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PubMed1997

Thoracoscopic treatment of esophagobronchial fistula with esophageal diverticulum.

Thoracoscopic fistulectomy and diverticulectomy for esophagobronchial fistula with esophageal diverticulum were performed on a 49-year-old-woman. The neck of the diverticulum and the fistula were divided with endo-stapling technique. Intraoperative esophagoscopy was found to be useful for the definite localization and complete excision of the fistula and the diverticulum and the avoidance of stenosis of the esophagus. To avoid the recurrence of fistula, a pedicle of viable mediastinal pleura was interposed between esophageal and bronchial closures. Postoperative course was uneventful, and the complete relief of symptom was experienced for a period of 10 months after the operation. It is to be considered that the present thoracoscopic procedure with intraoperative esophagoscopy can be used as a standard operative procedure for esophagobronchial fistula with esophageal diverticulum.

Bronchial Fistula↗

PubMed1997

[Taking advantage of thoracoscopic techniques for diagnosis and treatment of thoracic diseases].

The authors report their experience in VATS technique employed in the diagnosis and treatment of pleural and mediastinal diseases and lung tumors. Between 1992 and 1996, 50 thoracoscopic procedures were carried out in 48 patients. The following operations were performed: six thoracic sympathectomies, two cases of closing bronchial stump fistulas, six cases of successfully treated spontaneous pneumothorax. In eight cases (16.3%) it was necessary to convert this procedure into thoracotomy because of pleural adhesions. The diagnostic thoracoscopies (35 cases) included: mediastinal and lung tumor biopsies, taking up samples of pleural exudate. There were no complications connected with these procedures. We consider thoracoscopic technique to be a suitable method for the diagnosis and treatment of mediastinal and pleural lesions.

Adult↗

PubMed1997

[Thoracoscopic biopsy of pulmonary lesions in nonpulmonary malignancy following chemotherapy].

The appearance of focal pulmonary lesions in a patient with a nonpulmonary malignancy is worrisome. Apart from metastasis, the differential diagnosis includes benign conditions such as infectious and granulomatous diseases, enlarged lymph nodes, atelectasis, radiation pneumonitis, and bronchiolitis obliterans with organizing pneumonia (BOOP). CT-guided needle biopsy is not always diagnostic and may not be feasible in very small lesions. Since open lung biopsy is associated with considerable morbidity, many physicians tend to postpone tissue diagnosis for a few weeks and perform a biopsy only if repeat chest CT scans show increase in size or number of the lesions. This approach may lead to undesirable delay of appropriate treatment. We report video-assisted thoracoscopic lung biopsy in 7 patients with nonpulmonary malignancy who developed lung lesions following chemotherapy and/or radiation therapy. Histological examination proved metastatic lesions in only 2. There were no operative complications and recovery was rapid and smooth in all patients. Thoracoscopic lung biopsy is an effective, minimally invasive diagnostic tool that obviates the need for thoracotomy in these patients.

Adolescent↗

PubMed1998

[The diagnostic value of thoracoscopic examinations in tuberculous pleurisy].

We evaluated the diagnostic value of thoracoscopic examinations in eleven patients who had pleural effusion and were diagnosed as tuberculous pleurisy. The characteristic white or yellowish-white micronodules were observed by thoracoscopy in eight patients and all their biopsied tissue were compatible with tuberculosis. We had some cases which were not determined as tuberculous pleurisy from bacteriological examinations and were determined only from the thoracoscopic findings.

Adenosine Deaminase↗

PubMed1998

[Pulmonary metastasis from renal cell carcinoma diagnosed by using thoracoscopic biopsy: a case report].

A 70-year-old woman underwent radical nephrectomy for right renal cell carcinoma and received prophylactic interferon-alpha (rHuIFN-alpha) administration for one year. Followup computerized tomography scan showed a small nodule in the right lung 39 months postoperatively. Pulmonary nodules had become multiple and increased in size (6 mm) at 53 months. To examine the pulmonary lesions, histopathologically thoracoscopic biopsy of the right pulmonary nodule was performed and the diagnosis of metastatic renal cell carcinoma was confirmed. Because of its minimal invasiveness, thoracoscopic biopsy may be indicated in selected cases.

Aged↗

PubMed1998

Thoracoscopic diaphragmatic plication.

We report on thoracoscopic plication of the the paralyzed right hemidiaphragm of a 33-year-old woman with a history of reactive airway disease. The paralysis was secondary to transection of the phrenic nerve during right first rib resection for thoracic outlet syndrome 1 year prior to evaluation. By use of video-assisted thoracoscopic surgery (VATS), the diaphragm was plicated as with open thoracotomy. Postoperative recovery was uneventful, with minimal pain and early discharge. Preoperative symptoms of exertional dyspnea and orthopnea were significantly improved.

