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At least 991 records · Page 55Linked to original sources
PubMed1997

Thoracoscopic surgery of the oesophagus in rats: a training concept for the treatment of tracheo-oesophageal malformations in preterm infants

In extremely preterm babies with type Vogt III b oesophageal atresia, the primary operative management can be restricted to a gastrostomy and ligation of the fistula. Some of these patients, however, may not even tolerate a thoracotomy or placement on the operating table. We developed a minimally invasive procedure to prepare and ligate the oesophagus thoracoscopically and perform laparoscopic gastrostomy in a rat model. In 15 operations we observed only one complication. This study implies that after adequate practice, thoracoscopic dissection of the oesophagus with ligation of a tracheo-oesophageal fistula could be performed even in every small infants.

Journal Article↗
PubMed1997

[Evaluation of thoracoscopic surgery with mini-thoracotomy for primary lung cancer--as seen from the angle of lymph node dissection].

The extent of thoracoscopic surgery using a mini-thoracotomy for radical lung cancer surgery was investigated with regard to practical applicability. Thirteen patients with lung cancer underwent video-assisted lobectomy or segmentectomy and lymph node dissection through a 6-8 cm mini-thoracotomy. Eleven of thirteen cases were able to undergo video-assisted lobectomy and segmentectomy, but in one patient with strong adhesion and one patient who developed hemorrhage due to pulmonary arterial injury, thoracotomy was extended to 15-20 cm. Ten patients with lung cancer who underwent lobectomy under standard thoracotomy, underwent lymph node dissection under simulated 6-8 cm mini-thoracotomy. These ten cases and five cases who underwent lymph node dissection under 6-8 cm mini-thoracotomy were then switched over to standard thoracotomy to examine the possibility of residual lymph nodes. On the right-side, R2 lymph node dissection was practical, but on the left-side, #3, 3p, 4, 7 lymph node dissections were insufficient or impractical in some cases. The above results suggested that right-sided lobectomy is practical for radical thoracoscopic surgery with a mini-thoracotomy is practical for up to stage II. However, on the left side, the procedure should be confined to stage I.

Adenocarcinoma↗
PubMed1997

[Analysis of small peripheral lung cancer diagnosed by open lung or thoracoscopic biopsy].

Twenty-six cases with lung cancer diagnosed by open-lung (n = 11) or thoracoscopic (n = 15) biopsy were analyzed. Mean tumor size was 19 mm. Biopsies were conducted due to the appearance of a nodular shadow determined by the retrospective X-p films in 13 cases, nodular shadow enlargement in 9, the positive suspicion of malignancy X-p findings without retrospective films in 3, and nodular shadow enlargement after medication of anti-tuberculosis drugs in one. Histology was adenocarcinoma in 18 cases, squamous cell carcinoma in 4, large cell carcinoma in 3, and adenosquamous cell carcinoma in one. The tumor stage was T1N0M0 in 14 cases, T1N0M0 in 3, T1N2M0 in 3, and unknown N factor because of lung wedge resection in 6 cases. Motality due to tumor recurrence was T1N2M0 in 3 cases and T1N1M0 in one. The remaining 22 cases survived without tumor recurrence. In short, small pulmonary nodules newly appearing or becoming with enlarged or found by retrospective X-p films should be conducted positively in thoracoscopic biopsy because of the high possibility of malignancy. Even if the tumor is small, lobectomy with lymph node dissection should be done, because of the very likely lymph node metastasis.

Adenocarcinoma↗
PubMed1997

Unilateral left-sided thoracoscopic sympathectomy for visceral pain control: a pilot study.

