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PubMed2002

[Surgical policy in tuberculous pleurisy].

Two hundred and eighty seven cases of tuberculous pleurisy are analyzed. According to the pleural contents, four phases of development of this disease are identified. These include: 1) free pleurisy; 2) partially encysted pleurisy; 3) encysted pleurisy, and 4) adhesive pleurisy. An algorithm of use of draining procedures and surgical interventions depending on the phase of pleurisy is proposed. Among other things, indications for thoracoscopy that was performed in 66 patients with tuberculous pleurisy for its therapy were stated. Thoracoscopy is ineffective in adhesive pleurisy, in the presence of a rigid residual cavity in particular, and thus preference should be given to thoracotomy with pleurectomy and decortication of the lung. This operation was made in 39 cases. Timely use of draining procedures and surgical interventions make it possible to achieve recovery from tuberculous pleurisy over shorter periods of time and with minimal residual changes.

Adolescent↗
PubMed1992

[Videothoracoscopy in diagnosis and treatment of chronic pleural effusions].

Thoracoscopy is the most important method for the diagnosis, and in particular cases for the treatment, of chronic pleural effusion of unknown aetiology. The Authors report their experience of 4 cases, 2 males and 2 females, that underwent a thoracoscopy from June to December 1992. The method was done in 3 cases in general anesthesia and in one case in local anaesthesia.

Aged↗
PubMed1992

Treatment of recurrent spontaneous pneumothorax.

Thoracoscopy is a natural extension of laparoscopic techniques that have proved to be useful in the treatment of biliary tract disease and other general surgery problems. Similar to the experience with laparoscopic surgery, thoracoscopy also provides for early recovery and return of normal activity. The treatment of spontaneous pneumothorax under thoracoscopic guidance represents a major advance in thoracic surgery. Recently developed endoscopic stapler devices allow for both the excision and closure of ruptured blebs in a fashion identical to the traditional approach with open thoracotomy. Presented in this report are 17 consecutive cases of pneumothorax that were treated using a thoracoscopic approach. No postoperative complications were encountered and no recurrences have been identified. The surgical methods and techniques are outlined.

Adolescent↗
PubMed2003

[Amyloidosis and pleural calcification].

INTRODUCTION: Pulmonary diseases during the course of generalised amyloidosis are principally represented by tracheobronchial involvement and diffuse parenchymal localizations. CASE REPORT: The authors report the case of a 66-year-old woman presenting with pleural amyloidosis in the context of generalised amyloidosis. Thoracoscopy performed in the investigation of recurrent transudative pleural effusions found evidence of an inflamed parietal pleura with areas of calcification. Pleural biopsies confirmed amyloid infiltration pleural ossification. Talc pleurodesis was performed. CONCLUSIONS: The authors' conclusion is that, meeting an unexplained pleural effusion even transudative during the course of a generalised amyloidosis, the thoracoscopy is the diagnosis key test as it allows moreover a pleural pleurodesis to be performed.

Aged↗
PubMed2003

Thoracoscopic thymectomy in children with myasthenia gravis.

Although conservative medical management is the mainstay in the treatment of myasthenia gravis (MG), severest forms of the disease often require surgical thymectomy. Thoracoscopic thymectomy (TT) represents a minimally invasive alternative to traditional thymectomy via sternotomy. We present our preliminary experience with TT as definitive treatment for severe forms of MG. The charts of 5 children (4 girls and 1 boy; age range, 11-17 years) who underwent TT for MG were retrospectively reviewed. TT was typically performed via left thoracoscopy using 4- or 5-mm ports with 1 of the ports enlarged at the end of the procedure for specimen retrieval. Thymic veins were identified and ligated with surgical clips in all cases. Surgical parameters assessed were the following: operating time, intra- and postoperative complications, length of postoperative stay, and resolution of symptoms. Follow-up ranged from 6 months to 2 years. All 5 TTs were successfully completed. In 1 case, right-sided thoracoscopy was added to ensure complete gland excision. Surgical pathology in all cases demonstrated complete excision. Mean operating time was 121 minutes (range 88 minutes to 188 minutes). There were no intra- or postoperative complications. Length of postoperative stay averaged 1.6 days (range, 1 to 3 days). Four of 5 (80%) had clear resolution of symptoms with 1 showing minimal resolution at 6 months. Thoracoscopic thymectomy is a safe and potentially attractive alternative to traditional thymectomy via median sternotomy in severe forms of myasthenia gravis. Complete thymectomy, the goal of traditional surgical treatment for myasthenia gravis, can effectively by achieved via this minimally invasive technique.

