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PubMed1993

Thoracoscopic procedures in children.

Although thoracoscopy was initially reported in 1910, the first specific report in children came in 1976. Over the past 15 years, reports from a small number of institutions have described experience with this technique. For the past 2 years, as pediatric surgeons have become involved with minimally invasive abdominal surgery, there has been renewed interest in the application of endoscopy for thoracic disorders in children, the most common indication for thoracoscopy is evaluation of mediastinal masses. Other common indications include evaluation of localized or diffuse pneumonia, management of pleural diseases such as refractory empyema, and management of recurrent pneumothorax, with either pleurodesis or excision of subpleural blebs.

Adolescent↗
PubMed1996

[Experience with 2 cases of traumatic diaphragmatic hernia occurred at the same time].

Two cases of traumatic diaphragmatic hernia (TDH) which occurred at the same traffic accident, are reported. The first case, a plain chest X-P was diagnostic of TDH. With thoracotomy and additional laparotomy, lacerated diaphragm was repaired. The second case, continual observation on plain chest X-P was useful to suspect TDH, and thoracoscopy was diagnostic. With thoracotomy diaphragm was repaired. Two patients recovered well. It has not been reported that two cases of TDH occurred at same trauma. For diagnosis of TDH, chest X-P is useful for suspicion, and thoracoscopy is useful for correct diagnosis. Surgical approach should be decided in consideration of phase, location, and complicated injuries.

Accidents, Traffic↗
PubMed1996

Video-assisted thoracoscopic surgery (VATS): preliminary experience in Ratchaburi Hospital.

Thoracoscopy is used as an adjunct to traditional diagnostic thoracoscopy. Because of advances in endoscopic surgical equipment and anesthetic technology, surgical treatment via thoracoscopic is now possible. Between June and November 1995, seven male and two female patients underwent thoracoscopic procedures under general anesthesia with a double-lumen endotracheal tube in Ratchaburi Hospital. The procedures for diagnostic purposes included 2 diffuse lung diseases, 1 pleural metastatic disease; and the procedures for therapeutic purposes included 1 case of massive pleural effusion, 2 of clot haemothorax, 2 empyema thoracis, and 1 solitary pulmonary nodule. The thoracoscopic procedures included 2 lung biopsies, 1 pleural biopsy, 2 decortication with removal of blood clots and 2 decortication of empyema, and 1 pulmonary wedge resection. There was no mortality associated with VATS. We believe that the patients have benefited from VATS in reducing post-operative pain, rapid recovery, and decreased scarring of the chest wall. VATS is a minimally invasive surgical technique causing a low morbidity rate and attaining a high diagnostic accuracy.

Adolescent↗
PubMed1996

[Penetrating wounds of the thorax].

From January 1989 to December 1993 at the Institute of Clinical Surgery of the University of Perugia, 5 patients were under observation for penetrating chest injuries. Two of them had show-wounds, one a slash, one a stabbing and slash and one a cutting blow. One of the patients with shot-wounds died on the operating table from a haemorrhage while the other was saved by surgery. One patient successfully underwent surgery for loss of tissue in the thorax walls. Another had a mini-thoracotomy plus lung suture which were successful. Finally, in the patient with a slash in the front region of the thorax and a slight pneumothorax, we inserted a chest thorax tube and so obtained a complete re-expansion of the lung. Total mortality was 20%. Surgical exploration of the thorax we believe is necessary wherever there is a risk of haemorrhage or possible lung damage requiring only surgery. According to many authors, video-thoracoscopy has the advantage of a reliable diagnosis and above all, enable us to repair lung wounds without opening the thorax. In one of our patients we could have avoided the mini-thoracotomy and used thoracoscopy to repair the lung damage.

Adult↗
PubMed1997

[Thoracoscopic truncal vagotomy].

Abdominal re-operation in patients with recurrent peptic ulcer disease is associated with a high morbidity rate and a mortality rate of 5%. As an alternative procedure, therefore, transthoracic truncal vagotomy was early recommended as a less invasive intervention, and good results can be achieved with it. With the development of minimal invasive surgery, this procedure can now be performed via thoracoscopy and patient stress thus reduced even further. Via a left-sided thoracoscopy, the parietal pleura is incised and a 3-5 cm long segment of the distal oesophagus mobilised and dissected free. Both the posterior and anterior trunks of the vagus nerves are identified and, after applying clips, transected. In order to achieve complete vagotomy, further fine branches have to be searched out and, if found, also divided.

