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PubMed2004

Computed tomography-guided pulmonary nodule localization before thoracoscopic resection.

PURPOSE: To assess the success rate and complication rate of a CT-guided pulmonary nodule-marker system before thoracoscopic resection. MATERIAL AND METHODS: In 24 patients (15 M, 9 F; age range, 18-71 years) a total of 25 pulmonary nodules (in 1 patient 2 lesions simultaneously) were marked with a special wire under CT-guidance and then thoracoscopically resected. We evaluated lesion size, lesion distance to the pleura, the time of intervention, complications, and thoracoscopic success rate. RESULTS: Mean lesion size was 7 mm (range 4-15 mm) and mean lesional distance to the pleura was 13 mm (range 2-31 mm). The pulmonary nodule-marker system was positioned successfully in all 25 pulmonary nodules within 5-11 min (mean 7.5 min). Minimal pneumothoraces were observed in five patients with no requirements of chest drains. In addition, no bleeding complications or hematothorax were observed. All 25 pulmonary nodules could be resected thoracoscopically. However, in one patient (4%), the guide-wire dislocated during thoracoscopy, but the lesion could be successfully resected during thoracoscopy. CONCLUSION: The CT-guided placement of the pulmonary nodule-marker system used here offers a safe and accurate guide for the localization of small pulmonary nodules during thoracoscopic resection.

Adolescent↗
PubMed2001

Thoracoscopic management of chylothorax complicating esophagectomy.

BACKGROUND: Chylothorax is a relatively uncommon complication of esophageal surgery that may lead to severe respiratory, nutritional, and immunologic deficiencies. PATIENTS AND METHODS: Between 1992 and 2000, 3 of 316 patients (0.9%) undergoing transthoracic esophagectomy for carcinoma developed postoperative chylothorax. Two of them had previously been treated with neoadjuvant chemoradiation, and one had been submitted to esophagogastric resection through a left thoracotomy. After a 2-week trial of total parenteral nutrition and drainage, two patients underwent thoracic duct ligation via thoracotomy. In the last patient, the operation was completed by thoracoscopy. The azygos vein and the periaortic tissue above the diaphragm were encircled en bloc by a right-angled clamp, and a roticulating endostapler was applied. RESULTS: Reoperation was successful in all patients. The postoperative hospital stay was 4 days. CONCLUSION: Thoracoscopy is a safe and effective procedure for the treatment of chylothorax complicating esophagectomy. Given the minimal trauma to the patient, early thoracoscopic reoperation can be advocated in patients with high-output chyle loss in order to reduce the hospital stay.

Adenocarcinoma↗
PubMed2005

Benefits of the thoracoscopic approach for short- or long-gap esophageal atresia.

OBJECTIVE: To evaluate the feasibility and results of thoracoscopy in various types of esophageal atresia (EA). MATERIALS AND METHODS: From April 2001 to August 2002, 5 patients with EA were treated by thoracoscopy. Their mean gestational age was 38 weeks and mean birth weight was 2700 g. Two patients had short-gap atresia with tracheo-esophageal fistula (type III according to Ladd's classification). Three had long-gap atresia: 2 with low fistula to the carina (type IV) and 1 without fistula (type I). Patients were placed in a prone position with the right side elevated at 80 degrees . Four intrapleural ports were necessary. The fistula when present was dissected and sutured with intrathoracic knots and esophageal anastomosis performed in the same manner. RESULTS: Positive airway pressure increased in all patients after insufflation but was kept in a safe range to prevent lung injury. An esophageal anastomosis was performed in 3 cases (2 short gaps and 1 long gap). Oral feeding started on day 6, and their mean length of hospital stay was 14 days. For one child with type IV EA, the anastomosis was impossible because of a long gap confirmed by an immediate thoracotomy. The ends were just approximated. A "spontaneous" fistula developed, and normal feeding was possible 2.5 months later. For the child with type I EA, the pouches could be only approximated at 2 months of age. A spontaneous fistula developed with a stenosis. A redo anastomosis by open surgery allowed for normal feeding. CONCLUSION: The thoracoscopic repair of an esophageal atresia is a reasonable choice for experienced surgeons treating patients, including those with long gaps.

Adult↗
PubMed2006

Robot-assisted thoracoscopic esophagectomy with the patient in the prone position.

