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PubMed1989

Thoracoscopy in the diagnosis of pleural effusions.

Between January 1981 and December 1986, thoracoscopies were carried out on 152 patients in order to evaluate the diagnostic accuracy of the technique in cases of pleural effusion. All patients had previously undergone a thoracentesis together with an unguided pleural biopsy but had remained undiagnosed. Of them, 74 cases were confirmed as malignant; the others were benign. In 71 of the 74 cases of malignant pleural effusion, an accurate diagnosis had been obtained from the thoracoscopy and guided pleural biopsy, a diagnostic accuracy of 94.6%. Among 78 cases, diagnosed by the thoracoscopy as benign pleural effusion, there were 63 cases of tuberculosis and 15 of non-specific pleurisy. Nine of the 15 cases of non-specific pleurisy showed no evidence of malignancy after being under observation for between six and 30 months, the remaining six cases being lost in the follow-up. No complication arose in our series. We conclude that thoracoscopy is a safe and useful diagnostic procedure for pleural effusion.

Adult↗
PubMed1979

[Thoracoscopy in pleural mesothelioma. Diagnostic, prognostic and therapeutic interest (author's transl)].

Thoracoscopy with a single opening was carried out under general anesthesia with a cold light thoracoscope of 7 mm in diameter. Biopsies were taken under visual control for optical and electron microscopic examination. In a series of 40 mesotheliomas, 30 patients with pleural effusion underwent 36 thoracoscopies. In 29 patients the macroscopic lesions were compatible with the diagnosis of mesothelioma. The most specific aspects consisted in white-yellowish nodules, almost translucent, arising from the parietal pleura (9 patients). Another typical pattern, a dense pleural thickening, was found in 10 patients. In the remaining patients, the lesions observed were less specific. The biopsy was positive in 35/36 thoracoscopies (97%). A talc poudrage was carried out in 10 patients: their mean survival was 458 days. In ten matched mesothelioma patients who underwent pleurectomy the mean survival was only 395 days. In 12 patients at an early stage, the visceral pleura was not involved by the tumor: their mean survival was 636 days. In 11 patients both parietal and visceral pleura were involved by the tumor: their mean survival was 138 days: (p less than 0,001). It is concluded that in mesothelioma pleural effusions, thoracoscopy is a safe and efficient procedure in order to reach a precise diagnosis, prognosis and efficient palliative treatment of the effusion.

Humans↗
PubMedDate not supplied

[Results of thoracoscopies in the diagnosis of diseases of the lungs and of the pleura (author's transl)].

The diagnostic results of 125 thoracoscopies in patients aged 17-85 years are analysed retrospectively. The condition for relevant diagnosis by thoracoscopy is an intrapleural space permitting the installation of a pneumothorax of sufficient size for tissue-biopsy under direct vision. The results are largely dependent upon the choice of suitable cases. Macroscopic appearance and histological examination made it possible in 100 of 125 cases to make a definite diagnosis or to exclude it. Thoracoscopy is a suitable diagnostic method especially for the following indications : pleural disorder of uncertain origin (metastatic, tuberculous or of other origin); primary pleural disease (mesothelioma); disseminated pulmonary processes (silicosis, sarcoidosis, miliary tuberculosis, interstitial fibrosis of the lung); peripheral lung disease and spontaneous pneumothorax are other indications. Some representative cases are reported. Biopsy by thoracoscopy is certainly superior to blind pleural biopsy, and is not unpleasant for the patient. The method is even suitable for smaller hospitals, if the technique is careful and indications are well chosen.

Adolescent↗
PubMed1981

Thoracoscopy: results in non cancerous and idiopathic pleural effusions.

Two hundred and fifty pleural effusions were studied prospectively comparing the results obtained simultaneously by investigation of the pleural fluid, blind needle biopsy of the pleura and thoracoscopy. Thoracoscopy was necessary in 50% of the cases for the diagnosis or the exclusion of a neoplastic or tuberculous etiology. The combined cytological and histological results of the pleural effusions and the needle biopsies established the diagnosis of malignancy in 74%. Tuberculosis was proven histologically in 52% by needle biopsy, in 62% when the cases were not included where only inadequate tissue was obtained. If the bacteriological results of tb-cultures including those of the pleural effusions are added, 74% of the tuberculous pleurisies were diagnosed. Thoracoscopy had a significantly higher yield with 97% in malignant and 99% in tuberculous effusions. The value of thoracoscopy in pleural effusions of other or of idiopathic origins has to be seen in the light of these results showing the probability with which a tumour or a tuberculosis can be excluded, 9% of the cases remained indeterminate (idiopathic).

