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At least 973 records · Page 54Linked to original sources
PubMed1994

[Thoracoscopic treatment of mediastinal thymic cyst].

A mediastinal thymic cyst was excised under thoracoscope in a 66 year-old man. Mass lesion was noted in the left anterior mediastinum on chest X-p during a screening examination. Based on the findings of the chest CT and MRI, the mass was diagnosed as a cyst containing low fat and low protein fluid without solid tissue. This lesion was diagnosed as a mediastinal thymic cyst. Under general anesthesia, the thoracoscopy was inserted to the left thoracic cavity. Then, the cyst was resected sharply and bluntly with pair of scissors, while electric coagulation was performed as needed. In cases of mediastinal thymic cyst, it is possible to completely resect the cyst by thoracoscopic treatment, causing minimal surgical invasiveness. Considering that a few thymic cysts are combined with malignant tumor, complete resection of the lesion is required in the treatment of thymic cyst.

Aged↗
PubMed1994

[Are video-assisted thoracoscopic resections in oncological surgery defensible?].

Video-assisted thoracoscopic surgery (VATS) is not to be accepted in oncologic patients at present. Up till now, the technical facilities are not as advanced as to compete with the established procedures of conventional surgery. The thoracoscopic, more indirect surgical methods are not able to adequately adjust to the specific growth pattern and paths of metastatic spread of bronchial carcinoma. Surgery for pulmonary metastasis has to be considered under the same aspects. Preoperative staging of lung cancer and the location and number of pulmonary metastases cannot be sufficiently assessed by computed tomography. Consequently, palpation of both the inflated and deflated lung is mandatory. Oncologic surgery includes complete lymph node dissection in all compartments, which cannot be achieved by VATS at present. It is irresponsible to risk the internationally quite homogenous stage-related results obtained in bronchial carcinoma for the sake of some new technical equipment. In surgery for lung metastasis, curative treatment demands to completely remove all lesions and the corresponding lymph nodes. This management alone promises benefit for the patient. VATS is established in 1) removal of coin lesions (change to open surgery in case of malignancy; 2) diagnostic resection in metastasis surgery. Results after VATS have to be assessed for quality control in VATS in the same way as it is done for open surgery.

Carcinoma, Bronchogenic↗
PubMed1994

Thoracoscopic Heller's cardiomyotomy: a new approach for achalasia.

The authors performed Heller's myotomy using an endothoracoscopic technique on two patients with swallowing difficulties that were clinically demonstrated to be oesophageal achalasia. At 12 and 18 months' followup, respectively, both patients were asymptomatic. Extramucosal cardiomyotomy, as reported by Heller in 1913, is the most common approach to repair achalasia of the oesophagus. The advantages of the laparoscopic technique (less pain, small scars, reduced hospital stay) are given, as well as the disadvantages (possible mobilization of left lateral liver segment, possible splenic damage, difficulty retracting abdominal contents). More studies are needed to determine the rate of pulmonary complications caused by the extended degree of pulmonary collapse in the thoracoscopic approach and to compare the laparoscopic and thoracoscopic approaches to Heller's myotomy.

Adult↗
PubMedDate not supplied

Thoracoscopic management of malignant pleural effusion.

The results of thoracoscopic biopsy and talc pleurodesis in the management of malignant pleural effusions, is analysed. The study population consisted of 213 patients. Pre-operative cytology was positive in only 27% of patients; the diagnostic yield using thoracoscopic biopsy was 91.5%. (Sensitivity 99%; specificity 100%; positive predicted value 100%; negative predicted value 88%). Talc pleurodesis at thoracoscopy produced symptomatic improvement in 93% of patients. Post-operative complications occurred in 3.7% and there was a 2.3% mortality. Recurrent effusion was not a significant clinical problem. Thoracoscopy enhances the accuracy of diagnosis of pleural effusions; simultaneous talc pleurodesis has a high therapeutic success.

Adult↗
PubMed1994

[Treatment of hemopneumothorax under thoracoscopic guidance: a case report].

A 32-year-old man was admitted to our hospital complaining of chest pain and increasing dyspnea. Chest X-ray on admission revealed a collapsed lung and an air fluid line in the left hemithorax. Shock developed following drainage of 1,500 ml hemorrhagic pleural fluid. Following blood transfusion, emergency surgery was carried out. At operation under thoracoscopic guidance, a bleeding artery originating from the apex of the thoracic cavity and a bulla on the upper lobe were noted. The artery was successfully ligated with surgical clip, and the bulla was resected using EndoGIA. This case report indicates that hemopneumothorax can be safely operated on under thoracoscopic guidance after the patient has recovered from shock by adequate blood transfusion.

Adult↗
PubMed1993

Thoracoscopic pulmonary lobectomy. Early operative experience and preliminary clinical results.