OBJECTIVE: To examine the effect of unilateral left sided thoracoscopic denervation of the upper gastrointestinal tract for treatment of chronic pain. DESIGN: Prospective study. SETTING: University hospital, Sweden. SUBJECTS: Patients with intractable upper abdominal pain. Nine patients were treated who had the following diagnosis: pancreatic carcinoma (4), duodenal carcinoma (n = 1), chronic pancreatitis (3), and portal vein thrombosis (n = 1). INTERVENTIONS: Left-sided thoracoscopy with the patient anaesthetised using double-lumen endotracheal intubation that allowed ventilation of the right lung only. The sympathetic chain and splanchnic branches were divided from level IV to X-XI. MAIN OUTCOME MEASURES: Severity of pain assessed by a visual analogue scale and mean consumption of analgesic drugs. RESULTS: All patients reported substantial relief of pain postoperatively when they were studied during a mean follow-up period of 3 months. However, two patients (1 with pancreatic carcinoma and 1 with portal vein thrombosis) had recurrent pain after 3 months. CONCLUSION: Unilateral thoracoscopic sympathectomy induces adequate and lasting relief of pain caused by benign as well as malignant diseases originating from the pancreatic region.

Abdominal Pain↗
PubMed1997

Video-assisted thoracoscopic closure of postpneumonectomy bronchopleural fistulas.

Despite improved surgical techniques and advances in medical-surgical treatment, postpneumonectomy bronchopleural fistulas remain an important cause of morbidity and a therapeutic challenge. Video-assisted thoracoscopic closure of these fistulas reinforced by transposition of bulky chest wall muscles or omentum to obliterate the residual space may lessen risks and complications of repeated thoracotomy in these often frail, debilitated, and compromised patients. We report our initial experience with video-assisted thoracoscopic debridement of the empyema cavity and closure of the postpneumonectomy bronchopleural fistula by transposing an entire pectoralis major muscle in one patient and by transposing a pedicled omentum in another patient.

Aged↗
PubMed1997

Thoracoscopic sympathectomy for palmar hyperhidrosis. A case report.

Palmar hyperhidrosis is a disabling condition that manifests itself as excessive sweating of the hands. Although the exact cause is unknown, several medical and surgical therapies are available to treat it. Recent developments in surgical technique have made the less invasive thoracoscopic sympathectomy a viable alternative to the open sympathectomy for medically refractory cases. We believe that thoracoscopic sympathectomy is a safe and effective treatment for palmar hyperhidrosis.

Adult↗
PubMedDate not supplied

Thoracoscopic dissection of the esophagus for cancer.

Eighteen patients affected by a resectable intramural tumor of the esophagus have undergone esophagectomy with thoracoscopic dissection of the esophagus in the last 4 years. All patients had a relative contraindication to transthoracic esophagectomy with radical lymphadenectomy. All esophagectomies were completed thoracoscopically and reconstruction of the digestive tract was performed in 17 cases through cervical gastroplasty and in 1 case through cervical coloplasty. One cirrhotic patient died in the postoperative period due to cervical anastomotic leak. Six other patients experienced a postoperative complication (mortality rate 5.5%; morbidity rate 33.3%). After a median follow up of 17 months, 14 patients are alive without evidence of disease. One patient, who had excision of a cutaneous metastasis at a trocar insertion site 6 months postoperatively, eventually died with locoregional recurrence 14 months postoperatively. Another patient died 20 months after surgery with mediastinal recurrence. One patient died 28 months postoperatively after massive hematemesis with a suspect abdominal recurrence. The results of the present series and those reported by other authors do not seem to indicate presently evident advantages from the minimally invasive procedure during resection of the esophagus for cancer. At the present time, no indication to this procedure exists for standard clinical use; wider randomized trials and longer follow-up to be performed only in selected centers are needed to further evaluate the procedure.

Adenocarcinoma↗
PubMedDate not supplied

Methylene blue localizations of pulmonary nodules under CT-guidance: a new procedure used before thoracoscopic resections.