Adolescent↗
PubMed1995

Thoracoscopy: anesthetic considerations.

Thoracoscopy is surgical procedure which was performed in the early 1900s primarily for the treatment of tuberculosis until antibiotics became the treatment of choice. Over the last two decades, thoracoscopy has experienced a rebirth as the indications for this endoscopic procedure have become numerous. Although less invasive than the thoracotomy, thoracoscopy is not without potential complications. The anesthesia provider must be alert for problems related to one-lung ventilation, lateral positioning, and pleural cavity insufflation. The anesthetic technique must be planned with the physiological changes which occur during thoracoscopy in mind.

Anesthesia↗
PubMed1994

Thoracoscopy for the evaluation and treatment of pleural space disease.

Pleural disease provided the first and, for many years, the only indication for thoracoscopy. It remains the most efficient way of obtaining a diagnosis in cases of pleural effusions not diagnosed by thoracentesis and closed-needle biopsy, especially when malignancy is suspected. Thoracoscopy also can provide enough tissue to define cell type. In malignant mesothelioma, it can help assess the resectability of the tumor. In cases of metastatic disease or inoperable malignant mesothelioma, treatment of the effusion by talc poudrage can be combined with a diagnostic procedure. Any case of empyema in which a chest tube does not result in defervescence or complete evacuation of the pleural fluid within 2 to 3 days should be considered for thoracoscopy. In early empyemas, adhesions and loculatons can be addressed, the infected material removed, and the cavity irrigated. If the lung then fully expands, the tubes may be removed when the drainage ceases, precluding the prolonged retention of empyema tubes. Thoracoscopy also has proved useful in the management of benign pleural tumors, hemothorax, and chylothorax.

Empyema, Pleural↗
PubMed1994

Thoracoscopy for pleural space disease.

We reviewed the results of 40 consecutive patients who underwent thoracoscopy on the general thoracic surgery service at our institution. Pleural space disease was the indication for thoracoscopy in 34 patients (85%). In 18 patients (46%), a malignant tumor accounted for the pleural space disease. In all patients with malignant disease, the diagnosis was established by a single thoracoscopy. For patients with benign pleural space disease, the timing of the thoracoscopic intervention is important. Despite advances in the extended application of thoracoscopy, the diagnosis and management of pleural space disease continues to be the primary indication for the procedure.

Adenocarcinoma↗
PubMed1996

[Closure of patent ductus arteriosus by video thoracoscopy in 282 children].

Closure of patent ductus arteriosus by video thoracoscopy is a standardised procedure. The authors report their experience of closure of patent ductus arteriosus by video-thoracoscopy from May 1991 to December 1995. The series included 282 patients divided into 3 groups according to age: under 6 months (78 patients, 27.6%), from 6 months to 4 years (135 patients, 42.88%) and over 4 years of age (69 patients, 24.6%) with an average weight of 12.6 kg (range: 1.2 to 65 kg). Symptomatic pulmonary hypertension was observed in 39 cases and 9 children had associated intracardiac malformations (ostium secundum: 3; ventricular septal defect: 5; abnormal pulmonary venous drainage: 1) which were not corrected. The technique consisted of placing two titanium clips in position under video-thoracoscopy to close the ductus. An echo performed immediately afterwards confirmed closure of the ductus. The main complications were: persistence of a shunt (4 cases) at the beginning of our experience requiring immediate reoperation by video-thoracoscopy in 3 cases and by thoracotomy in one case; left recurrent laryngeal nerve palsy in 6 cases (2.1%) with regression in 5 and persistence in one case; one case of postoperative chylothorax which regressed rapidly. There were no fatalities or haemorrhages and no blood transfusions were required in this series. The average operating time was 20 +/- 15 minutes and the duration of hospital stay around 48 hours when the patients were over 6 months old and 72 hours when less than 6 months of age. Video-thoracoscopic closure of patent ductus arteriosus is rapid, safe, economical, it provides excellent results and may be used in children of all ages.

