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At least 1,099 records · Page 61Linked to original sources
PubMed1998

[Thoracoscopic surgery for diagnosis of interstitial pneumonia special reference to medicoeconomical effect].

We compared thoracoscopic surgery (TS) and open thoracotomy for the diagnosis of interstitial pneumonia. Intraoperative blood loss and duration of postoperative chest drainage were significantly less with TS than with thoracotomy. The length of postoperative hospital stay and social insurance costs with TS was significantly less than with thoracotomy. These results show that TS for the diagnosis of interstitial pneumonia is superior to open thoracotomy in terms of surgical stress and cost.

Adult↗
PubMed1998

[Video-assisted thoracoscopic surgery in spontaneous hemopneumothorax].

We retrospectively studied the safety and utility of video-assisted thoracoscopic surgery (VATS) in the treatment of spontaneous hemopneumothorax. Of 128 cases of spontaneous pneumothorax operated on our hospital from April 1988 to October 1997, hemopneumothorax developed in 8 cases (2 cases treated by thoracotomy and 6 by VATS). In all 8 cases, bleeding points and pulmonary bullae were easily found and hemostasis and resection of pulmonary bullae conducted quickly and safely. Two cases of VATS involved elective surgery. Of surgical emergent cases, the duration from visit our hospital to operation and surgical duration in VATS were almost as long as those in thoracotomy. The mean duration of postoperative chest drainage and postoperative hospital stay in VAST were less than in thoracotomy except for a VAST case with persistent air leakage. Blood loss from onset to operation and blood transfusion for VATS were almost equal to thoracotomy. Postoperative duration of analgesic use for VATS were shorter than that for thoracotomy. The VATS case with persistent air leakage should be necessary to reinforce the pulmonary stapled line or to convert to thoracotomy. In all cases, residual hematoma was found in the thoracic cavity. We conclude that early surgical repair should be performed once spontaneous hemopneumothorax is diagnosed and confirmed, and that VATS may be the first choice of surgery because it provides a better view and more facilitated manipulation during surgery than thoracotomy, and is a safe, nonaggressive therapeutic option.

Adult↗
PubMed1999

Video-assisted thoracoscopic esophagomyotomy for achalasia after pulmonary lobectomy.

A 52-year-old man developed achalasia and a lung abscess due to aspiration pneumonia. We conducted a right upper lobectomy by thoracotomy for the abscess and, 2 weeks later, video-assisted thoracoscopic myotomy and fundoplication (modified Belsey Mark IV procedure) though the left thorax for achalasia. Three months after surgery, the patient was free of dysphasia and chest pain and had regained his original weight. Esophageal myotomy and fundoplication using video-assisted thoracoscopy appear to be feasible in treating achalasia involving impaired pulmonary function.

Endoscopy↗
PubMed1999

[Thoracoscopic therapy of pleural empyema after pneumonectomy].

In a 4-year period two right-sided empyemas occurred following a total of 39 pneumonectomies for lung cancer. In another case pneumonectomy was performed for left-sided lung cancer with concomitant empyema as an emergency procedure in a patient referred from an outside hospital. Empyema was treated with repeated thoracoscopic debridements and intermittent lavage with polyvinylpyrrolidine-iodine solution and streptocinase/streptodornase. Three to seven thoracoscopies were required to sterilize the pleural cavity. After a median follow-up of 14 months all three patients are well and without any evidence of infection. VATS is suitable for definitive treatment of postpneumonectomy empyema and is associated with excellent functional and cosmetic results.

Adult↗
PubMed1998

[Thoracoscopic excision of an uncertain intramural esophagus tumor (granular cell tumor/Abrikossoff tumor)].

A granular cell tumor is one of the rare tumors of the esophagus. We present the case of a 65-year-old male patient, who was admitted to our hospital for an elective cholecystectomy. In the routine diagnostic gastroscopy an intramural tumor in the distal esophagus was incidentally found. Repeated endoscopic biopsies did not reveal the histologic diagnosis, although endoscopic ultrasound invasion to the tunica muscularis could not be excluded. After indicating the operative therapy, the tumor was removed through a thoracoscopic approach. The histologic specimen showed a granular cell tumor of the esophagus (tumor of Abrikossoff). Since the tumor grade was unknown, our therapy seemed to be justified because of the low risk involved in minimally invasive operative procedures. There has been much discussion and controversy in the literature on this subject, including the potential for malignancy and the correct therapy regime, with a general shift to conservative or minimally invasive treatment. The case is discussed with a review of the literature.