We describe a new technique of esophagectomy by robot-assisted thoracoscopy with the patient in the prone position, followed by laparoscopy and left cervicotomy with the patient in the supine position. We report two procedures performed November 2002 and September 2003. The technique should allow more thorough lymph node removal while reducing postoperative pain and morbidity. The thoracoscopy is robot-assisted and the articulations within the pleural cavity improve the surgeon's dexterity and reduce trocar movements. The prone position allows mobilization of the esophagus with only three trocars because the lung, which is partially deflated, does not block access. With the patient in the prone position, bleeding does not obscure the operative field. Stomach mobilization, gastric tube creation, and celiac lymphadenectomy are performed by laparoscopy. The esogastric anastomosis is a totally mechanical side-to-side anastomosis realized by left cervicotomy.

Carcinoma, Squamous Cell↗
PubMed1995

The use of minimal access surgery in pediatric trauma: a preliminary report.

Minimal access surgery (MAS) is becoming an accepted modality in the management of adult trauma, but its use in children is rarely reported. Recently, we began using minimal access surgery to evaluate injured children. The purpose of this report is to review our preliminary experience with the use of laparoscopy and thoracoscopy in blunt and penetrating pediatric trauma. Eight children aged 2-14 years old were evaluated using MAS. Two children with blunt injuries had persistent abdominal pain despite normal radiologic studies. Laparoscopy documented a disrupted gallbladder and a small bowel perforation. Laparoscopy was also used to evaluate five hemodynamically stable children with penetrating wounds to the abdominal wall with potential peritoneal penetration. Only one child was converted to a laparotomy. Four were found to have either tangential penetrating wounds or nonbleeding solid organ injuries and were spared an open exploration. Two children with penetrating trauma with potential mediastinal injury were assessed with thoracoscopy. MAS was also used as a therapeutic modality in two children who had diaphragmatic lacerations repaired with an endoscopic "hernia" stapler. MAS accurately identified all injuries. All children were subsequently discharged without complications. We conclude that MAS is a safe and effective way to evaluate and manage hemodynamically stable children with both penetrating and blunt traumatic injuries.

Adolescent↗
PubMed1999

The role of thoracic surgery in diagnosing interstitial lung disease.

In this article, the current status of thoracic surgery options for reaching a diagnosis in interstitial lung disease is described. When surgery is needed, mediastinoscopy is the first step in cases of suspected stage I or II sarcoidosis. If this is not the case, video-assisted thoracoscopy is currently preferred to open lung biopsy because the need for analgesia lessened, less blood is lost, the operative time is shorter, the complication rate is lower, and the postoperative stay is shorter. In some cases, video-assisted thoracoscopy may also be preferred to mediastinoscopy, especially in young women, for cosmetic reasons.

Analgesia↗
PubMedDate not supplied

Thoracoscopic treatment of bullous emphysema in 3 dogs.

OBJECTIVE: To report thorascopic partial lobectomy for treatment of bullous emphysema in dogs. STUDY DESIGN: Prospective clinical study. ANIMALS: Three dogs with spontaneous pneumothorax. METHODS: Thoracoscopy without pulmonary exclusion was used to identify bulla. The thorascope was introduced into the thorax lateral to the xyphoid process, and instrument portals were made at different levels along the thoracic wall between the third and tenth intercostal spaces. The thorascope was passed through the mediastinum to view the opposite pleural cavity. After identification of bullae, the affected lung was excised using an endoscopic stapler, and the incision line was checked for air leakage. Thoracic drains were used for air aspiration for 2 days after surgery. RESULTS: Bullae were confirmed histologically as emphysematous lesions. Lung inflation did not interfere with identification of bullae or with surgery. All dogs had full recovery without recurrence for 18 to 29 months after surgery. CONCLUSIONS: Identification and ablation of bulla can be performed thoracoscopically without pulmonary exclusion in dogs. CLINICAL RELEVANCE: Thoracoscopy offers several advantages compared with thoracotomy for treatment and diagnosis of idiopathic pneumothorax, including ease of identification of bullae and reduced postoperative pain and morbidity.

Animals↗
PubMed1996

Thoracoscopic approach to implantable cardioverter defibrillator patch electrode implantation.