Age Factors↗
PubMed1996

[Thoracoscopy in malignant pleural effusions].

To assess the value of thoracoscopy in malignant pleural effusions, the procedure and results of thoracoscopy by using a fiberoptic bronchoscope and a rigid cold-light thoracoscope in 130 cases with malignant pleural effusion are reported. The overall diagnostic rate was 91.5% (119/130). The malignant pleural mesothelioma in 24 cases and metastatic cancers in 95 cases were histopathologically confirmed. Talcum powder, tetracycline and Corynebacterium parvum were separately sprayed through thoracoscope into pleural cavity in 69, 10 and 10 patients, and the success rates of complete and lasting pleurodesis were 87.0%, 5/10 and 8/10 respectively. Postoperative complications included transient fever and chest pain, local subcutaneous emphysema in 6 cases and tumor seeding at thoracoscopy site in 4 cases. It is concluded that thoracoscopy is simple, safe, reliable and of high practical value in the diagnosis of malignant pleural effusions and in assessment before exploratory thoracotomy, and that transendoscopical administration of drugs for pleurodesis is a very effective method for controlling malignant pleural effusions. The efficacy of the talc poudrage is better than tetracycline and Corynebacterium parvum.

Adenocarcinoma↗
PubMedDate not supplied

Present day concepts of thoracoscopy as a modality in pediatric cancer management.

Recent improvements in video imaging and instrumentation have encouraged a wider use of thoracoscopy as a modality for diagnostic procedures. Its utility for resection is still being reviewed. To assess the utility, diagnostic accuracy, and morbidity of thoracoscopy in children with cancer, we reviewed the experience at our institution. Between January 1991 and July 1995 sixty-four (64) procedures were performed either to diagnose pulmonary nodules of indeterminate origin (n = 42) or mediastinal masses (n = 11) or to evaluate pulmonary infiltrates in leukemia (n = 11). Thoracoscopy yielded a successful diagnosis in 90% of the cases. Conversion to open thoracotomy was necessary in 11 patients. Thoracoscopy in the management of children with cancer is useful for staging, obtaining diagnostic tissue, and is associated with a low morbidity.

Adolescent↗
PubMed1997

Management of concurrent pleural effusion in patients with lymphoma: thoracoscopy a useful tool in diagnosis and treatment.

Pleural effusion represents a frequent feature both of Hodgkin's (HL) and non-Hodgkin's (NHL) lymphoma. The aims of the present study were: 1) to analyse the diagnostic accuracy of thoracoscopy as compared to pleural cytology in patients with lymphoma and concurrent pleural effusion; and 2) to evaluate the effectiveness of chemical pleurodesis with the tetracycline derivative, rolitetracycline. Seventeen patients with pleural effusion and concurrent lymphoma (10 NHL and seven HL) were studied. Analysis of pleural fluid revealed the presence of lymphoma cells in six cases (four NHL and two HL); histopathological examination of samples obtained by thoracoscopy was consistent with pleural infiltration by NHL in eight cases and by HL in six cases. Overall sensitivities of pleural cytology and histology were 35 and 82%, respectively. Following chemical pleurodesis, complete response was observed in five of the 17 cases (two NHL and three HL), partial response in four cases (two NHL and two HL), whereas failure was observed in the remaining eight cases. Two patients who had presented failure underwent subsequent pleurectomy by thoracotomy (one case of HL) or video-thoracoscopy (one case of NHL). Complete response was observed in both cases following this treatment. No major complication was recorded after chemical pleurodesis or pleurectomy. Thoracoscopy may be considered a useful tool to evaluate the involvement of pleural space in patients presenting with pleural effusion in the course of lymphoma. Chemical pleurodesis plays an important role in the palliative treatment of this condition. Further studies are necessary to assess the role of pleurectomy in the treatment of such patients.

Adult↗
PubMedDate not supplied

Video-assisted thoracoscopy for the diagnosis of mediastinal masses in children.

