Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “THORACOSCOPY”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,153 records · Page 64Linked to original sources
PubMed1986

[Diagnosis of tuberculous pleurisy with special reference to thoracoscopic biopsy findings].

132 tuberculous pleurisies were diagnosed between 578 thoracoscopies from 1970 to June 1985. A histological confirmation of diagnosis was achieved in 51.5% of the specific pleurisies, whereas in 15.2% typical endoscopic findings were present. 33.3% of the diseases were diagnosed based on the clinical and roentgenological appearance or ex juvantibus after antituberculous therapy. An increase of histologically negative biopsies was noted after a pretreatment of more than 4 weeks before thoracoscopy. This fact is interpreted as caused by an increasing exudation of fibrin, which permits to perform a probe-excision only without optical control. If there were macroscopic findings suspicious for pleural tuberculosis a histological confirmation succeeded in 68.8%. In cases with the uncharacteristic picture of "fibrinous pleurisies" the diagnosis of tuberculosis was confirmed morphologically in 33.9%. These investigations support the diagnostic value of the macroscopic criteria in case of pleural tuberculosis which are reported by Sattler.

Biopsy↗
PubMed1984

Malignant mesothelioma of the pleura: clinical aspects and symptomatic treatment.

A series of 140 patients with malignant pleural mesothelioma is reported. Clinical presentation was delayed in cases without a large effusion, but there was extensive tumour at presentation, shown by thoracoscopy, thoracotomy or computed tomography, in all patients investigated. Thoracoscopy was a useful diagnostic alternative to thoracotomy. With progression of disease, mesothelial extension was more important than distant metastases, which were usually too small and sparse to produce symptoms. Skin deposits of tumour in sites of previous invasive procedures did not cause pain or other clinical problems, and we consider that diagnostic and therapeutic procedures should not be withheld to avoid them. In the management of recurrent pleural effusions, intrapleural bleomycin, preceded by aspiration and followed by suction, was a useful alternative to surgery. Pneumothorax, spontaneous or iatrogenic, required decortication. Adequate pain relief was difficult; radiotherapy and nerve blocking procedures were not effective and opiates were often necessary.

Adult↗
PubMed1994

New diagnostic techniques in trauma.

Advances in diagnostic and therapeutic interventions originally intended for use under elective circumstances have been applied to the trauma victim. This review examines the use of three of these techniques--transesophageal echocardiography (TEE), laparoscopy, and thoracoscopy--in the evaluation and treatment of the trauma patient. Initial experiences with TEE show it to be superior to transthoracic echocardiography in the evaluation of the heart. In limited studies, TEE appears to have the sensitivity to use as a screening tool for aortic disruption; however, it is severely limited by its ability to evaluate the distal aorta only. TEE cannot be used to visualize the ascending aorta or brachiocephalic vessels, which may account for 15% to 20% of injuries. Use of laparoscopy has been reported in more than 350 patients. Its primary use appears to be in decreasing negative and nontherapeutic laparotomies associated with penetrating trauma. The ability to operate through the scope continues to increase as additional improvements in instrumentation are introduced. Thoracoscopy has recently been shown to be able to evacuate retained hemothoraces and even drain empyemas and decorticate the pleural cavity.

Diagnostic Imaging↗
PubMedDate not supplied

[Video-assisted thoracic surgery. Current techniques and indications].

Up til recently, thoracoscopy was essentially performed for diagnostic purposes, allowing biopsies of the pleura or peripheral lesions of the lung tissue. Indications with a therapeutic objective were less frequent, usually in cases of recurrent pneumothorax. The recent development of less aggressive, more surgical instruments has virtually "forced" the surgeon to use the thoracoscope. Video thoracoscopy surgery thus entered the therapeutic armenatum. Small access channels less than a centimeter in diameter are used for videothoracoscopy giving an indirect view on the screed of the thoracic contents. Under these conditions, thoracoscopic procedures are possible to treat pneumothorax and resect small pleural or parenchymatous tumours. Inversely, gross resections (lobectomy, pneumonectomy) are technically more complex and raise the nearly unsolvable problem of removing the surgical specimen. In fact, a mini-thoracotomy has been required in many cases, leading to the development of video-assisted thoracic surgery. This new surgical technique is performed via a small incision and is guided by optic probes connected to the video screen. The surgeon can thus follow the entire operation both directly via the mini-thoracotomy and indirectly on the screen. This new approach is an interesting compromise between conventional thoracic surgery and videothoracoscopy.

Humans↗
PubMed1995

[The surgical management of pneumothorax in patients with AIDS].