Adolescent↗
PubMed2003

Early experience with thoracoscopic sympathectomy for palmar hyperhidrosis.

Excessive craniofacial, palmar and axillary hyperhidrosis can be very distressing in young people, especially in hot climates. In this study, we are presenting our operative experience and the long-term effect of the technique of thoracospic electrocoagulation of the thoracic sympathetic chain in the treatment of this condition. We reviewed the results of 22 thoracoscopies performed on 16 patients at Asir Central Hospital in Abha, Saudi Arabia during the period from January 1999 to December 2002. The patients were 11 males and five females with a mean age of 26.9+/-5 years (range 19-35 years). Except for one patient who presented with post-traumatic, left upper limb chronic regional pain syndrome (CRPS), the rest presented with craniofacial, palmar and axillary hyperhidrosis. In the first 10 patients, sympathectomy was performed unilaterally and in the following six patients it was performed bilaterally in the same sitting. While pneumothorax occurred in three patients (19%), only one patient (6%) required chest tube insertion. During the mean follow-up period of 25.6+/-14.2 months (range 4-47 months), only one patient (6%) presented with recurrent left axillary hyperhidrosis. The patient underwent another thoracoscopy which failed due to lung adhesions and required subcutaneous electrocautery of the sweat glands. In conclusion, thoracoscopic sympathectomy is very effective (94%) in the treatment of palmar and axillary hyperhidrosis with no mortality, minimal morbidity and durable long-term effect.

Adult↗
PubMed2004

[A case of tuberculosis pleuritis with high serum soluble IL-2 receptor].

A 56-year-old man was admitted to our hospital because of bilateral pleural effusion. Computed tomography revealed solitary mediastinal lymphadenopathy, splenomegaly and a small amount of ascites. No lung parenchymal lesion was seen. Although lymphocyte predominance without atypia and a high adenocine deaminase concentration in the pleural fluid were compatible with tuberculous pleurisy, no mycobacteria could be detected either with Ziehl-Nielsen stain or with PCR. Because the serum soluble interleukin 2 receptor (sIL-2 R) level was unexpectedly high (> 8,000 U/ml), and a level not previously reported in benign diseases, we performed thoracoscopy- and mediastinoscopy-assisted biopsies, both of which eventually confirmed the diagnosis of tuberculosis. After a 4-drug anti-tuberculous regimen was initiated, pleural effusion and ascites subsided, with a marked decrease in the sIL-2R level. This case indicates that in tuberculous pleurisy, serum sIL-2R can rise to a level suggestive of hematological malignancies, it and also illustrates the validity of thoracoscopy-assisted pleural biopsy in such situations.

Biomarkers↗
PubMed1992

[Diseases of the pleura. Materials used and study technics].

Pleural diseases frequently pose problems to the pulmonary physician. The clinical and radiological approaches are often insufficient and it is necessary to resort to techniques which enable a precise morphological diagnosis of the pleural lesion. Starting with a needle puncture and biopsy, the medical investigation of the pleura has been enriched by thoracoscopy which enables visualisation of not only the parietal and visceral pleura and the lung but also the mediastinum and the pericardium. Using this technique the diagnostic yield and the harmless nature of the technique are of the first importance. After recording traditional techniques of investigation of lung disease (puncture, needle biopsy) the equipment, the technique, the indications and the risks and the diagnostic results from thoracoscopy are discussed.

Biopsy, Needle↗
PubMed2004

[Hardship of development of mini-invasive surgery: the hard history of sympathectomy].