Even if transvenous lead system for automatic implantable cardioverter defibrillators (ICDs) has been one of the main surgical advances in the recent past, its major limitation is the high defibrillation thresholds in some cases. Thus, an additional patch may be required and implanted either in a subcutaneous position or in an epicardial position. We describe another possibility: the implantation of extrapericardial patch under video-thoracoscopic control. This new technique allows a deep implantation of the whole material without thoracotomy. Seven patients were included in our preliminary experience. During defibrillation threshold evaluation, two patients required 34 J with the single transvenous lead system, and five patients were not defibrillated with the single lead system; therefore, they required a 300-J external rescue shock. We decided to implant an additional patch in those seven patients with high defibrillation thresholds. This patch was inserted into the pleural cavity through a left subcostal incision. Under video thoracoscopy, it was positioned and stitched onto the pericardium. The defibrillation generator was then implanted through the left subcostal incision in a subdiaphragmatic space. As a result, preoperative defibrillation thresholds were significantly reduced (14.29 +/- 3.45 J, mean +/- SD) and remained stable during follow-up controls (eighth day and second month). Long-term follow-up (14 +/- 4.5 months) was uneventful, with an excellent tolerance for the patients. In conclusion, extrapericardial implantation of defibrillation patches under video thoracoscopy is an easy technique that allows low defibrillation thresholds.

Adult↗
PubMed2006

Thoracoscopic surgery for pulmonary arteriovenous malformation.

We report 6 consecutive cases of pulmonary arteriovenous malformation in the periphery of the lung, which were treated successfully by thoracoscopy. Pulmonary wedge resection was performed with a linear cutting stapler to divide the feeding artery, drainage vein, and aneurysmal lesion of the arteriovenous malformation. Operative time ranged from 30 to 95 min (mean, 50 min). Bleeding was minimal in all cases. No major surgery-related complications were observed. Postoperative hospital stay was limited to one week except for one patient who had experienced a brain infarction preoperatively, caused by migration of an embolization coil. Histological examination confirmed that the arteriovenous malformation foci were completely removed. Pulmonary wedge resection through thoracoscopy is feasible as an alternative treatment for arteriovenous malformation located in the periphery of the lung parenchyma when pulmonary embolization therapy is difficult or unsuccessful.

Adult↗
PubMed2002

Cavitary endoscopy in trauma: 2001.

Laparoscopy and thoracoscopy have been used in the evaluation of injured patients for over 30 years. Despite this long history, indications for use of these techniques remains controversial. The widespread availability of videoscopic equipment which followed the introduction of laparoscopic cholecystectomy increased interest and utilization of minimally invasive techniques in evaluation of trauma patients. Laparoscopy has been most beneficial in the evaluation of hemodynamically stable victims of stabbings and gunshots. This technique has primarily been used to detect peritoneal penetration in tangential wounds of the abdominal wall and for evaluation of the diaphragm in patients with thoracoabdominal wounds. Laparoscopic evaluation in blunt trauma patients is of unproven utility, but has been used in the assessment of patients with documented solid organ injury and in the evaluation of patients with suspected hollow viscus injury. Small subsets of patients are candidates for therapeutic laparoscopic interventions, i.e., suture repair of diaphragmatic lacerations. Thoracoscopy or videoassisted thoracic surgery (VATS) is useful for evaluation of the diaphragm, early evacuation of clotted hemothorax, and assessment of ongoing bleeding.

Emergency Medical Services↗
PubMed2006

Long-term follow-up of thoracoscopic talc pleurodesis for primary spontaneous pneumothorax.

The aim of the present study was to evaluate the long-term outcome of patients with primary spontaneous pneumothorax treated with talc pleurodesis. A follow-up study was undertaken in all patients with primary spontaneous pneumothorax who underwent talc pleurodesis for prolonged air leak or recurrence using thoracoscopy. In total, 112 patients underwent pleurodesis and follow-up data was obtained in 63 (56%) patients: 45 patients were available for clinical follow-up, 14 for telephone follow-up and four were dead. The causes of death were unrelated to the pleurodesis. There were no episodes of acute respiratory failure following pleurodesis. A total of 56 (95%) out of the cohort of 59 patients had a successful pleurodesis. Surgical pleurectomy was required in three (5%) patients for persistent air leak. Median duration of follow-up after talc pleurodesis was 118 months. Long-term success was observed in 53 (95%) out of 56 patients. Recurrent pneumothorax was observed in three (5%) out of 56 patients. Patients with successful talc pleurodesis had a median forced vital capacity (FVC) of 102% and median total lung capacity of 99% at follow-up. Comparing smokers and nonsmokers, the forced expiratory volume in one second (FEV(1)) was significantly lower in smokers and there was a tendency for the FEV(1)/FVC ratio to be lower in smokers. Talc pleurodesis in patients with primary spontaneous pneumothorax via thoracoscopy is an effective procedure associated with normal lung function in patients who do not smoke.

Adolescent↗
PubMed2002

A case of dumbbell tumor of the superior mediastinum removed by combined thoracoscopic surgery.