The occurrence of a pneumothorax occurring as a complication of AIDS is a poor prognostic sign. We have undertaken a review of 26 patients admitted to hospital for a pneumothorax of whom 25 were admitted for therapy: five resolved under simple drainage; twenty required a pleurodesis which was performed on thirteen under video thoracoscopy: these were recurrent pneumothoraces and were bilateral in half the patients; all had failed under simple drainage. The hospital mortality was 30%; the follow-up was unusually long in the majority of cases and only 20% had a simple follow-up. The analysis of this population showed that the results were not tied to the proposed treatment but to the state of the disease and to the pre-existence of pulmonary lesions most often in relation to pneumocystis. Video thoracoscopy enables one to inspect the lung and to resect the diseased area at the origin of the air leak. The technique also enables the pleurodesis to be achieved and a pleural or lung biopsy to be obtained in a relative non-invasive fashion.

AIDS-Related Opportunistic Infections↗
PubMed1994

[Thoracoscopic techniques in treatment of esophageal diseases].

Some malignant and benign diseases of the esophagus are generally treated through a thoracotomic approach. While this may be justified in the curative treatment of cancer, thoracotomy may be avoided for benign diseases if good functional results can be obtained through a minimally invasive approach. Long-term results with careful clinical and manometric monitoring of patients operated on for epiphrenic diverticula have to be considered to define the possible role of thoracoscopic approach to this disease since a laparoscopic approach, which includes transhiatal diverticulectomy, myotomy, and fundoplication, seems to have excellent results. As for leiomyomas thoracoscopy represents the first choice approach since it allows a complete removal of the benign tumor with a limited access. In case of malignant diseases, thoracoscopic esophagectomy has in our opinion few indications. Extent of lymphnodal dissection appears to be the major limiting factor of the technique. Moreover, high-risk patients need anyway a double-lumen intubation and a prolonged single-lung ventilation. Modifications of respiratory function after thoracoscopy have to be compared with those occurring after thoracotomy and after transhiatal esophagectomy. Studies on lymphadenectomy and on respiratory physiopathology will help in define a possible role of this approach.

Carcinoma, Squamous Cell↗
PubMed1994

[Videothoracoscopy, laparoscopy and minimal-access surgery].

Since we start our way in endoscopic surgery, a total of 101 procedures (93 by laparoscopy and 8 by thoracoscopy) have been performed. In two cases (splenectomy, lobectomy) the combination with a minimal enlargement of the wall incision let us remove the entire piece and reduce the operatory time. This is the review of our experience. While the 51.5% of the cases concern to the genitourinary system, the 40.5% of the pathology was digestive and only the 8% was thoracic. The age of the patients ranged between 20 days and 17 years with a clear predominance of the boys. Absence of complications and a high grade of success should do laparoscopy and thoracoscopy frequent surgical procedures in any department of pediatric surgery.

Adolescent↗
PubMedDate not supplied

Thoracoscopic management of malignant pleural effusion.

The results of thoracoscopic biopsy and talc pleurodesis in the management of malignant pleural effusions, is analysed. The study population consisted of 213 patients. Pre-operative cytology was positive in only 27% of patients; the diagnostic yield using thoracoscopic biopsy was 91.5%. (Sensitivity 99%; specificity 100%; positive predicted value 100%; negative predicted value 88%). Talc pleurodesis at thoracoscopy produced symptomatic improvement in 93% of patients. Post-operative complications occurred in 3.7% and there was a 2.3% mortality. Recurrent effusion was not a significant clinical problem. Thoracoscopy enhances the accuracy of diagnosis of pleural effusions; simultaneous talc pleurodesis has a high therapeutic success.

Adult↗
PubMed1993

Video-assisted thoracoscopic excision of intrathoracic masses in children: report of two cases.

Video-assisted thoracoscopy was used to remove a bronchogenic cyst in a 6-year-old boy and a foregut duplication cyst in a 2-year-old girl. Access ports were placed along the site of a proposed thoracotomy incision and chest tube exit site. Thoracoscopic excision was uneventful, and each child left the hospital on the second postoperative day. Video-assisted thoracoscopy has a role in the evaluation and the definitive treatment of intrathoracic masses in children.

Bronchogenic Cyst↗
PubMed1993

[Thoracoscopic interventions].

The technique of minimal invasive surgery has successfully been introduced into the area of thoracic surgery. Surgery of the intrathoracic organs may now be performed without compromise of respiratory mechanics, thus allowing the operative treatment of an ever widening range of pathological conditions. An analysis of our experience (287 thoracoscopic interventions in the last three years) reveals that the diverse procedures performed on the pleura (pleurectomy and pleurodesis), on the lung (wedge resection, fistula closure and ligature of parenchymatous leaks) and on other defined anatomical structures such as the sympathetic nerves or the thoracic duct, are effective in the therapy of intrathoracic disease. The most important pathological conditions which may be treated by thoracoscopy are listed. The range of complications and their causes, which developed in 8% of all procedures, are discussed. The current limitations of this method are defined in the context of the situations where thoracoscopy was discontinued (9 times), a thoracotomy performed (17 times) or a further procedure became necessary (14 times). Current developments and innovations are summarized by a short review of the literature.

