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At least 1,063 records · Page 59Linked to original sources
PubMed1997

[Bilateral video-assisted thoracoscopic volume reduction surgery for treatment of advanced pulmonary emphysema].

In a prospective study, we investigated the functional results, complications, and survival of patients who underwent bilateral video-assisted thoracoscopic (VAT) lung volume reduction surgery (VRS) for severe, diffuse pulmonary emphysema (FEV1 0.77 +/- 0.03 [1], RV/TLC 0.65, 12' walking distance 482 +/- 26 [m]). From January 94 to March 97, 67 of 179 candidates underwent the operation, and 58 patients (mean age 64 +/- 1.1, range 42-78 years; 17 women) fulfilled the study criteria. There was no 30-day mortality; hyperinflation decreased to an RV/TLC ratio of 0.52 +/- 0.01 after 3 months; FEV1 increased to 1.2 +/- 0.08 [1]; and the 12' walking distance was 687 +/- 29 [m].

Adult↗
PubMed1998

[Thoracoscopic resection of epiphrenic esophageal diverticula by an intracavitary/endoluminal combined intervention].

Epiphrenic oesophageal diverticula are of the pulsation type, the underlying cause is a motility disorder. Resection is indicated by severe symptoms like dysphagia, regurgitation or aspiration and should be performed after endoscopic dilatative treatment of the neuromotor disturbance. Thoracoscopic resection under endoluminal endoscopic surveillance is considered to be a reliable procedure with low morbidity for the patient.

Dilatation↗
PubMedDate not supplied

Video-assisted thoracoscopic surgery in the management of pediatric empyema.

BACKGROUND: Management of empyema in children has progressed from open thoracotomy to video-assisted thoracoscopic surgery (VATS). The purpose of the present study was to evaluate the efficacy and safety of VATS in children with multiloculated empyemas. METHODS: Nine children (mean age, 4 years; range, 21 months to 13 years) with empyema, in whom multiple loculations were found on computed tomography, were treated with VATS from January, 1994, to November, 1996. All patients underwent VATS under general anesthesia, with drainage of the empyemas, decortication, and placement of chest tubes under direct vision. RESULTS: In all nine patients, VATS was successful. Average operating time was 120 minutes. Blood loss was insignificant, except in one patient who needed an intraoperative blood transfusion. This child required extensive decortication, with blood oozing from raw areas. All patients recovered well, with no recurrences to date. An algorithm for the use of VATS in the treatment plan for children with empyema was established. CONCLUSION: VATS provides safe and effective treatment in the management of pediatric empyema. Moreover, it avoids lengthy hospitalization, prolonged intravenous antibiotic therapy, and unnecessary pain and stress secondary to placement of chest tubes without anesthesia.

Adolescent↗
PubMed1997

Acute postoperative pancreatitis after laparoscopic cholecystectomy. Results of the Prospective Swiss Association of Laparoscopic and Thoracoscopic Surgery Study.

BACKGROUND: The introduction of laparoscopic cholecystectomy (LC) changed the treatment strategies for patients undergoing biliary surgery. There is a lack of data about acute postoperative pancreatitis (APP) as a complication of LC. OBJECTIVES: To determine the incidence, morbidity, and mortality of APP after LC and to analyze the possible intraoperative and pathogenic factors associated with APP. DESIGN: A prospective cohort study of 10174 patients who underwent LC. The data for 32 patients with APP after the completion of LC and 8 patients with APP after an attempted LC that was converted to an open cholecystectomy were analyzed. SETTING: A multi-institutional study of the Swiss Association of Laparoscopic and Thoracoscopic Surgery. Eighty-one surgical services or surgeons in private practice participated. RESULTS: The incidence of APP after a completed LC was 0.34%. In comparison, the incidence of APP after conversion to an open procedure (0.96%) was significantly (P = .02) increased. A biliary origin of APP could be established in 4 (12.5%) of the 32 patients. No evidence for a causative role of intraoperative cholangiography or trauma to the pancreas was found. Factors shown to be associated with APP were the surgeon's experience level and a high morbidity of 31.3%. The mortality was 3%. CONCLUSIONS: The incidence of APP after LC is low; the risk increases after conversion to an open procedure. In the rare event of an APP after LC, a biliary cause should be suspected. The mortality of patients with APP did decrease substantially compared with those undergoing open biliary surgery.

Acute Disease↗
PubMed1998

Thoracoscopic T2-T3 sympathicolysis for essential hyperhidrosis in childhood: effects on pulmonary function.