We report a case of a neurogenic dumbbell tumor in the superior mediastinum resected completely by the combined application of thoracoscopy and neurosurgery performed by an orthopedic surgeon. A 54-year-old female was admitted because her chest X-ray showed a superior mediastinal mass. Computed tomography and magnetic resonance imaging revealed that the tumor was extradural dumbbell-shaped and compressed the spinal cord through the intervertebral foramen between Th2 and Th3. First, she underwent laminectomy of the vertebrae (Th1similarTh3) and separation of the tumor from the dura mater and the root of the second left intercostal nerve in the right semilateral position. Then in the same position, three thoracic ports were placed and the tumor was resected completely using thoracoscopy in a one-stage operation. The pathological diagnosis was neurilemmoma. There has been no sign of serious neurologic deficits or of recurrence four years after the operation. Thus, the procedure is a minimally invasive approach, which is both safe and useful.

Female↗
PubMed1992

Thoracoscopic resection of pulmonary metastases.

OBJECTIVE: To describe the use of thoracoscopic techniques to achieve parenchymal sparing wedge resection of peripheral lung lesions in patients with a history of malignancy, and to describe the morbidity, mortality, and hospital course associated with this approach. DESIGN: Case series. SETTING: University hospital. PARTICIPANTS: Patients with a history of malignancy and lesions on computerized tomography in the outer one third of the lung parenchyma. MAIN OUTCOME MEASUREMENTS: Histologic analysis of resected lung lesions, operative findings, operative time, duration of chest tube drainage and hospital stay, operative morbidity, and mortality. RESULTS: Twenty-one thoracoscopic resections of pulmonary parenchymal lesions were performed on 15 patients. All peripheral lesions identified by computerized tomography were found at thoracoscopy and successfully resected with the Nd:YAG laser (n = 7), an endoscopic stapler (n = 10), or both (n = 4). The mean diameter of the lesions was 0.8 cm (range 0.2 to 1.5 cm). Histologic analysis revealed metastatic disease in 13 patients and benign disease in 2 patients. All resection margins were free of tumor. The mean duration of chest tube drainage and postoperative hospital stay were 1.8 +/- 0.1 and 3.3 +/- 0.1 days, respectively. Mean operative time was 111 min (range 45 to 155 min). One patient who underwent a right thoracoscopic resection developed a transient left vocal cord paresis. There were no other complications and no deaths. CONCLUSION: Thoracoscopy was successful in identifying peripheral lung lesions and allowed for parenchymal sparing resection identical in extent to that performed with open approaches. For select patients with peripheral lung nodules felt to be metastases, thoracoscopic resection may result in reduced morbidity, cost, hospital stay and allow for more rapid institution of therapy for the primary disease.

Adult↗
PubMed1994

CT-guided localizations of pulmonary nodules with methylene blue injections for thoracoscopic resections.

As only peripheral subpleural lesions can be visualized at thoracoscopy, deep nonpalpable pulmonary nodules have to be identified before performing wedge resections. We evaluate the efficiency of computed tomographic (CT) guided methylene blue injections to localize these nodules before their thoracoscopic resection. Twenty-three nodules in 21 patients were preoperatively localized under CT guidance and marked with methylene blue injections. The localizations under CT guidance of the 23 nodules were successful in all cases. The surgeon confirmed accurate localization of 22 nodules. In one case, the injected methylene blue could not be identified during thoracoscopy. Complications of this technique included six cases of asymptomatic pneumothorax, four cases of local and asymptomatic pulmonary hemorrhage, and two cases of fit of coughing. Because of this technique, 22 thoracotomies could be avoided and the duration of the hospital stay was then reduced. Computed tomographic-guided localization with methylene blue injection is a simple, effective, and rapid technique enabling good thoracoscopic surgery results.

Evaluation Studies as Topic↗
PubMed1995

Prevention of malignant seeding after invasive diagnostic procedures in patients with pleural mesothelioma. A randomized trial of local radiotherapy.

The purpose of this randomized prospective study was to assess the efficacy of local radiotherapy in preventing malignant seeding along invasive diagnostic procedures (cytology, needle biopsy, thoracoscopy, or chest tube placement) in patients with malignant pleural mesothelioma. Forty consecutive patients with histologically proven malignant mesothelioma were enrolled. Twenty patients received three daily sessions of radiotherapy at a dosage of 7 Gy 10 to 15 days after thoracoscopy. The other 20 patients did not receive radiotherapy. None of the 20 patients treated developed entry tract metastasis. In contrast, 8 of the 20 (40%) patients who were not treated developed metastases. These findings confirm the efficacy and safety of early local radiotherapy in preventing malignant seeding after invasive diagnostic procedures in patients with malignant pleural mesothelioma.