Humans↗
PubMed1993

Techniques for localization of pulmonary nodules for thoracoscopic resection.

Significant advances in surgical equipment, video monitoring, and endoscopic surgical techniques have expanded the role of thoracoscopy to include pulmonary resection. One limitation of the thoracoscopic technique is the loss of manual palpation to identify the nodule that is either too small or too deep beneath the pleural surface. We describe the techniques used in 300 thoracoscopic pulmonary resections that have aided in identification of pulmonary nodules. These techniques include careful preoperative assessment of the computed tomogram, preoperative injection of methylene blue, or a needle localizing system to identify the nodule. Intraoperative techniques include instrument palpation, digital palpation, and intraoperative ultrasonography. It should be possible to identify the majority of pulmonary nodules at the time of thoracoscopy with these localizing techniques. All nodules were successfully identified in our last 200 thoracoscopic resections.

Humans↗
PubMed1995

[Use of CT-guided metal wires in pre-thoracoscopic localization of peripheral pulmonary nodules].

The recent developments in thoracic surgery have broadened the application spectrum of thoracoscopy. Video-assisted thoracoscopic lung resection is now available both to diagnose and to treat peripheral pulmonary nodules. A major factor limiting the success of thoracoscopic lung resection is the difficult localization of the pulmonary nodule. When lesions are very small and deep inside the lung, their preoperative detection may be difficult. This study was aimed at investigating the effectiveness of hookwires for CT-guided localization of peripheral pulmonary lesions requiring thoracoscopic resection. In 12 patients 12 nodules, previously detected with chest radiography, were localized with hookwires under CT guidance. Ten of 12 patients underwent thoracoscopic resection for diagnostic purposes, while the extant two patients underwent therapeutic wedge resection. In all patients prethoracoscopic hookwire positioning was successful. In 11 of 12 patients the lesion was accurately localized, while in the extant patient the wire tip was inserted deeper than the nodule. In 3 patients the wire was dislodged before surgery: in all of them a small hemorrhage developed on the visceral pleura and wedge resection was likewise possible. Four patients had a small pneumothorax which was not treated before surgery. In conclusion, percutaneous hookwire localization of peripheral lung lesions is an easy and efficacious technique and promotes thoracoscopy as a less invasive alternative to thoracotomy.

Adenocarcinoma↗
PubMed1995

[Modern examination methods in pneumology].

In addition to qualitative establishment of diagnosis the aim of modern investigational procedures is quantitative analysis of disease extension and of functional impairment. The most important endoscopic-bioptical techniques for establishment of diagnosis are bronchoscopy and thoracoscopy. In bronchology flexible bronchoscopy with a relative share of about 90% clearly holds now a dominant position versus the rigid technique. Suspected cancer is the most prominent indication (ca. 60%). Visible intrabronchial lesions can be diagnosed in more than 90%. In extrabronchial and peripheral bronchopulmonary disease technical aids like transbronchial needle aspiration (TBNA), bronchoalveolar lavage (BAL) or transbronchial biopsy (TBB) are required, resulting in a diagnostic yield, that may range between 30 and 90% depending on the particular disease entity. Thoracoscopy is the second most important endoscopic procedure and accounts for about 1/10 of the investigational frequency of bronchoscopy. Pleural - generally exsudative - effusion provides by far the most frequent indication with a relative incidence of 75%. Etiological diagnosis can be established in about 90% of pleural effusions. The maximum yield of 100% may be achieved in tuberculous effusions, in malignant effusion sensitivity comes close to 100%. Non-endoscopic bioptical techniques include guided perthoracic needle aspiration and "blind" pleural biopsy. Diagnostic escalation or tumor staging may require surgical procedures, which can be performed by conventional techniques (mediastinoscopy, minithoracotomy) or video-assisted thorascopy. Explorative thoracotomy is the most extensive investigation. For functional evaluation of number of "classical" techniques are available (spirometry, gas transfer analysis, spiroergometry) more recently expanded by radionuclide perfusion and ventilation studies. Besides grading of functional impairment they allow clinical diagnosis of diseases characterized by specific functional patterns (asthma, bronchitis, emphysema, sleep associated disorders) and serve preoperative assessment in surgery. Increasingly important modern imaging techniques like computed tomography (CT), nuclear magnetic resonance (NMR) or ultrasonic investigation are not featured in this clinically focused article.

Bacteriological Techniques↗
PubMed1995

[The morphological characteristics of the changes in spontaneous pneumothorax. Thorascopic observation].