Thoracoscopic video-assisted lobectomy procedures were performed in 11 patients (7 men, 4 women; age range 40 to 74 years, mean 66 years). Ten patients had peripheral pulmonary opacities: eight of these were bronchogenic carcinomas, one was an atypical carcinoid lesion, and one was a pulmonary infarct. All of these cases had preoperative evaluation by computed tomographic scanning to exclude mediastinal lymphadenopathy. The remaining patient had preoperatively diagnosed lobar bronchiectasis. Surgical access was gained via three stab (1 cm) incisions and one short (7 cm) submammary incision, which was made without rib separation and was used for specimen delivery. Lobes resected were the left upper (n = 4), left lower (n = 2), right upper (n = 2), and right lower (n = 3). All patients survived. Overall mean operative time was 3.3 hours and blood loss 263 ml. For the latter five cases, however, these figures were reduced to 2.3 hours and 100 ml, respectively, indicating improvement with experience. In no cases was ventilatory assistance required. Mean high-dependency unit time was 41 hours. In each case, it was possible to perform a standard dissectional lobectomy with lobar lymph node clearance equal to that obtained at open thoracotomy. Comparison with a series of 33 open lobectomy procedures demonstrated reduced postoperative pain, morphine consumption, and high-dependency unit stay. This preliminary experience supports the development of video-assisted thoracoscopic pulmonary lobectomy for patients with small peripheral opacities or known benign disease.

Adenocarcinoma↗
PubMed1993

Thoracoscopic intracavitary drainage for pneumothorax secondary to bullous emphysema.

Most patients with spontaneous pneumothorax secondary to bullous emphysema are successfully managed by chest-tube drainage. Occasionally a very large air leak prevents full lung expansion. The authors report on a patient in whom thoracoscopic intracavitary drainage of a leaking bulla led to rapid resolution of the pneumothorax and obliteration of the bulla. A large bronchopleural fistula was converted to a controlled bronchocutaneous fistula. The authors conclude that when conventional management fails to provide full lung expansion in cases of pneumothorax secondary to bullous emphysema, thoracoscopic intracavitary drainage is useful.

Aged↗
PubMed1993

[Thoracoscopic partial resection of the lung by use of Nd-YAG laser and standard suturing technique].

The patient was a 62-year-old woman who was referred to our department for bilateral diffuse abnormal shadows along with a sigmoid colon cancer that had been resected one month previously. Thoracoscopic partial resection of the left S8 region was performed. Nd-YAG laser with a contact tip was used for the resection. Hemostasis at the bed of the resection was assured by applying a free laser beam to oozing and non-coagulated surface. Additionally, the resected end was closed by standard continuous double over-and-over sutures in order to minimize the air leakage. Endo-Bulldog clamp facilitated the operation, minimizing hemorrhage from the resected end. This device can clamp any part of the lung and save one percutaneous puncture site necessary for thoracoscopic procedures. Postoperative course was uneventful. Pathological diagnosis was reported as an alveolar cell carcinoma of the lung.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed1993

Thoracoscopic sympathectomy.

With the advent of advanced video and laparoscopic techniques, new applications have been found for thoracoscopy's expanding role in thoracic surgery. Described herein are three cases of thoracoscopic sympathectomy for three different indications. The evaluation and surgical technique are described in detail. Thoracoscopic sympathectomy is an excellent alternative to open transthoracic approach.

Adult↗
PubMed1993

Video thoracoscopic dorsal sympathectomy: a new approach.

With the recent popularization of video laparoscopic cholecystectomy comes a renewed interest in thoracoscopy and its clinical applications in intrathoracic disease. Successful video thoracoscopic dorsal sympathectomy was accomplished in a patient with causalgia of the right upper extremity with immediate and complete resolution of pain and vasomotor symptoms. Standard operative approaches to dorsal sympathectomy are technically difficult, having risks of major nerve injury and Horner's syndrome. Video thoracoscopic dorsal sympathectomy obviates these risks and should become the procedure of choice in the future.

Adult↗
PubMed1993

[Thoracoscopic partial resection of the lung for peripheral lung tumor].

We report a thoracoscopic partial resection of the lung for the peripheral lung tumor in a 66-year-old woman. Her chest roentgenogram and computed tomographic scan showed a single tumor 1.9 cm in diameter within the periphery of the right lower lobe. A solitary metastatic lung tumor of colon cancer, which was resected one year ago, was suspected. Partial resection of the lung involving this tumor was performed using the MULTIFIRE ENDO GIA 30 disposable surgical stapler under thoracoscopy. There was neither air leak nor bleeding at the resection line. Pathological examination of the tumor revealed benign localized pleural mesothelioma. Her postoperative course was uneventful and she was discharged from the hospital on the eighth postoperative day. Thoracoscopic pulmonary resection using EndoGIA is a safe technique for a peripheral lung tumor.

Aged↗
PubMed1993

One-stage operation for bilateral spontaneous pneumothorax using imaged thoracoscopic technique: case report.

Bilateral apical bullae have previously been approached by staged or one-staged bilateral thoracotomy. In a 26-year-old male with bilateral primary spontaneous pneumothorax, bilateral apical bullae were successfully removed with thorough pleural abrasion using imaged thoracoscopic surgery in one operation. Postoperative pain was markedly reduced, pulmonary toilet was easily accomplished and cosmetic appearance of the scar satisfactory. Bilateral bullectomy and pleurodesis using imaged thoracoscopic surgery can, therefore, provide a simpler and safer option for bilateral pneumothorax.