Aged↗
PubMed1999

[Video-assisted thoracoscopic access in pleural empyema compared with mere chest tube drainage].

Video-assisted thoracoscopic (VAT) debridement is gaining importance in the fibrino-purulent phase of empyema thoracis. However, evaluation of this access compared with mere chest tube drainage or thoracotomy remains unsatisfactory. A total of 356 parapneumonic empyemas from 1986 to 1997 were retrospectively analyzed concerning the results after primary treatment (chest tube 225, thoracotomy 80, VAT 51). The three groups did not differ significantly for gender and associated diseases. Median age of the chest tube drainage group (54 years) was higher than for thoracotomy (43.5 years) or VAT (39 years). Median duration of chest tube treatment after thoracotomy (7 days) was shorter than after VAT (13 days) or chest tube drainage (20 days) (P < 0.0001). The more invasive procedures were also superior to the lesser invasive treatment concerning duration of postoperative hospitalization, recurrence rate and treatment failures. In spite of its better results thoracotomy will be pushed back by VAT in the treatment of empyema thoracis. Acceptance of VAT is reflected in rising numbers of admissions. Based on these retrospective results we are planning a prospective multicenter trial to evaluate the indication for VAT in empyema thoracis.

Adult↗
PubMed2002

[MAC-TL twin screw. A new thoracoscopic implantable stabilization system for treatment of vertebral fractures--implant design, implantation technique and in vitro testing].

Due to the lack of an appropriate instrumentation system for minimally invasive procedures to treat spinal fracture, a new thoracoscopically implantable stabilization system was developed. This report describes the new implant design and implantation technique. In a biomechanical in vitro study, an anterior corpectomy model representing the worst case of burst fracture instability was simulated, and the primary stability parameters of the new system were evaluated in comparison to a dorsal stabilization system. With the interbody graft and fixation, the new system demonstrated higher stabilizing effects in flexion/extension and lateral bending and restored axial stability beyond the intact spine and the dorsal stabilization system. Considering all the advantages of the endoscopic procedure and this biomechanical characterization, the clinical trial is warranted; its usefulness has been demonstrated in more than 150 cases in a multicenter study to date.

Aged↗
PubMed2002

[Mechanical testing of implant properties of thoracoscopic implantation of ventral spinal stabilizing systems. Comparative study with the ISO/DIS 12189-2 corpectomy model and an improved synthetic model].

A new modular anterior fixation system MACS TL (modular anterior construct system for the thoracic and lumbar spine) has been developed for use in thoracoscopic spondylodesis. This system demonstrates high angular stability and meets the surgical requirements for an endoscopic approach. The objective of the current study was fatigue testing of the MACS TL implant system using a corpectomy model according to ISO/DIS 12189-2 and a synthetic model recently developed by Kotani et al. [6]. The MACS TL system demonstrated good mechanical properties with a high stiffness compared to the published data reviewed. The importance of dynamic testing in a corpectomy model has been demonstrated by comparing the MACS TL plate system with an early prototype, which has not yet been clinically evaluated. The corpectomy model according to Kotani et al. offers an interesting alternative to the ISO/DIS 12189-2 test method for asymmetrically designed and antero-laterally positioned spinal implants due to the unconstrained ball joint.

Biomechanical Phenomena↗
PubMed1998

Preliminary application of dynamic pulmonary xenon-133 single-photon emission tomography in the evaluation of patients with pulmonary emphysema for thoracoscopic lung volume reduction surgery.

Dynamic pulmonary xenon-133 single-photon emission tomography (SPET) with three-dimensional (3D) displays was preliminarily applied to select resection targets for thoracoscopic lung volume reduction surgery (LVRS) and to assess regional ventilatory changes following surgery. Dynamic SPET was performed using a triple-detector SPET system in 14 patients with pulmonary emphysema before and after LVRS. After reconstructing colour-illuminated, surface-rendered 3D images of equilibrium (EQ) and 3-min washout (WO3), a single 3D fusion display was created from these two different time-course image sets, in which the 3D WO3 image indicating 133Xe retention was visible through the overlying 3D EQ image delineating lung contours. Volumetric extent of retention on this display was quantified by a 133Xe retention index, defined as the ratio (%) of total pixel numbers of segmented 3-min WO data to those of EQ data. 133Xe SPET and appropriately thresholded 3D displays efficiently localized a total of 36 retention sites; 19 (52.7%) of these sites were not localized by CT because they were within the widely or homogeneously spreading non-bullous emphysematous lung tissues. The 3D displays enhanced the perception of anatomical configurations and the extent of 133Xe retention compared with multislice tomograms. Postoperatively, 3D fusion display visualized the details of regional changes in retention, and changes in the retention index on the 3D display with a standardized threshold correlated well with changes in 133Xe clearance time (T1/2) and %FEV1 (r = 0.881 and 0. 856, respectively; P<0.0001). This preliminary study indicates that 133Xe SPET and appropriately thresholded, topographic 3D displays are of potential use in selecting resection targets for LVRS, and in evaluating the treatment effects on regional ventilation.