Aged↗
PubMed1997

Lung herniation through a postthoracoscopy chest wall defect: demonstration with spiral CT.

The incidence of complications following thoracoscopy is approximately 10%, the most prevalent being prolonged air leak and chest pain. We report two cases of lung herniation through the chest wall defect created by thoracoscopy. Use of the Valsalva maneuver during CT scanning is recommended as a diagnostic imaging method in cases with suspected lung herniation.

Endoscopy↗
PubMed1997

The importance of sputum cytology in the diagnosis of lung cancer: a cost-effectiveness analysis.

STUDY OBJECTIVE: To assess the potential health and cost effects of initial testing with sputum cytology to diagnose lung cancer. DESIGN: Cost-effectiveness analysis. DATA SOURCES: Surveillance Epidemiology and End Results (SEER) program; cost data from Northern California Kaiser Permanente Hospitals and Universities of Stanford and Iowa; National Center for Health Statistics; and a MEDLINE search. INTERVENTIONS: The use of sputum cytologies preceding other tests (ie, fine-needle aspiration, bronchoscopy, thoracoscopy) in patients with suspected lung cancer. MAIN OUTCOME MEASURES: Mortality associated with testing and initial surgical treatment (eg, performance of thoracoscopy to remove a local-stage, centrally located cancer), cost of testing and initial treatment, life expectancy, lifetime cost of medical care, and cost-effectiveness. RESULTS: In central lesions, sputum cytology as the first test was the dominant strategy because it both lowers medical-care costs ($2,516 per patient) and lowers the mortality risk (19 deaths in 100,000 patients) of the evaluation without adversely affecting long-term survival. In peripheral lesions, sputum cytology costs less then $25,000 per year of life saved if the pretest probability of cancer exceeds 50%. The estimated annual savings of adopting sputum cytology as the first test for diagnosing lung cancer in the United States is at least $30 million. CONCLUSIONS: Experience in regional centers indicates that sputum cytologic testing is infrequently ordered before implementing invasive diagnostic techniques, even in patients with central lung masses. The study findings suggest that sputum cytology as the first test in suspected lung cancer is likely to be cost saving without adversely affecting patient outcomes.

Biopsy, Needle↗
PubMed1998

Thoracoscopic talc poudrage in malignant pleural effusions: effective pleurodesis despite low pleural pH.

STUDY OBJECTIVE: To determine the effectiveness of pleurodesis by thoracoscopic talc poudrage (TTP) in patients with low pH malignant pleural effusions. DESIGN: Review of prospectively collected data on all thoracoscopic procedures performed from 1982 to 1996. PATIENTS AND SETTING: Twenty-five members in a prepaid, closed-panel health maintenance organization, whose malignant pleural effusion pH was < or = 7.30. INTERVENTIONS: Pleural fluid pH was measured prior to diagnostic and therapeutic, single puncture, rigid thoracoscopy, under local anesthesia, in an operating room. MEASUREMENTS AND RESULTS: Success of pleurodesis was determined with serial radiographs at 10 days, 30 days, and frequent intervals until death or up to 1 year following the procedure. Failure was indicated by evidence of recurrent fluid or persistence of a space between the visceral and parietal pleura. Morbidity of the procedure, days of chest tube drainage, and days of hospitalization were recorded concurrently during hospitalization and outpatient follow-up. Fifty of the 76 patients found to have a pleural pH measurement had a pleural pH >7.30, averaging 7.37 (7.31 to 7.55). The other 26 patients (34%) with pH < or = 7.30 (low pH) are the subjects of this study, of whom 25 were evaluable. Pleurodesis was successful in 22 of 25 (88%), although 4 died prior to 30 days. The three failures all had trapped lung. Chest tube drainage averaged 3.2+/-1.3 days, which approximated the time of hospitalization (3.3+/-1.1 days). There were no thoracoscopy-related deaths; significant morbidity occurred only in one patient with trapped lung, who had prolonged chest tube drainage before and after TTP, and eventually developed empyema. CONCLUSIONS: TTP is an effective pleurodesis technique in malignant pleural effusions, even when the pleural pH is low. The short hospital stay and high success rate make this approach a good choice in palliating symptomatic malignant pleural effusions.

Adult↗