BACKGROUND AND OBJECTIVES: Video-assisted thoracoscopy has been successfully used for several different thoracic procedures in adults. However, its use in children has been limited. The present study evaluated our experience with video-assisted thoracoscopy in the diagnosis of mediastinal masses in children. METHODS: Nine children (age range, 3 to 18 years) with undiagnosed mediastinal masses underwent video-assisted thoracoscopy. The operation was performed using general anesthesia, with the patient intubated with a single lumen endotracheal tube. RESULTS: In all cases adequate tissue for diagnosis was obtained. Three patients had tuberculosis, two had Hodgkin's disease, two had granuloma, one had metastatic Wilms' tumor, and one had thymic hyperplasia. There were no complications related to the operative procedure. CONCLUSIONS: Video-assisted thoracoscopy for the diagnosis of mediastinal masses in children is a safe procedure. It provides good visualization, access to the mediastinum and adequate tissue for diagnosis. Further, postoperative discomfort is tolerable and cosmetic results are excellent.

Adolescent↗
PubMed2006

Evaluation of respiratory muscle strength by randomized controlled trial comparing thoracoscopy, transaxillary thoracotomy, and posterolateral thoracotomy for lung biopsy.

OBJECTIVE: The aim of this study was to demonstrate that the postoperative recovery of respiratory muscle strength is better in patients who undergo video-thoracoscopy than in patients who undergo transaxillary thoracotomy or posterolateral thoracotomy. DESIGN: Randomized controlled trial with three parallel groups. STUDY POPULATION: Eligible patients had undergone wedge resection for lung biopsy in interstitial lung disease or in pulmonary nodule. Twenty-four patients were randomly assigned to one of the three thoracic procedures: eight in the video-thoracoscopy (VT) group, eight in the transaxillary thoracotomy (TT) group, and eight in the posterolateral thoracotomy (PLT) group. MEASUREMENTS: The postoperative respiratory muscle strength was assessed by maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) measured by mouth pressure. Measurements were made the day before the operation and 2, 4, and 30 days after the operation. Changes in postoperative MIP and MEP were expressed as a percentage of preoperative values. RESULTS: The three groups were comparable with respect to age, gender, comorbidity, preoperative spirometry, preoperative MIP, MEP and peak flow, and volume of lung tissue. At 2, 4, and 30 days after the operation, mean MIP were, respectively, 111+/-22%, 119+/-22%, and 124+/-22% in the VT group, 76+/-22%, 109+/-22%, and 127+/-22% in the TT group, and 51+/-22%, 50+/-22%, and 77+/-22% in the PLT group (p<0.0001). At 2, 4, and 30 days after the operation, mean MEP were, respectively, 94+/-15%, 103+/-15%, and 105+/-15% in the VT group, 61+/-15%, 98+/-15%, and 126+/-15% in the TT group, and 62+/-15%, 75+/-15%, and 87+/-15% in the PLT group (p<0.05). CONCLUSIONS: Video-thoracoscopy allows better recovery of respiratory muscle function after surgery than posterolateral thoracotomy. However, at 4 and 30 days after surgery, video-thoracoscopy and transaxillary thoracotomy gave similar results of impairment of respiratory muscle strength.

Adult↗
PubMed2000

Defining the pediatric spinal thoracoscopy learning curve: sixty-five consecutive cases.

STUDY DESIGN: Consecutive case prospective chart and radiographic review. OBJECTIVES: The purpose of this study was to define the learning curve of spinal thoracoscopy. SUMMARY OF BACKGROUND DATA: Thoracoscopy is an alternative to open thoracotomy in the treatment of pediatric spinal deformity. The learning curve for spinal thoracoscopy has not been described. METHODS: In this prospective study 65 consecutive cases of thoracoscopic anterior release with discectomy and fusion performed by one surgeon for the treatment of pediatric spinal deformity were reviewed. The patients were, on average, 14 +/- 3 years old and had the following diagnoses: idiopathic scoliosis (n = 13), Scheuermann's kyphosis (n = 9), neuromuscular spinal deformity (n = 35), congenital scoliosis (n = 4), and tumor/syrinx (n = 4). RESULTS: The average operative time for the thoracoscopic procedure was 161 +/- 41 minutes (range, 50-240 minutes). There was a slight decrease in the average operative time as the series progressed. The average number of discs excised was 6.5 +/- 1.5 (range, 3-10), and the number increased as the series progressed. The average operative time per disc was 29.3 +/- 7.7 minutes in the first 30 patients compared with 22.3 +/- 4.7 minutes in the next 35 patients (P < 0.01). The average blood loss during the thoracoscopic procedure was 301 +/- 322 mL (range, 25-2000 mL) and did not decrease as the series progressed. Initial postoperative scoliosis and kyphosis corrections were 59% +/- 17% and 92% +/- 12%, respectively. Complications occurred in six patients (cases 4, 8, 17, 31, 39, and 46) and were evenly distributed throughout the series. CONCLUSIONS: The learning curve for thoracoscopy is substantial, but not prohibitive. This technique provides a safe and effective alternative to thoracotomy in the treatment of pediatric spinal deformity.