Adult↗
PubMed1993

[Thoracoscopic surgery: current indications].

Recent advances in the technologies for minimal invasive surgery have expanded the indications for thoracoscopic surgery. The thoracoscopic approach is for various operations, including pleurectomy, decortication, pulmonary wedge resection, pericardial window, the approach of first choice. Other operations such as resection of tumors in the mediastinum or thoracic wall, lobectomies or others, can often be performed by thoracoscopy. Indications and technical details are described.

Humans↗
PubMed1995

[Thoracoscopic debridement for acute empyema].

Thoracoscopic debridement for acute empyema was successfully performed in three patients who were refractory to closed drainage, irrigation and antibiotic therapy. In two patients anaerobic organisms were isolated from the pus. None of the patients had bronchopleural fistula. All patients were relieved of fever promptly after surgery. Operative invasion was minimal, and postoperative lung function was well maintained one month after the operation. If empyema is in the fibrinopurulent phase and does not respond to pleural drainage, thoracoscopic debridement may be indicated before more aggressive therapy.

Acute Disease↗
PubMed1996

Laparoscopic and thoracoscopic surgery in infancy and childhood, the Münster/Gent experience.

Laparoscopic and thoracoscopic surgery have had a tremendous impact on adult surgery, but are still rarely used in children. In the past 3 years 168 children have been treated endoscopically in the three cooperating institutions. The course of all patients was documented prospectively in order to determine the value and prove the safety of endoscopic surgery in children. The operations performed endoscopically comprised appendectomy (n = 39), diagnostic procedures (24), adhesiolysis (n = 22), cholecystectomy (n = 13), bowel resection (n = 8), pyloromyotomy (n = 6), ovarial resection (n = 6), hiatus hernia repair (n = 22), splenectomy (n = 6), first stage of Fowler-Stephens operation for kryptorchidism (n = 3) and interruption of persistent botallic ducts (n = 6) in preterm infants. Apart from four wound infections (2.4%) following perforated appendicitis, one of which required laparotomy for perityphlitic abscess there were no serious complications. No patient died, and overall morbidity related to the procedure was 1.8% (i.e. incidence of uneventful minor intraoperative complications). Furthermore endoscopic surgery provides a better diagnostic survey of the abdomen or thorax so that missing of secondary pathology is unlikely. Pain and reflectory impairment of bowel-function or respiration were diminished, the aesthetic results were excellent and hospitalization could be reduced to a minimum. It is concluded that laparoscopic and thoracoscopic surgery are safe and reliable procedures for children and yield very encouraging results.

Adolescent↗
PubMed1996

[A case of pulmonary dirofilariasis diagnosed through thoracoscopic lung biopsy].

A fifty-year-old man was admitted to our hospital for evaluation of an abnormal shadow in a routine chest X-ray film. Thorax CT scan revealed a relatively well defined nodule with a diameter 15 mm and pleural thickness in the posterior segment of the right lower lobe. A diagnosis by broncoscopy was undefinite and suspected to be a lung cancer. So thoracoscopic lung biopsy was performed to remove it. In a cross section of the resected nodule two degenerated worm structures were revealed and we diagnosed pulmonary dirofilariasis. Pulmonary dirofilariasis has been an increasing reported disease. Most of cases revealed a peripheral lung lesion. Thoracoscopic lung resection was useful for the diagnosis, considering as minimally invasive examination.

Animals↗
PubMed1996

[Thoracoscopic upper thoracic sympathectomy for primary palmar hyperhidrosis].

We report our initial experience, over the past 3 years, with thoracoscopic sympathectomy for severe, primary, palmar hyperhidrosis in children and adolescents. From 1992-1995, 179 thoracoscopic sympathectomies were performed in 61 girls and 35 boys, 5.5 to 18 years old (mean 14.8). During the first 2 years the procedures were performed bilaterally but not simultaneously. During the past years, 65 underwent bilateral, simultaneous sympathectomy, using a single 10 mm subaxillary port of entry. 94 (98%) had immediate and permanent relief of palmar sweating. The immediate postoperative course was uneventful in all except 2 who had residual pneumothorax that required 24-hour intercostal drainage. These results compare favorably with the open method and are actually better in terms of less pain, early discharge, quicker return to normal activity and a smaller and less conspicuous scar. We emphasize the benefits of early surgery in children with severe, palmer hyperhidrosis, to avoid the many years of psychological, social and physical discomfort during adolescent growth and development.

Adolescent↗
PubMed1996

[Intrapulmonary lymph node diagnosed by thoracoscope: a case report].

A 62-year-old man was admitted to our hospital because of abnormal shadow on chest X-ray. Chest X-ray and CT showed a subpleural tumor 12 mm in diameter in the S8 segment of the right lung. Thoracoscopic observation revealed a subpleural black nodule. Wedge resection of the S8 segment was performed. Pathologically, the nodule was diagnosed as an intrapulmonary lymph node. It should be noted that thoracoscope was very useful for differentiation of intrapulmonary lymph node from other small malignancy.

Diagnosis, Differential↗