Aged↗
PubMed2006

Video-assisted thoracoscopic surgery for recurrent spontaneous pneumothorax: the long-term benefit.

BACKGROUND: Management of recurrent primary spontaneous pneumothorax by open surgery was considered the treatment of choice until recently. The major drawbacks of this management are the prolonged postoperative pain and cosmetic results. In the last decade, video-assisted thoracoscopic surgery (VATS) has replaced the routine use of open surgery. Most papers that compared limited open surgery to VATS addressed the early postoperative results, and studies that assessed the long-term results focused primarily on the rate of recurrence and pulmonary function tests. The aim of this study was to compare the outcome of minithoracotomy and VATS with emphasis on patients' long-term, subjective perspective and satisfaction. METHODS: Medical records of patients with recurrent primary spontaneous pneumothorax were retrospectively reviewed. Patients who underwent surgical treatment by limited thoracotomy (63 patients) or VATS (58 patients) more than 3 years ago were enrolled. Hospital medical charts were used to compare the early postoperative results. Outpatient clinic records and a telephone questionnaire were employed to evaluate long-term results. RESULTS: There was no mortality or major morbidity in either group, and hospitalization time was similar. Patients in the thoracotomy group needed significantly higher doses of narcotic analgesia for a longer period. There were two cases of recurrence in the VATS group (3%). Seventy-eight percent of patients in the VATS and 21% in the thoracotomy group classified their pain as insignificant a month following the operation (P < 0.05). Three years following surgery, 97% of the VATS group patients considered themselves completely recovered from the operation compared with only 79% in the thoracotomy group (P < 0.05). Nineteen percent of the thoracotomy group and 3% of the VATS group suffered from chronic or intermittent pain necessitating use of analgesics more than once a month. Thirteen percent of patients from the open procedure group required services from the pain clinic. Patients in the VATS group were, in general, much more satisfied with their operation and with the surgical scars compared with patients from the thoracotomy group. CONCLUSION: We recommend video-assisted surgery as the first-line surgical treatment for patients with recurrent primary spontaneous pneumothorax. This recommendation is based on its somewhat favorable early postoperative course, the superior long-term outcome, and patient satisfaction.

Adolescent↗
PubMed1999

Thoracoscopic surgery for pulmonary tuberculosis.

Tuberculosis historically was a major impetus for the development of thoracic surgery, and it remains a serious health problem of global proportion. Thoracoscopy was first introduced at the turn of this century for closed chest adhesiolysis as an adjunct to collapse therapy for treatment of tuberculosis. This indication became obsolete with the discovery of streptomycin during the 1940s; and for a long time since then thoracoscopy was used only sporadically for the diagnosis of pleural disease. However, over the last few years, modern video-assisted thoracoscopic surgery (VATS) has provided a new approach to the management of pulmonary tuberculosis. Over the last 5 years we have used VATS for diagnosis or treatment (or both) of 62 patients with pulmonary tuberculosis, including 20 pleural biopsies, 8 decortications, 17 wedge lung resections, 8 drainages of empyema, and 9 lobectomies. There was no surgical mortality, and complications were few. We conclude that VATS provides a safe, effective diagnostic modality (pleural biopsy, wedge resections) and therapeutic modality (decortications, drainage of empyema) for selected patients with pulmonary tuberculosis.

Adolescent↗
PubMed1999

Current status of thoracoscopic lung volume reduction.

Surgical therapy has recently been reintroduced for the treatment of emphysema, and a number of investigators have used video-assisted thoracic surgical (VATS) techniques to accomplish lung volume reduction. The published reports differ with regard to patient selection, preoperative preparation, operative approach, and surgical technique. The results of these reports are reviewed and compared. Thoracoscopic lung volume reduction appears to be a useful part of the surgeon's armamentarium in managing patients with severe pulmonary emphysema.

Humans↗
PubMed2000

Video-assisted thoracoscopic lobectomy achieves a satisfactory long-term prognosis in patients with clinical stage IA lung cancer.