The results obtained by thoracoscopy in 58 patients with spontaneous pneumothorax for the period 1990-1992 were discussed. The distribution of the patients by sex was: male--46 (79.31%); female--12 (20.69%). The mean age was 36.5 and the most patients was between 36-45 years (37.95%). The procedure was performed under local anesthesia with neuroleptanalgesia. Right localisation of the pneumothorax we found in 67.24% and left--in 32.76% of the cases. According to the degree of the collapse of the lung the distribution was: total pneumothorax--in 72.41% and partial pneumothorax--in 27.59% of the patients. Thoracoscopy in recidivist pneumothorax was performed in 18.5% from the followed up group of patients. The most often found causes for developing of spontaneous pneumothorax are: bullous emphysema--79.31%; pleural adhesions-in 15.52% and idiopathic pneumothorax--in 5.17%.

Adolescent↗
PubMed1996

Catamenial pneumothorax caused by thoracic endometriosis.

A 28-year-old woman presented with monthly returning thoracic pain and cough. Catamenial pneumothorax was diagnosed. Thoracoscopy showed multiple nodules on the diaphragm, parietal pleura and lung itself, which proved to be thoracic endometriosis. Thoracoscopy is a useful procedure for diagnosis and treatment of this rare condition.

Adult↗
PubMed1996

Role of thoracoscopic lymph node staging for lung and esophageal cancer.

Staging is extremely important in determining the proper treatment of patients with thoracic malignancies. Staging groups can be used to predict outcome after cancer treatment and allocate patients to appropriate treatment regimens. Thoracoscopy is an excellent means of staging intrathoracic malignancies. It is a good tool for biopsy of mediastinal lymph nodes and evaluation of the pleural cavity. Routine thoracoscopic and laparoscopic lymph node staging have been used in patients with esophageal carcinoma with excellent results. For patients with lung cancer, thoracoscopy augments other noninvasive and minimally invasive staging procedures. It is used as a complement to standard cervical mediastinoscopy in assessing mediastinal and hilar lymph nodes. It can thus help avoid an unnecessary thoracotomy for attempted resection in a patient who is found to have gross spread of locoregional disease.

Biopsy↗
PubMed1996

[Spiral computerized tomography and videothoracoscopy in the assessment of contralateral nodular lesions in patients with bronchogenic carcinoma].

Recent improvements in endoscopic technology and surgical techniques have widened the application field of video-assisted thoracoscopy (VAT). We report our personal experience in 14 male patients (mean age: 67 years, range: 55-73 years) in whom one or multiple indeterminate contralateral lung nodules were found during bronchogenic carcinoma staging and then surgically resected with VAT. All patients underwent volumetric CT of the chest. Sixteen lung nodules were detected contralateral to the neoplasm; their mean diameter was 5 mm (range: 2-10 mm). The mean distance between pleural surface and lung nodule was 8 mm. All patients had primary lung cancer (3 central and 11 peripheral lesions), histologically confirmed by bronchoscopic or percutaneous CT-guided biopsy. None of them had any contraindication to surgery because of extrathoracic pathologic conditions. VAT was performed as normal, under general anesthesia, with assisted ventilation with a double-lumen endotracheal tube and using a percutaneous mechanical stapler. The nodules were easier to identify using a skin reference point corresponding to the parietal projection of the nodule, positioned with CT before surgery. Surgery lasted 58 minutes on the average (range: 30-120 minutes). In all patients VAT was successful in resecting the nodule. In 9 patients a metastasis from a contralateral lung cancer was found: 4 adenocarcinomas, 4 epidermoid carcinomas and 1 small cell carcinoma. In the remaining 5 patients, VAT-resected lung nodules were of chronic inflammatory nature. The latter patients underwent definitive surgery of the primary tumor (2 adenocarcinomas, 2 epidermoid and 1 large cell carcinomas) ten days later (range: 9-30 days). There were no major complications but a prolonged air leak in one patient, which needed drainage to be maintained for 5 days. Presently, VAT permits an atypical resection, avoiding the morbility of thoracoscopy and thus represents a mandatory technique in selected patients amenable to definitive surgery.

Aged↗
PubMed1996

Thoracoscopic approach to the diagnosis and treatment of diaphragmatic disorders.

Thoracoscopy was used in the diagnosis and treatment of three patients with diaphragmatic disorders, including traumatic injury of the diaphragm, partial eventration of the diaphragm, and catamenial pneumothorax (endometriosis of the diaphragm). An excellent view of the diaphragm was obtained by using thoracoscopy. The diaphragmatic injury was repaired primarily, the eventration plicated, and the focal endometriosis resected. Recovery was rapid and uneventful in all three patients. Thoracoscopic surgery, although relatively new, may be an acceptable alternative to the conventional operative management of diaphragmatic disorders and may actually reduce the morbidity and mortality associated with thoracotomy.

Adult↗