Thoracoscopic T2-T3 sympathicolysis (TS) is a minimally invasive treatment for patients suffering from severe, refractory essential hyperhidrosis (EH). TS has previously been shown to be safe and efficacious in children. In order to examine the effects of TS on respiratory function, pulmonary function tests (PFT) were performed prior to and 6 weeks and 6 months after TS in 12 children with EH (3 boys; mean age 12.8+/-2.5 years). Small asymptomatic decreases in forced expiratory volume in one second (FEV1; -2%), forced expiratory flow after expiration of 75% of vital capacity (FEF75; -9.6%), total lung capacity (TLC; -1%), transfer factor for diffusion of carbon monoxide (T(LCO); -7.6%), and transfer coefficient for diffusion of carbon monoxide (K(CO); -1.5%) were observed 6 weeks after TS. These changes are comparable to those observed in adults but did not reach statistical significance in small children. In line with observations in adults, TLC (and T(L,CO)) returned to baseline values 6 months after TS, whereas FEV1, FEF75, and K(CO) remained at their 6-week level. In conclusion, TS causes only small, statistically insignificant, and asymptomatic decreases in pulmonary function in children. TS can, therefore, be considered a safe treatment option in children suffering from severe, refractory EH.

Adult↗
PubMed1994

Right thoracoscopically assisted oesophagectomy for cancer.

Thoracoscopic mobilization was performed in nine patients with oesophageal cancer. Five principles emerged as essential for successful dissection: (1) the selection of patients with mobile oesophageal tumours without evidence of local invasion; (2) double-lumen anaesthesia and complete collapse of the right lung during surgery; (3) simultaneous use of a flexible gastroscope; (4) high-quality illumination; and (5) minimal blood loss during dissection. The surgeon should have adequate training in thoracic operations. Further experience should permit mediastinal lymph node dissection. Postoperative pulmonary complications were common, requiring prolonged intensive care management. Widespread adoption of the technique cannot be recommended.

Adenocarcinoma↗
PubMed1994

Thoracoscopic evaluation of the diaphragm in patients with knife wounds of the left lower chest.

The role of thoracoscopy in assessing the status of the diaphragm in penetrating knife wounds of the left lower chest was studied prospectively in 55 patients. Those with positive thoracoscopic findings (n = 22) proceeded to exploratory laparotomy and those with an uninvolved diaphragm (n = 32) were observed. Thoracoscopy was inconclusive in one patient and two were lost to follow-up. With operative findings or 30-month follow-up data as evaluation endpoints, thoracoscopy in 52 patients was 100 per cent sensitive, 90 per cent specific and 94 per cent accurate. A projected negative laparotomy rate of 63 per cent would have occurred with a policy of mandatory laparotomy; using thoracoscopy the actual rate was 6 per cent. Thoracoscopy is a safe and reliable method of evaluating the diaphragm in patients with left lower thoracic stab wounds.

Adult↗
PubMed1996

No obvious advantages for thoracoscopic two-stage oesophagectomy.

Thoracoscopically assisted Ivor-Lewis oesophagectomy potentially combines the pulmonary advantages of transhiatal oesophageal dissection, with the visibility and control permitted by thoracotomy. This study reviewed 17 patients who underwent this procedure with an intrathoracic anastomosis. Five patients required conversion to thoracotomy, four because of technical difficulties with the anastomosis. After operation 13 patients had radiological evidence of atelectasis, six developed a left pleural effusion and five had clinically significant pneumonia. Three patients developed an anastomotic leak, two of whom died giving an in-hospital mortality rate of 12 per cent. Median postoperative hospital stay was 12 days. Four patients developed benign anastomotic strictures requiring dilatation. The 1- and 2-year survival rates were 73 per cent (11 of 15 patients) and 63 per cent (five of eight) respectively. The use of minimal access techniques in this context does not appear to reduce the postoperative incidence of either pulmonary or anastomotic complications.

Adenocarcinoma↗
PubMed2003

A comparison of video-assisted thoracoscopic oesophagectomy and radical lymph node dissection for squamous cell cancer of the oesophagus with open operation.

