoscopic pyloromyotomy.

Six cases of recurrent bleeding duodenal ulcer were treated by bilateral truncal vagotomy via a right transpleural thoracoscopic approach and laparoscopic pyloromyotomy at Tainan Municipal Hospital. The vagus nerves were completely transected, which was proved by pathology. Basal acid output and insulin-stimulated maximum acid output were reduced by 68%-77% and 87%-92%, respectively, after vagotomy. On the other hand, there was no delay in gastric emptying on the basis of either patients' complaints or an upper gastrointestinal series of x-rays. Transpleural thoracoscopic bilateral truncal vagotomy and laparoscopic pyloromyotomy are safe, effective and offer more complete transection of the vagus nerves in treatment of complicated peptic ulcer. In addition, this new technique provides shorter hospitalization and an earlier convalescence.

Adult↗
PubMed1994

[Clinical application of thoracoscopic surgery: a report of 19 cases].

Nineteen cases (14 males and 5 females) had been operated with thoracoscopic surgery. Ten cases of spontaneous pneumothorax and 1 spontaneous hemopneumothorax had been underwent thoracoscopic bullous or bleb resections by Endo-GIA 30 or 60. Four cases of plural effusion including primary and secondary malignancies were performed to be pleurodesis by talc sclerosis. Among 4 cases of lung mass, 3 were operated by wedge resection. Lobectomy was performed by VATS in one case with primary lung cancer (T1N0). VATS were satisfactory by using the 3 small incisions giving the advantage of rapid and complete recovery without any obvious complications. Even no any secondary pneumonia. So far the VATS is not fully accepted in China due to the cost of the disposable instruments.

Adolescent↗
PubMed1994

[Occlusion with interrupted titanium clips for ruptured bullae under video-assisted thoracoscopic surgery].

Spontaneous pneumothorax is a common disease and as many as 20% of these patients should be operated because of a recurrent pneumothorax, persistent air leak, or failure to completely reexpand the lung. From January 1993 until March 1994, on the basis of experiment, we performed video-assisted thoracoscopic surgery (VATS) intervention and talc pleurodesis on 8 patients with spontaneous pneumothorax caused by ruptured bullae, and designed a new procedure of occluding the bullae with interruptured titanium clips. This procedure has some advantages of complete occlusion of lung tissue at the base of the bulla, minimal loss of lung tissue, effectively preventing leakage and recurrent pneumothoraces, and enough capacity of anti-tension while the lung expands. Also Authors have advocated giving a negative pressure suction to opsilateral lumen of the Carlen's tube interbation to visualize adequately the intrathoracic structures, while selective lung ventilation is performed. This method keeps hemodynamic stability and is performed more easily and safely than that of positive pressure insufflation is done. Postoperatively, complete lung expansion was obtained in all patients. There were no perioperative complications related to VATS, and no recurrences to date. These early results with thoracoscopic management of spontaneous pneumothorax caused by ruptured bullae have encouraging.

Adult↗
PubMed1994

[Thoracoscopic approach of pericardial effusion].

We report the technique of pericardial approach through the thoracoscope. This approach has several advantages. Extensive pericardial fenestration can be performed as well as pericardoscopy whenever indicated and additional biopsies such as mediastinal or lung parenchyma biopsies. Among the 12 patients operated on, the procedure was possible in all but one case. When there is no contraindication to selective tracheal intubation or lateral positioning, the thoracoscopic approach is the method of choice. In other cases, the subxiphoid approach remains indicated.

Acute Disease↗
PubMed1994

[Successful treatment of a giant bulla by thoracoscopic excision and laser ablation].

A 39-year-old male complaining of shortness of breath on mild exertion. Radiographs revealed that a giant bulla occupied more than half the area of the right lung field. Thoracoscopic excision of the giant bulla was performed using some autosutures. After the emphysematous lesion was consolidated by laser ablation, it was sutured using PDS thread. The bulla in the left lung was similarly excised 3 weeks after the first procedure. The FEV1.0% improved from 72% to 89% after excision and laser ablation of a giant bulla and bullae. Thoracoscopic excision and laser ablation of a giant bulla appears to be an effective alternative to conventional thoracotomy.

Adult↗
PubMed1994

[A case of esophageal cyst resected by thoracoscopic surgery].

A 59-year-old woman was admitted with back pain and an abnormal chest shadow in the left hilar region. Her chest CT scan showed a posterior mediastinal mass surrounding the descending aorta. By transesophageal ultrasonography, a diagnosis of mediastinal cyst was made. She underwent thoracoscopic resection under general anesthesia with new endoscopic devices including endo-scissors, endoscopic hemoclips and electrocautery. Pathologically, the tumor was an esophageal cyst lined by ciliated columnar and squamous epithelium overlying smooth muscle layers. She made an uneventful recovery. Her back pain subsided following the operation. Thoracoscopic resection is a useful technique for patients with mediastinal cystic tumor.

Esophageal Cyst↗
PubMed1994

Thoracoscopic management of spontaneous pneumothorax allows prompt return to aviation duties.

Primary spontaneous pneumothorax, a disease of young adults, is occasionally encountered in aviation personnel. Surgical intervention is often recommended after the first episode for those patients involved in aviation or diving duties due to the increased risk of recurrence secondary to barotrauma. Thoracoscopic surgery can be used effectively to resect the causative blebs or bullae and to perform a mechanical pleurodeisis. When compared to the traditional open technique, post-operative recovery time is less with this approach and allows more rapid return to aviation duties. Thoracoscopic surgery should be considered in all cases of spontaneous pneumothorax encountered in aviators.

Adult↗
PubMed1995

[Therapy of acute empyema thoracis using thoracoscopic instruments].

Adequate pleural drainage is imperative for the treatment of acute empyema thoracis. But chest tube drainage sometimes cannot operate effectively if blocked by intrathoracic loculations. We successfully treated two cases of acute empyema thoracis using thoracoscopy. These patients had both undergone closed intercostal drainage, but the drains had not worked effectually. We performed thoracoscopy under local anesthesia. Loculations were broken by the thoracoscopic instruments. After pleural irrigation, chest tubes were properly positioned under thoracoscopy. It seems likely that thoracoscopic procedures may be useful in shortening the length of hospitalization and in improving lung re-expansion of acute empyema thoracis patients.

Acute Disease↗