With the expending use of video-assisted thoracoscopy for a wide range of indications, we present our experience of CT-guided localizations of pulmonary nodules with methylene blue injections before their thoracoscopic resections. This technique was developed for deep non-palpable nodules of small size. Forty seven nodules in 44 patients were preoperatively localized under CT guidance and marked with methylene blue injections. The localizations under CT guidance of the 47 nodules were successful in all cases. The surgeon confirmed accurate localization of 46 nodules. In one case, the injected methylene blue could not be identified during thoracoscopy. Complications of this technique included 7 cases of asymptomatic pneumothorax, 5 cases of local and asymptomatic pulmonary hemorrhage, and 2 cases of fits of coughing. Because of this technique, 46 diagnostic thoracotomies could be avoided. CT guided localization with methylene blue injection is a simple and rapid technique enabling good thoracoscopic surgery results.

Cough↗
PubMed1996

[Diagnosis and treatment of pulmonary nodules by video-assisted thoracoscopic surgery--surgeons' view].

We reviewed 48 cases of pulmonary nodules in which video-assisted thoracoscopic surgery was done at Jichi Medical School Hospital from 1992 through 1995. The pulmonary nodules comprised 14 malignant tumors (9 lung cancers and 5 pulmonary metastases), 10 benign tumors (7 hamartomas, 2 localized mesotheliomas and 1 tumorlet), 19 granulomas (8 inactive infectious tumors, 7 active infectious tumors, and 4 granulomas as sequelae of other diseases), 4 intrapulmonary lymph nodes, and 1 pulmonary cyst. Conventional operations for lung cancer were done in 7 cases, and 6 were found to be ST-I. Tumor resection by video-assisted thoracoscopic surgery allowed diagnosis of rare diseases and treatment of benign lung tumors and of lung metastases. We conclude this procedure is very useful for diagnosis and treatment of indeterminate pulmonary nodules.

Adult↗
PubMed1997

[Hypercapnea during thoracoscopic surgery under regional anesthesia].

A 23-year-old woman was supposed to undergo thoracoscopic surgery for the 10th pneumothorax that accompanied histiocytosis X. The past history included Lylle's disease, asthma, myocarditis, drug-induced leucocytopenia and bronchitis obliterans. The preoperative arterial blood gas analysis under receiving O2 at rate of 2 l.min-1 via a nasal cannula revealed normal values. General anesthesia and intubation with a double-lumen endotracheal tube would have been preferable, but regional anesthesia was chosen because of her medical history and positive results of the skin tests for vecuronium, pancronium, diazepam and midazolam. During the first 10 min of thoracoscopic procedure, her respiration became rapid and shallow and she was restless and comatose. The operation was cancelled. Arterial blood gas analysis under receiving O2 at rate of 4 l.min-1 via a face mask revealed: pH 7.025, PaO2 113.8 mmHg, PaO2 244.8 mmHg, HCO3- 29.7 mEq.l-1, BE-5.6, and O2 saturation 99.1%. Manual artificial ventilation with a mask and bag was initiated. Her spontaneous respiration and consciousness recovered in next 30 min. The postoperative course was uneventful. Tachypnea, caused from anxiety, dyspnea and stimulation of irritant receptors in the airway, were considered to be responsible for the event. The duration of inspiration became shorter as tachypnea developed, that made the tidal volume to decrease and hypercapnea ensued.

Adult↗
PubMed1997

[Complications of thoracoscopic surgery for spontaneous pneumothorax].

We reviewed the cases of 122 patients with primary spontaneous pneumothorax who underwent thoracoscopic surgery at our institution between 1992 and 1995. In 9 cases, thoracotomy became necessary because of severe adhesions (3 cases), large foci (3 cases), and unrecognized foci (3 cases). Complications occurred in 17 cases: collapse in 1 patient after removal of the thoracic drain, persistent air leakage (> 7 days) in 2 patients, and recurrent pneumothorax in 14 patients. There were no significant differences between the recurrent and non-recurrent cases in age, sex location of bullae, past history of pneumothorax, operating time, intraoperative blood loss, or duration of chest tube drainage after surgery. The interval between onset and consult was significantly longer in recurrent cases than in non-recurrent cases, and the number of patients who required chest tube drainage before surgery was significantly higher in recurrent cases. Reoperation was performed in 9 cases. Bullaes that were not detected during the first surgery were found in the 7 of these cases. The recurrent cases in our study were regarded as resulting from a lack of surgical skill that may improved with increasing surgical experience. The Brinkman index was significantly higher in recurrent cases. Smoking and air-leakage before surgery may be risk factors for recurrence following thoracoscopic surgery for spontaneous pneumothorax.