BACKGROUND: A direct comparison of open operation and video-assisted thoracoscopic surgery (VATS) for radical oesophagectomy has yet to be published. METHODS: Medical records of 149 patients with oesophageal squamous cell carcinoma who underwent oesophagectomy and three-field lymphadenectomy were reviewed. Seventy-seven patients had the thoracic procedure performed via a 5-cm minithoracotomy and four ports (VATS group); the others were operated on by conventional posterolateral thoracotomy (open group). RESULTS: The mean number of retrieved mediastinal nodes, blood loss and morbidity were similar in the VATS and open groups (33.9 versus 32.8 nodes, 284 versus 310 g, and 32 versus 38 per cent respectively). The thoracic procedure took longer in patients having VATS than in the control group (227 versus 186 min; P = 0.031). Vital capacity reduction was less with VATS than in the open group (15 versus 22 per cent; P = 0.016). The 3- and 5-year survival rates were similar: 70 and 55 per cent respectively for VATS compared with 60 and 57 per cent for the open procedure. CONCLUSION: VATS provides comparable results to open radical oesophagectomy, with less surgical trauma.

Adult↗
PubMed2004

Anatomical basis for a successful upper limb sympathectomy in the thoracoscopic era.

In this clinico-anatomical study, factors potentially responsible for unsuccessful upper limb sympathectomy (ULS) by the thoracoscopic route were evaluated. This study comprised two subsets: 1) in the clinical subset, 25 patients (n = 50 sides) underwent bilateral second thoracic ganglionectomy for palmar hyperhidrosis, and factors predisposing to unsuccessful ULS were identified; and 2) in the anatomical subset, the neural connections of the first and second intercostal spaces were bilaterally dissected in 22 adult cadavers (22 right, 21 left; n = 43 sides). Alternate neural pathways (ANP) were noted in 9 of 50 sides in the 25 clinical cases (18%). In three asthenic patients (5 sides), fascia overlying the longus colli muscle mimicked the sympathetic chain. The right superior intercostal vein (SIV) was located anterior to the second thoracic ganglion in 6 of 50 sides (12%) and predisposed to troublesome bleeding in 2 of 50 cases; the SIV was posterior to the ganglion in 19 of 50 sides (38%), posing no technical problem. On the left, the SIV was noted outside the field of dissection in all but one case. A successful outcome to sympathectomy was noted in all 25 patients. A spectrum of sympathetic contributions to the first thoracic ventral ramus for the first intercostal space was noted in 37 of 43 anatomical cases (86%). These were categorized according to the arrangements of the intrathoracic ramus between the second intercostal nerve and the first thoracic ventral ramus. The cervicothoracic ganglion (37/43 cases; 86%) and an independent inferior cervical ganglion (6/43 cases; 14%) were always located above the second rib. The second thoracic ganglion was consistently located in the second intercostal space. This study demonstrates that ANPs have little clinical significance when a second thoracic ganglionectomy is undertaken. Technical failures may be avoided if the surgeon is mindful of anatomical variations at surgery.

Adult↗
PubMed1993

Partial congenital defect of the left pericardium: angiographic diagnosis and treatment by thoracoscopic pericardiectomy: case report.

Congenital defects of the pericardium are extremely rare and frequently difficult to diagnose. We present a diagnosis of partial congenital defect of the left pericardium based on a characteristic chest X-ray and left ventriculogram. Additionally, we report findings of a diastolic, migratory coronary stenosis on coronary arteriography which, to date, has not been reported. Confirmation of the diagnosis by mediastinoscopy was followed by thoracoscopic pericardiectomy.

Adult↗
PubMed1999

Microcirculatory perfusion of the canine esophagus before and after blind longitudinal dissection and thoracoscopic distal transsection.

In the treatment of distal esophageal pathology, surgical mobilization and exteriorization of the thoracic esophagus can be necessary. This may threaten its vascularization. We investigated the effect of longitudinal dissection and distal transsection on the microcirculatory perfusion of the canine esophagus. Esophageal perfusion and muscular oxygenation were investigated in 11 dogs using laser Doppler fluxmetry and oxygen pressure measurements before and up to 2 weeks after longitudinal dissection with and without distal thoracoscopic transsection. Histological examination was performed at the end of the follow-up period. Distal esophageal perfusion was higher than proximal. Longitudinal dissection caused an insignificant reduction, whereas additional transsection significantly lowered esophageal perfusion, which was restored only partially during follow-up. After transsection distal muscular oxygen pressure was also significantly lower than proximal. Histologically, no significant ischemic cell damage was observed. Laser Doppler perfusion measurement is a feasible technique to measure (changes in) microcirculatory circulation of the esophageal wall. This may be useful in clinical settings to monitor the viability of the esophagus after surgical interventions. Distal transsection substantially reduces esophageal perfusion without apparent short-term histological damage.