We designed a prospective trial to determine the long-term prognosis of video-assisted thoracoscopic (VATS) lobectomy versus conventional lobectomy for patients with clinical stage IA (T1N0M0) lung cancer. Between January 1993 and June 1994, 100 consecutive patients with clinical stage IA non-small cell lung carcinoma underwent either conventional lobectomy through an open thoracotomy (open group; n = 52) or VATS lobectomy (VATS group; n = 48). Lymph node dissections were performed in a similar manner in both groups. No significant differences were observed in the number of dissected lymph nodes between the 2 groups. Pathologic N1 and N2 disease was found in 3 and 1 patients, respectively, from the open group, and in 2 and 1 patients, respectively, from the VATS group. During the follow-up period, distant metastases and local or regional recurrences developed in 7 and 3 of the open group patients, respectively, and in 2 and 3 of the VATS group patients, respectively. Two and one of the open and VATS group patients developed second primary cancers, respectively. The overall survival rates 5 years after surgery were 85% and 90% in the open and VATS groups, respectively (log-rank test, p = 0.74; generalized Wilcoxon test, p = 0.91). VATS lobectomy with lymph node dissection achieved an excellent 5-year survival, similar to that achieved by the conventional approach.

Aged↗
PubMed2003

Bilateral phrenic-nerve paralysis treated by thoracoscopic diaphragmatic plication in a neonate.

Traditionally, diaphragmatic plication (DP) is performed via a thoracotomy that includes incision of the lower intercostal muscles, which are involved in respiratory movement. This may adversely affect ventilation by causing deterioration of respiratory function and making ventilation less efficient. These problems do not occur with thoracoscopic DP (TDP), since the lower intercostal muscles are left intact. We describe a full-term newborn infant with bilateral phrenic-nerve paralysis (PNP) who was treated by TDP and conclude that this method may be effective in the treatment of PNP even in small infants.

Diaphragm↗
PubMed2002

Thoracoscopic sympathectomy using ultrasonic coagulating shears: a technical improvement in the treatment of palmar hyperhidrosis.

Thoracoscopic sympathectomy has emerged in recent years as the treatment of choice for primary palmar hyperhidrosis when medical treatment fails. Postoperative complications have been reported in large series, however, including neurologic problems such as temporary or definitive Horner syndrome and peripheral nerve injuries. The authors report the use of ultrasonic coagulating scissors instead of electrocautery for the dissection and removal of a segment of sympathetic chain in an 11-year-old girl. A bilateral procedure was performed sequentially through three 5-mm axillary trocars on each side. The use of ultrasonic shears eliminates the risk of distal nerve injury induced by the spread of electric current and could possibly reduce the incidence of the above-mentioned complications.

Child↗
PubMed2004

Thoracoscopic repair of diaphragmatic eventration.

We report a 6-month-old child who presented with recurrent chest infections associated with a right diaphragmatic eventration. Failure in conservative management lead to thoracoscopic plication at 17 months of age and discharge on the third postoperative day. At one year followup he is completely free from all symptoms, and his chest x-ray demonstrates a marked improvement in the position of the diaphragm. We recommend thoracoscopy as a viable approach in treating this condition in children.

Diaphragmatic Eventration↗
PubMed2005

Thoracoscopic diaphragmatic procedures under artificial pneumothorax.

Diaphragmatic plication is technically simple using a conventional operative technique, but it requires a large skin incision and rib injury. We present an alternative technique for thoracoscopic plication of the diaphragm and evaluate the advantages of the procedure. Six patients (five with diaphragmatic eventration and one with diaphragmatic hernia with a sac) ranging in age from 8 to 20 months were treated by this method. Three of the six cases were right-sided, and three were left-sided. The operation was performed under artificial pneumothorax using carbon dioxide gas at 4 mmHg. Three trocars for laparoscopy were inserted at the 4th and 5th intercostal spaces. An adequate operative view was obtained by pressing the diaphragm throughout the operation. The eventrated diaphragm was plicated with several rows of nonabsorbable sutures in the anterolateral-to-posterolateral direction to prevent injury to the main phrenic nerve. A tight diaphragm was confirmed by decompressing the artificial pneumothorax. The technique was successfully performed in all cases, and the patients' postoperative courses were uneventful. During the operation, the hemodynamic effects of carbon dioxide gas at 4 mmHg were minimal. Over a mean follow-up period of 3.1 years (range, 1-6 years), no recurrence of diaphragmatic eventration was seen. Judging from the satisfactory postoperative course, this procedure is suitable for children with all forms of diaphragmatic eventration.

Diaphragmatic Eventration↗