Adolescent↗
PubMedDate not supplied

[Thoracoscopy with mediastinoscope in pediatric complicated parapneumonic effusion]

OBJECTIVE: To evaluate our experience with thoracoscopy with small mediastinoscope in complicated parapneumonic effusion in children.METHODS: From July 1995 to June 1997, seven children with complicated parapneumonic pleural effusion underwent thoracoscopy with mediastinoscope at Hospital de Clínicas de Porto Alegre. The procedure was carried out with a small mediastinoscope built in our hospital.RESULTS: There were six girls and one boy. The procedure was preformed under general anesthesia, without selective intubation. Six patients had previous intercostal tube drainage; one underwent thoracoscopy as a primary procedure. No complication was observed after the procedure. During follow-up, two children underwent pleurotomy due to residual pleural effusion with persistent fever; two others presented asymptomatic small pleural effusion.CONCLUSION: Thoracoscopy with small mediastinoscope is safe, efficient and without severe complications. It is very useful to remove loculated complicated parapneumonic effusion at fibrinopurulent stage and to enable lung expansion.

Journal Article↗
PubMed1997

[Video-assisted thoracoscopy in diagnosis and therapy of intrathoracic diseases].

Video-assisted thoracoscopy has become an important adjunct to traditional thoracic surgical techniques for the diagnosis and therapy of numerous intrathoracic diseases. It has developed to the procedure of choice for patients with spontaneous pneumothorax, indeterminate peripheral lung nodule, diffuse lung disease, pleural disease and effusion and is a valuable alternative to traditional thoracotomy for various indications like the resection of benign intrathoracic tumors and cysts. Although video-assisted thoracoscopy is not recommended for curative therapy of malignancies, it can be useful for the diagnosis, staging and palliation of malignant disease. Video-assisted thoracoscopy should be performed only by surgeons with sufficient experience in thoracic surgery in institutions where adequate prerequisites are available. The clinical impact of video-assisted thoracoscopy is documented by the fact that in centers approximately 20 to 30% of all thoracic surgical procedures currently are performed with this new technique.

Endoscopes↗
PubMed1980

The use of thoracoscopy in the diagnosis of pleural disease.

Seventeen patients (ten male and seven female) between the ages of 21 and 76 years underwent thoracoscopy from 1976 through 1978 by the Stanford University University Thoracic Surgical Service. There was no morbidity or mortality. This technique was used when other conventional methods such as thoracentesis and pleural biopsy failed to obtain a diagnosis of suspected thoracic pathology. Thoracoscopy was diagnostic in 16 of 17 cases. The diagnosis of malignancy was made in 11 cases, whereas benign disease was found in the remaining six cases. Of the latter group, there was one false-negative result, which on subsequent thoracotomy was diagnosed as recurrent Hodgkin's disease. The current revival of thoracoscopy as a diagnostic entity is proving to be very valuable in the evaluation of thoracic disease. An increased awareness of the tool and its use should decrease the number of major thoracotomy procedures.

Adult↗
PubMed1986

Pleural effusion in breast cancer. Thoracoscopy for hormone receptor determination.

Metastatic breast cancer frequently presents as a malignant pleural effusion. Knowledge of the estrogen and progesterone receptor status of the tumor predicts response to hormonal therapy, but breast cancer tissue in the pleural space is not readily accessible for hormone receptor determination. Thoracoscopy was used in six breast cancer patients with pleural effusions; all but one had concurrent sites of metastases. In five of six women recurrent breast cancer in the pleural cavity was diagnosed by thoracoscopy, and in four sufficient tissue was obtained for receptor assay. All patients achieved excellent control of their pleural effusions through a combination of local sclerotic measures and systemic therapy. Thoracoscopy is a safe procedure that can be performed under local anesthesia and is useful to visualize the pleural space, not only for diagnosis but also for obtaining breast cancer tissue for hormone receptor determination.

Aged↗