Animals↗
PubMed1995

Thoracoscopic pericardial fenestration after cardiac transplantation.

A patient suffered from recurrent pericardial effusions following heart transplantation. Repeated pericardiocentesis and insertion of pericardial drains could not resolve the problem and therefore surgical intervention was necessary. The procedure was performed as a minimally invasive thoracoscopic pericardial fenestration. Four months postoperative the patient was without recurrences. This method of pericardial fenestration after heart transplantation has been used for the first time.

Heart Transplantation↗
PubMed1995

One hundred consecutive cases of video-assisted thoracoscopic surgery for primary spontaneous pneumothorax.

We reviewed our experience on video-assisted thoracoscopic surgery (VATS) from our first 100 cases of primary spontaneous pneumothorax (PSP) performed at our institution from September 1992 to January 1994. Apical bullae were identified in 87% of cases. Mechanical pleurodesis with Marlex mesh was performed on all patients. Excision with endoscopic staple cutter was performed in 69 cases; an endoloop was used in five cases; ablation with an argon beam coagulator (ABC) was done in six cases; excision with endoscopic suturing occurred in seven cases; and mechanical pleurodesis alone was used in 13 cases. The overall median postoperative chest tube duration was 2 days (range 1-25 days) and hospital stay 4 days (range 1-30 days). Complications occurred in 8 cases (8%): 1 wound infection; 1 chest wall bleeding; and 6 persistent air leaks which lasted for more than 10 days (one of which eventually required an axillary thoracotomy for control). Procedure failure with recurrence occurred in three cases (3%) at a mean follow-up of 17 months (range 8-24 months). The ABC group alone was responsible for one recurrence and two persistent leaks. We conclude that with the VATS approach in the treatment of PSP, staple resection of apical bullae is quick and most reliable but costly. Endoloop and hand suturing are applicable to selected patients with small and localized bullae and should be further studied, while our limited experience does not favor ABC as the primary treatment modality.

Adolescent↗
PubMed1996

Thoracoscopic surgery in the elderly population.

BACKGROUND: We review our experience in video-assisted thoracoscopic surgery (VATS) on patients over 75 years of age from a single institution. METHODS: From September 1992 to November 1995, 22 patients (13 males and 9 females with mean age of 78.1 years) underwent the following procedures: pleural biopsies with or without drainage and decortication (5), drainage of empyema (2), wedge lung biopsy (3), bullectomy and talc insufflation (1), major lung resections (5), mediastinal biopsy (1), pericardiectomy (3), and thymectomy (2). Pulmonary function tests of the entire group showed the mean forced expiratory volume in 1 s (FEV1) to be 1.46 1 (range 0.63-2.11) and forced vital capacity (FVC) to be 2.04 (range 0.98-3.55) 1. RESULTS: There was no mortality. Morbidity included prolonged chest drainage over 7 days in two patients (9.1%), one of whom was discharged with a drainage bag. Particularly of note was the lack of postoperative pulmonary complications. CONCLUSIONS: We conclude that VATS in the elderly population is safe. Age alone should not be a contraindication for major lung or mediastinal surgery.

Aged↗
PubMed1995

Port-site recurrence following video-assisted thoracoscopic surgery.

Video-assisted thoracoscopic surgery (VATS) is an established modality in the management of pleural diseases. We report a case of port-site recurrence following management of malignant pleural effusion in an elderly patient with extensive pleural metastasis from adenocarcinoma of the lung. Although her shortness of breath was relieved following VAT decortication and talc insufflation, at 3 months she was found to have a 2.5-cm subcutaneous nodule at the camera port site which on biopsy was confirmed to be metastatic in nature. Even though the nodule was asymptomatic and the patient prognosis was not affected, it is important that both the surgeon and future patients should be aware of this potential complication.

Adenocarcinoma↗
PubMed1996

Thoracoscopic repair of traumatic diaphragmatic rupture. A case report.

A 51-year-old man with a traumatic diaphragmatic rupture is presented. Preoperatively, diaphragmatic rupture and herniation of the stomach into the left thoracic cavity were suspected. Under thoracoscopic guidance, the stomach and omentum were repositioned in the abdominal cavity using Babcock forceps, and then the rupture site was closed using an endoscopic hernia stapler. The postoperative course was uneventful and the patient was discharged from our hospital with no symptoms.

Diaphragm↗