Adult↗

PubMed1998

[Thoracoscopic surgery for an aged patient with T1N0 non-small cell lung cancer: case report].

An 85-year-old woman was referred to our hospital because of an abnormal shadow in the right upper lung field in chest roentgenograms. CT scans revealed a tumor, 3 cm in diameter at the peripheral field of the upper lobe. The lesion was diagnosed adenocarcinoma of the lung by transbronchial lung biopsy (c-T1N0M0). She underwent a partial resection of he S3 in consideration of age and the clinical stage, by using thoracoscopic procedure. Her postoperative course was uneventful and she was discharged on the 14th postoperative day. Since then, she has been free from recurrence for the past 3 years. Thoracoscopic surgery appears to be useful for aged patients with peripheral early lung cancer because of low incidence of postoperative disability and complications.

Adenocarcinoma↗

PubMed1998

[A case report of small-sized peripheral lung cancer diagnosed by thoracoscopic biopsy].

A case who had surgical treatment for small-sized peripheral lung cancer diagnosed by thoracoscopic biopsy was reported. A 66-year-old female was admitted to our hospital because of evaluation of an abnormal shadow on chest X-ray. Chest CT showed that the tumor about 7 mm in diameter was situated in right S1b and suspected to be malignant. Transbronchial lung biopsy and brushing showed no malignancy. The tumor was finally diagnosed to be well-differentiated adenocarcinoma by thoracoscopic lung biopsy. Following this procedure, right upper lobectomy and lymph node dissection (R2a) were performed through postero-lateral thoracotomy at one stage. Pathological diagnosis showed that the tumor was well-differentiated papillary adenocarcinoma and pathological TNM classification was T1N0M0. The postoperative course was uneventful and the patient is now doing well with no relapse at 1 year 2 months after the operation.

Adenocarcinoma, Papillary↗

PubMed1998

Thoracoscopic thymectomy for myasthenia gravis: a case report.

Total thymectomy combined with medical therapy is currently the most effective therapeutic strategy for patients with myasthenia gravis. The standard approach for total thymectomy is that of a median sternotomy. Other approaches include the cervical approach and partial sternotomy. We report a patient who underwent video-assisted thoracoscopic thymectomy at our institution. There was no postoperative complications and the patient was discharged on the fifth postoperative day. Video-assisted thoracoscopic thymectomy has proved to be an effective surgical therapy for the treatment of myasthenia gravis. The long-term outcome awaits close follow-up of the patients operated using this technique.

Adult↗

PubMed1998

[A case of mediastinal cavernous hemangioma resected through thoracoscope].

A case of mediastinal cavernous hemangioma was reported. An abnormal shadow on the chest X-ray film was pointed out in a 55-year-old male. CT scan and MRI revealed a right posterior mediastinal tumor but did not aid in the final diagnosis. We underwent extirpation of the tumor through thoracoscope and confirmed to be a cavernous hemangioma histologically. No major vascular connections between the tumor and major vessels were found. It was useful of thoracoscopic surgery in this case.

Endoscopy↗

PubMed1998

[Thoracoscopic lung volume reduction surgery for emphysema].

In recent years, several institutions have been performing lung volume reduction surgery (LVRS) for emphysema, and have reported that LVRS is effective for patients with emphysema that is resistant to other forms of therapy. However, questions remain about the relationship between the extent of resection and the therapeutic benefits. In our study, 15 men with emphysema underwent thoracoscopic LVRS. We analyzed the effects of LVRS on pulmonary function, exercise performance, and subjective symptoms after both bilateral and unilateral procedures. The patients who underwent the bilateral procedure, demonstrated significantly improved pulmonary function and exercise performance and relief of their subjective symptoms. Those who underwent the unilateral procedure, demonstrated significantly improved pulmonary function and relief of their subjective symptoms. Forced expiratory volume in 1.0 second increased by an average of 51% after the bilateral procedure, and 17% after the unilateral procedure. We conclude that thoracoscopic LVRS is an effective treatment for emphysema, especially with the bilateral procedure.

Aged↗

PubMedDate not supplied

Thoracoscopic sympathectomy for vasospastic diseases.