The authors review the history of sympathectomy in the past more than fifty years and divide the whole course into four stages: thoracotomy, attempting toward mini-invasion, conventional thoracoscopy and video-assisted thoracoscopy (VATS). Emphasis is laid on the difficult course of how this procedure has developed step by step from its original embarrassed 'large incision, small surgery' status to the modern mini-invasion surgery. The fact has proved that it is the modern natural science particularly the development and utilization of modern instruments that has notably promoted, and will continuously promote, the whole surgery toward mini-invasion.

Humans↗
PubMed2005

Two year experience with minimal access surgery at Schneider Children's Medical Center of Israel.

BACKGROUND: The minimal access surgery revolution has only just begun to impact on pediatric surgery, thanks mainly to technologic advances and evidence of the benefits of minimally invasive procedures in this population. OBJECTIVES: To review the current status of MAS in a pediatric tertiary care center in Israel, in terms of feasibility, safety, and effect on standard practices. METHODS: We reviewed the files of all children who underwent a MAS procedure in our department during the period April 2002 to July 2004, and compared the findings with those of children treated by standard practices. RESULTS: A total of 301 procedures were performed in 271 patients: 107 thoracoscopic and 194 laparoscopic. There were no major intraoperative complications. The total conversion rate was 3.65%: 0 for thoracoscopy and 5.6% for laparoscopy (11/194). Twenty-four types of procedures were performed during the study period. The thoracoscopies accounted for 92.24% of all thoracic procedures in the department (107/116), and routine abdominal laparoscopic procedures replaced open surgery in 30-100% of cases (total 44.8%, 194/433). CONCLUSIONS: MAS procedures appear to be safe for a wide range of indications in children. In our center they currently account for a significant percentage of pediatric surgeries. We suggest that the integration of MAS training in the residency programs of pediatric surgeons be made a major long-term goal. The creation of a pediatric MAS study group that would allow for multi-institutional studies is especially important in Israel where a relatively large number of pediatric surgery departments handle a small annual number of patients.

Adolescent↗
PubMed1992

Thoracoscopic treatment of spontaneous pneumothorax without pleurodesis: a preliminary report.

Laparoscopy has shown to be associated with less morbidity than laparotomy. General surgeons are realizing that procedures so far performed through traditional incisions can be equally performed effectively by laparoscopy. Likewise it is apparent that some thoracic procedures are amenable to thoracoscopic approach. With the development of new instrumentation thoracoscopy is effective for the treatment of spontaneous pneumothorax. Pleurodesis seems to increase the morbidity associated with the thoracoscopic procedure and may reduce its effectiveness. Results of 17 consecutive cases of spontaneous pneumothorax treated thoracoscopically without pleurodesis are herein presented. No significant complications were encountered and no recurrences have been identified so far. Pleurodesis was omitted chiefly because it increases the morbidity of thoracoscopy.

Adolescent↗
PubMed2006

Minimally invasive esophagectomy by video-assisted thoracoscopic approach for esophageal carcinoma. A case report.

Esophageal carcinoma represents a pathological entity with a bad prognosis even if adequate multimodal treatment is applied. Because of the high operative morbidity and mortality, due especially to respiratory and infectious complications, the tendency nowadays is to mobilize the thoracic esophagus and to perform esophagectomy and mediastinal lymphadenectomy by thoracoscopy instead of thoracotomy. We present the case of a 55-year-old male patient who was diagnosed with a mediothoracic esophageal spinocellular carcinoma, in whom we successfully performed subtotal esophagectomy by cervico-thoraco-abdominal approach, the dissection of the thoracic esophagus being performed entirely by thoracoscopy.

Esophageal Neoplasms↗
PubMed2006

[Clinical features of thoracic injury; special reference to diaphragmatic injury].