Adolescent↗
PubMed1997

CT guided needle localization for video-thoracoscopic resection of pulmonary nodules.

Because of its decreased invasiveness Video-Assisted Thoracoscopic Surgery (VATS) has advantages over the traditional open thoracotomy. However, resection of small and subpleural pulmonary nodules via the thoracoscope is often technically difficult or impossible. To facilitate the resection of these difficult-to-palpate lesions, a protocol was established to localize the nodules percutaneously with a fine needle under CT guidance. This method was used in four patients to localize five lung lesions identified radiographically in various lung segments. Of the four patients in the study, three presented with malignancy of the lower extremities (alveolar sarcoma, squamous cell carcinoma, and spindle cell carcinoma). In two of these patients (having alveolar sarcoma and spindle cell carcinoma primaries), the resected pulmonary lesions proved to be metastatic disease. The lesions of the other two patients were nonmalignant (actinomycosis and fibrotic granuloma). The patients with actinomycosis had two distinct lesions which were identified preoperatively with two localizations. All five lesions were able to be localized and resected with clear margins. The patients tolerated the procedures well without complication. VATS with preoperative CT guided needle localization of a subpleural nodule can be a useful diagnostic tool. Its use in therapeutic metastasectomy, nonetheless, remains controversial.

Actinomycosis↗
PubMedDate not supplied

Video-assisted thoracoscopic surgery for management of spontaneous pneumothorax.

Spontaneous pneumothorax is a common problem facing thoracic surgeons, occurring in about nine individuals per 100,000 each year. Treatment options include observation, chest tube thoracostomy, and thoracotomy with or without pleurodesis. When surgery is indicated, thoracoscopic surgery has been shown to provide excellent results with low morbidity, low recurrence, high patient acceptance, a shorter hospital stay and possibly decreased costs. In this article, we present the successful treatment of two cases of recurrent pneumothorax via video-assisted thoracoscopic surgery, combined with mechanical and chemical pleurodesis.

Adult↗
PubMed1997

[Thoracoscopic surgery for benign esophageal diseases].

The thoracoscopic surgery for two benign esophageal diseases, esophageal leiomyoma and esophageal diverticulum, were successfully performed. Case 1 was a 37-year-old female with esophageal leiomyoma that was located at 30 cm from the incisor of the left anterior esophagus. The tumor was enucleated under the thoracoscopy, combined mini-thoracotomy for 3 cm in length. It was useful enough to rotate the left side to the right with two slings traction for better visualization of lesion site. After resection, the proper muscle layer of the esophagus was closed. Case 2 was a 70-year-old male, who complained of dysphagia because of esophageal diverticulum. It was 8 cm in size and located at 28 cm from the incisor of the right wall of the esophagus. It was also resected under the thoracoscopy, combined mini-thoracotomy for 3 cm in length. Intraluminal esophagoscope was useful to dissect safely and confirm the intralumen of the diverticulum. Its neck was divided parallel to the longitudinal axis of the esophagus by two endo-staplers. And then, the muscle layer was closed. It was suggested that esophageal leiomyoma and esophageal diverticulum were suitable for thoracoscopic surgery.

Adult↗
PubMed1997

[Thoracoscopic enucleation of esophageal leiomyoma].