BACKGROUND: Vasospastic disorders (acrocyanosis, Raynaud's syndrome, causalgia) can arise from different etiologic factors, but the pathogenesis is always represented by an altered mechanism of vasal motility. Upper dorsal sympathectomy has been demonstrated to be an effective treatment for these disorders by decreasing peripheral resistances. Surgical technique has shown long-lasting results, and it can now be performed by endoscopic approach. METHODS: Our experience with six cases of sympathectomy is illustrated. The indications, thoracoscopic technique, complications and long-term results are evaluated. Four women with Raynaud's syndrome and two men with causalgia were treated in this series. After an accurate preoperative evaluation, the second, third, fourth and fifth thoracic ganglia of the sympathetic chain were identified and excised. RESULTS: All patients experienced relief of symptoms with very limited pain and discomfort. They did not require further medical therapy and are relapse-free at follow-up. CONCLUSIONS: We conclude that thoracoscopic sympathectomy can be considered an effective, safe and simple treatment for selected cases of vasospastic phenomenon.

Adult↗

PubMed1999

Thoracoscopic surgery in a general surgical service.

Following the great success and wide acceptance of laparoscopic surgery, the mini-invasive approach has been adopted for use in thoracic surgery. Thoracoscopic surgery is gaining acceptability as the procedure of choice for the treatment of recurrent pneumothorax and bullous lung disease, peripheral benign and malignant lesions, diffuse pulmonary infiltrates, mediastinal and pleural lesions, esophageal surgery, and major pulmonary resections for primary lung tumors. We present the 4-year experience of a general surgery service that extended the use of its advanced laparoscopic skills to the performance of thoracoscopic surgery in 80 patients. Using thoracoscopy, we performed biopsy or excision of pulmonary lesions (23 patients), spontaneous pneumothorax (14 patients), thoracic sympathectomy (41 patients), and Heller's esophagomyotomy and pericardiotomy (1 patient each). The results are excellent, and we believe the procedures presented in this series, and similar ones, can be accomplished safely and successfully by well-trained laparoscopic surgeons.

Adult↗

PubMed1996

The thoracoscope as diagnostic tool for solid mediastinal masses.

BACKGROUND: Despite the accuracy of percutaneous biopsy of mediastinal masses under CT scan or sonographic control, there is still a need for surgical biopsy because of difficult location or because of insufficiency of the percutaneous biopsy, especially for those tumors requiring an immunological classification. METHODS: The thoracoscopic approach to mediastinal masses is an alternative to the usual surgical biopsies performed through thoracotomy, sternotomy, or anterior mediastinotomy. The procedure is performed under general anesthesia and one-lung ventilation. RESULTS: In a series of 47 cases, a histological diagnosis was obtained in 44 cases (93.6%). There was one hemorrhagic complication requiring thoracotomy (2.1%). The mean postoperative duration of stay was 3.2 days. CONCLUSIONS: Thoracoscopy is the method of choice in case of failure or contraindication of percutaneous biopsy. There is still a role for mediastinoscopy in treating paratracheal lymph nodes.

Adult↗

PubMed1993

Thoracoscopic clipping of patent ductus arteriosus in premature infants.

Patent ductus arteriosus is a frequent indication for surgical intervention in preterm infants. Commonly this operation is performed through a dorsolateral thoracotomy. In an animal trial (piglets smaller than 1,400 g) instruments and technique for thoracoscopic clipping of patent ductus arteriosus were developed. Since January 1993, 3 premature infants have been treated with this new minimally invasive procedure. The instruments and the surgical technique are demonstrated.

Ductus Arteriosus, Patent↗

PubMed1993

Thoracoscopic treatment of spontaneous pneumothorax.

In 1973, I tried a new thoracoscopic treatment for the management of spontaneous pneumothorax. Adhesive agents, electrocoagulation, hot air, the neodymium: yttrium-aluminum garnet laser, intrathoracic devices, or various combinations of these have been used in the repair of more than 2,800 cases of ruptured bullae. Today, because the indications are sensitively defined by thoracography, the recurrence rate has decreased to less than 2%.

Humans↗

PubMed1994

Method of thoracoscopic pleurectomy.

A method of thoracoscopic pleurectomy using hydrodissection is presented. The results of its use in 8 patients are described, and pleurectomy as a form of pleurodesis is discussed.

Dissection↗

PubMed1995

Laparoscopic and thoracoscopic assistance with CSF shunts in children.

Between June 1992 and June 1994, six children underwent laparoscopic or thoracoscopic assistance in the management of cerebrospinal fluid (CSF) shunts. Four children (3 to 12 years of age) required laparoscopic assistance. Two children (5 and 10 years of age) underwent thoracoscopy with insertion of syringopleural shunts for decompression of cervicothoracic hydromyelia. Most children who require CSF decompression do not need endoscopic assistance for placement of the terminal portion of the shunt. However, in selected patients who have undergone previous abdominal procedures, in patients with a persistent pseudocyst occupying an extensive portion of the abdominal cavity, and in patients requiring removal of a disconnected shunt, laparoscopy is the ideal approach. Thoracoscopy for a syringopleural shunt prevents the need for minithoracotomy.

Cerebrospinal Fluid Shunts↗