UNLABELLED: We investigated the clinical feature of thoracic injury patients, mainly with diaphragmatic injury. From 1993 to 2005, 739 patients with thoracic injury were treated at our life-saving emergency center. There were more blunt trauma patients than penetrating injury patients (693 cases vs 46 cases). Regarding the thoracic injury patients, the causes of trauma were traffic injury in 462 (62.5%), unexpected accident including work place accident in 153 (20.7%), suicide in 90 (12.2%), and assault in 34 (4.6%). As the numbers of injured organs increased, the mortality rate increased. Among 156 patients with cardiopulmonary arrest on admission, 155 patients died. This result suggested that saving the life of patients presenting with cardiopulmonary arrest on admission is extremely difficult. Thirty-eight cases (5.1%) required surgical treatment, and surgery to repair diaphragmatic injury was performed in 14 cases. In 6 cases of diaphragmatic injury, thoracoscopy was performed during the examination and/or surgery. CONCLUSION: Urgently transporting thoracic injury patients to hospital before the onset of cardiopulmonary arrest is therefore essential in order to reduce the mortality rate of these patients. In addition, thoracoscopy is very useful for both examining and treating traumatic diaphragmatic injury patients.

Diaphragm↗
PubMed2006

[Anesthetic management for left ventricular epicardial lead implantation with minimally invasive thoracoscopic guidance].

Medical treatment for left ventricular (LV) systolic dysfunction and congestive heart failure has improved quality of life for patients but mortality rates have remained unaffected. For a subgroup of such patients with interventricular conduction delays and ventricular contraction dyssynchrony, cardiac resynchronization by placement of a LV epicardial lead is a new approach to management. We report 3 cases in which such electrodes were implanted under the guidance of minimally invasive thoracoscopy. In the first 2 cases it was decided to place the LV electrode using thoracoscopic guidance because of complications or technical difficulties in the percutaneous procedure. In the third case thoracoscopy was used because of deterioration of the patient's condition after implantation of a double-chamber pacemaker and shifting of the lead to the right ventricle. The literature on the anesthetic management of such patients is scarce. Although sedation with general anesthesia and single-lung ventilation is indicated for percutaneous procedures, that technique also proved adequate for the thoracoscopic procedures.

Aged↗
PubMed1990

[Special diagnosis of pleural metastasis].

In 58% of cases diagnosis of pleural metastases is confirmed by identification of malignant cells in pleural effusions. Sensitivity of pleural punch biopsies ranges about the same. Combination of both methods increases success rate up to 75%. Thoracoscopy has a sensitivity of about 89%, charged with complications in 1.7%, and over-shadowed by a lethality of 0.08%. Classical thoracoscopy after Jacobäus has to be differentiated from Maassen's method, using the mediastinoscope. Highest success rates are achieved by means of diagnostics thoracotomy, which in fact is restricted to isolated cases, where previous methods proved unsuccessful.

Biopsy↗
PubMed1989

Diagnostic results in secondary malignant pleural effusions.

The results of thoracoscopy in over 365 secondary malignant pleural effusions are analysed with particular reference to the location of the primary tumour of the metastases and in comparison to "blind" methods. Thoracoscopy had a sensitivity of 95.6%.

Adult↗
PubMed1989

[Pleurodesis with tetracycline hydrochloride in spontaneous pneumothorax].

Treatment of spontaneous pneumothorax aims at avoiding relapses besides achieving immediate reexpansion of the lung. Thoracoscopy should definitely occupy a well-established position in the diagnostic and therapeutic step-by-step schedule. On the one hand, it enables local treatment methods, and on the other it helps in arriving at a decision with regard to the operation. If conditions permit, pleurodesis should be effected via the intrapleural rubber-tube drain, tetracycline hydrochloride having proved very suitable for this purpose. A retrospective review is given on the experiences with thoracoscopy and pleurodesis on the basis of own cases.

Adult↗
PubMed1986

[Pleurisy in blood diseases: value of thoracoscopic poudrage].

Twenty-five pleural effusions which occurred in 21 lymphoma patients (mean age: 50.6 +/- 4.6 years) were treated by pleural poudrage during thoracoscopy. The effusion was either serofibrinous (32%) or haemorrhagic (41%) or chylous (27%). The mean amount of fluid removed before poudrage was 5.2 +/- 0.6 litres. Thoracoscopy confirmed direct pleural invasion in 95.5% of the cases. Permanent pleural symphysis was obtained in all but 2 patients: one who required one single puncture withdrawing 400 cc, the other with mesothelioma on cured Hodgkin's disease, which was a failure. The mean duration of drainage was 4.8 +/- 0.2 days. The results obtained were identical with those reported with pleurisy in solid tumours.

Adolescent↗