We treated four cases of thoracoscopic enucleation of esophageal leiomyoma. All four cases were asymptomatic, but either barium swallow or esophagofiberscopic examination revealed esophageal submucosal tumor. The locations of the tumors were middle and lower in one case and middle in the other three cases. All patients were intubated with a double lumen endotracheal tube under general anesthesia. Two patients required thoracotomy due to the tumor surrounding the esophageal wall in one case and severe adhesion to the esophageal mucosa in the other. The mini-thoracotomy was used in three cases. In the other two cases, we used four and three trocars, respectively. The balloon catheter, which had been inserted into the esophageal lumen, was useful for removing the tumor. The tumor was pulled up using the traction suture and dissected from the mucosa and muscular layer. After enucleation of the leiomyoma, the split muscular layer was sutured. The postoperative course was uneventful. These two patients were discharged on the 12th and 15th postoperative days, respectively. We conclude that the thoracoscopic enucleation of the esophageal leiomyoma is useful for reduction of surgical stress and is a more feasible approach for the treatment of esophageal leiomyoma.

Adult↗
PubMed1997

[Necrotizing sarcoid granulomatosis diagnosed by video thoracoscopic lung biopsy].

A 28-year-old woman was admitted to our hospital because of chest pain. A chest roentgenogram and a chest computed tomogram revealed many nodular shadows on both sides. Examinations of specimens obtained by and by transbronchial lung biopsy during fiberoptic bronchoscopy were not diagnostic, and therefore video thoracoscopic lung biopsy was done. The lung lesion was characterized by aggregates of epithelioid cell granulomas, along with granulomatous and necrotizing angitis. We therefore diagnosed necrotizing sarcoid granulomatosis, and began to administer prednisolone. The nodular shadows disappeared within four weeks. In this case video thoracoscopic lung biopsy was useful in the diagnosis of necrotizing sarcoid granulomatosis in the lung.

Adult↗
PubMed1994

[A new video-assisted thoracoscopic surgical interruption of patent ductus arteriosus].

A new video-assisted thoracoscopic surgery was applied to patients with patent ductus arteriosus (PDA). After the ductus was carefully dissected and exposed, two or one titanium clips which were 11 mm in length were used to interrupt the ductus completely. Eight patients with PDA were successfully treated by the new technique between July 1992 and September 1993, which was the first successful series in Japan. Mean age was 4.3 years (range 1.7 approximately 6.7 years) and mean weight was 15.6 kg (range 10.0 approximately 24.0 kg). All patients had immediate complete PDA closure after the procedure which was proved to be successful by an esophageal stethoscope and color doppler echocardiogram. One patient had mild left recurrent laryngeal nerve dysfunction which was completely cured on 7th postoperative day. There were no other complications and the usual hospital stay was 4 or 5 days. No residual PDA shunt in all cases was revealed by color doppler echocardiogram during follow-up periods (range 3 approximately 12 months). The advantages of thoracoscopic surgery for PDA are: less postoperative pain and discomfort, early recovery and short hospital stay, and cosmetic preservation. Availability of smaller sized surgical instruments should allow this technique indicated for smaller children and premature infants.

Child↗
PubMed1994

[Thoracoscopic surgery of spontaneous pneumothorax and partial lung resection].

Fourty-five thoracoscopic operations were done from April 1992 to November 1993. There were 27 cases of pneumothorax, 13 cases of partial lung resection (8 lung biopsies, 3 resection of metastatic lesions, 2 benign lung tumors), 2 cases of mediastinal tumor and 3 other lesions. All procedures were performed under general anesthesia using a double lumen endobronchial tube, and the patient was positioned for a lateral or an axillary thoracotomy as in a standard operation. We operated through three or four trocar wounds of 5 to 12 mm. In case of pneumothorax, we basically used Nd-YAG laser ablation of the bullae but in a few cases that shrinkage of the bullae was not obtained by laser ablation alone we resected them by endoscopic stapler. All cases of partial lung resection were done using endoscopic stapler. Five patients(11.1%) were converted to standard thoracotomy. All the postoperative courses were uneventful and 8 patients(17.7%) did not use any drugs for pain postoperatively. Thoracoscopic surgery is a usefull procedure and has many advantages compared with conventional thoracotomy. However, if the procedure could result incomplete, thoracotomy should be followed without hesitation.

Endoscopy↗