Endoscopes↗
PubMed1997

[Limited axillary thoracotomy for recurrent spontaneous pneumothorax].

Recurrent spontaneous pneumothorax often requires surgical intervention. Recently, less invasive thoracic surgical techniques, such as video-assisted thoracoscopy (VAT) and limited axillary thoracotomy (LAT), have been developed and used for different thoracic procedures. We describe our results with limited axillary thoracotomy, as compared with those of video-assisted thoracoscopy as reported in the literature. From October 1994 to May 1996, 14 patients with recurrent spontaneous pneumothorax, aged 16-33 years, underwent limited axillary thoracotomy, resection of blebs and apical pleurectomy, using multifire GIA 80 staplers (Auto Suture Inc.). There were no complications or recurrences during 5-17 months of follow-up. Mean operative time was 52.2 minutes and mean hospital stay 2.3 days postoperatively. Full activity was regained within 12.1 days. In comparison with over 75 cases of VAT from the literature, LAT is safe and offers the potential benefits of decreased operative time, hospital stay and cost.

Adolescent↗
PubMed2000

Minimally invasive cardiac surgery defined.

There is no operation as complex, yet as fundamentally unchanged over time, as conventional coronary artery bypass grafting (CABG). This remarkable achievement is attributed to the operation's adaptability to a wide variety of clinical settings; its reproducibility, although performed by surgeons all across the world; and its proved track record for safety and effectiveness. A monumental effort, however, is currently under way to redefine CABG. This paradigm shift has received a groundswell of support as advances in minimally invasive surgery in other areas, such as arthroscopy, laparoscopic cholecystectomy, and thoracoscopy, combined with an increasing focus on cost containment, have forever changed the milieu of the cardiac surgeon. This review examines the clinical and research issues surrounding minimally invasive CABG from the vantage point of a surgeon-scientist working in the field.

Coronary Artery Bypass↗
PubMed1998

Intrapleural administration of interleukin-2 for the treatment of patients with malignant pleural mesothelioma: a Phase II study.

BACKGROUND: The prognosis associated with malignant pleural mesothelioma (MPM) is poor in spite of surgery, radiotherapy, photodynamic therapy, or chemotherapy. Therefore, new therapeutic strategies, including intrapleural immunotherapy, are being investigated. Several clinical studies have demonstrated objective antitumoral responses to intrapleural interleukin-2 (IL-2) administration in the treatment of malignant pleurisy. The maximum tolerated dose, 24 x 10(6) IU/m2/day for 5 days, was determined in a Phase I study. Based on these results, a Phase II study was conducted, in which intrapleural IL-2 (21 x 10(6) IU/m2/day for 5 days) was given to patients with MPM. METHODS: Patients with histologically documented MPM were evaluated for response 36 days after treatment by computed tomography scan and thoracoscopy with biopsies. Toxicity was recorded and graded according to World Health Organization criteria. Survival was calculated from the start of treatment to death according to the Kaplan-Meier method, and the survival of responders and nonresponders was compared using the log rank test. RESULTS: Twenty-two patients entered this study. Of the 22 cases of MPM, 19 were epithelial, 2 were mixed, and 1 was fibrosarcomatous. Three patients had Stage IA disease, 1 had Stage IB, 16 had Stage II, 1 had Stage III, and 1 had Stage IV (Butchart classification). All patients received their planned treatment. No dose reduction or interruption occurred. There were 11 partial responses and 1 complete response. Stable disease occurred in 3 patients and disease progression in 7 patients. The overall median survival time was 18 months; the median survival time of responders differed significantly from that of nonresponders (28 months vs. 8 months, P < 0.01). The 24- and 36-month survival rates for responders were 58% and 41%, respectively. CONCLUSIONS: These results confirm that intrapleural administration of IL-2 is well tolerated and has antitumor activity in patients with MPM. The authors recommend a dose of 21 x 10(6) IU/m2/day for 5 days. However, determination of the schedule of IL-2 and its superiority to conventional treatment in a Phase III study has yet to be accomplished.

Adult↗
PubMed1995

Minimally invasive surgery in children with cancer.

BACKGROUND: The safety and efficacy of minimally invasive oncologic procedures in children have not been well defined and only limited anecdotal experience has been published. METHODS: A retrospective review of all patients undergoing either a laparoscopic or thoracoscopic procedure at Childrens Cancer Group institutions between December 1, 1991, and October 1, 1993, was performed. RESULTS: Eighty-five children underwent 88 minimally invasive surgical procedures as part of the evaluation or treatment for cancer at 15 participating centers. In 25 patients, laparoscopy was performed and 60 patients underwent 63 thoracoscopic operations. Tissue biopsies were taken in 67 cases and diagnostic material was obtained in 99% of the biopsies. Seven complications occurred, all within the thoracoscopic group. These included conversion of six operations to an open procedure. One patient developed atelectasis postoperatively. CONCLUSIONS: In pediatric patients with suspected cancer, laparoscopy was highly accurate with minimal morbidity; thoracoscopy was nearly as efficient with slightly higher morbidity. Both modalities are useful for assessment of resectability, for staging purposes, and for evaluation of recurrent or metastatic disease.

Adolescent↗
PubMed2002

Surgical versus non-surgical management of pleural empyema.

BACKGROUND: Pleural empyema is a collection of pus between the lungs and the chest wall. Approximately 50% of cases complicate pneumonia. There are a variety of treatment options ranging from intravenous antibiotics alone to open thoracotomy and debridement, depending in part on the stage of the empyema and the severity. The condition changes with time, becoming loculated and more difficult to drain. There is much debate about the most appropriate therapy particularly with the advent of new treatments such as fibrinolytic enzymes (e.g. streptokinase, urokinase) and video-assisted thoracoscopic surgery (VATS). OBJECTIVES: To determine which is more effective for the management of empyema: surgical (e.g. thoracoscopy, thoracotomy) or non-surgical techniques (e.g. thoracocentesis, chest tube drainage) and to establish whether there is an optimum time for intervention. SEARCH STRATEGY: The Cochrane Controlled Trials Register and DARE database were searched in addition to the Cochrane Acute Respiratory Infections Group's own register of trials. A specialised topic search with no language restrictions was used to search MEDLINE and EMBASE using Silverplatter. Bibliographies and the reference lists of identified studies and review articles were handsearched. Personal communication with authors and experts in the field is ongoing. SELECTION CRITERIA: Randomised controlled trials (RCTs) of surgical techniques versus non-surgical approaches for treatment of pus in the pleural cavity in children and adults but not neonates. Studies of empyema associated with tuberculosis or malignancy were excluded. DATA COLLECTION AND ANALYSIS: Trial quality was assessed using Jadad criteria as recommended by the ARI group (Jadad 1996). The primary outcomes were death or resolution of the empyema. Secondary outcomes addressed length of time chest tubes were required, pain, hospital stay and any complications. MAIN RESULTS: Only one small randomised study was identified which met the inclusion criteria. It was conducted in a university thoracic surgery department. There were some methodological quality considerations which cast some doubt on validity ( patient selection, unclear allocation concealment and outcome assessor blinding) and it scored 'B' overall (Jadad score 3). The main results of the study were that when compared with chest tube drainage combined with streptokinase, the video-assisted thoracoscopic surgery (VATS) group had a significantly higher primary treatment success and spent less time in hospital. Each group suffered one mortality. REVIEWER'S CONCLUSIONS: It would appear that for large, loculated pleural empyemas VATS is superior to chest tube drainage with streptokinase in terms of duration of chest tubes and hospital stay. However there are questions about validity and the study is also too small to draw conclusions. There are risks of complications (associated with all treatments) which may not apparent with small numbers. VATS is performed under general anaesthetic and one lung ventilation. Fibrinolytics are also associated with side effects. Further larger multicentre studies need to be conducted.

Chest Tubes↗
PubMedDate not supplied

Choice of procedure for surgical treatment of non-small cell lung cancer.

Asymptomatic coin lesions without specific patterns of benign calcifications can and should have a diagnosis established. Surgical diagnosis can be accomplished with very low morbidity. Accurate staging of lung cancer requires tissue confirmation of mediastinal node status either by thorough sampling or by complete node dissection. Complete resection with lobectomy is the preferred treatment providing better results than lesser resections. Segmental or wedge resections and internal radiotherapy are appropriate for patients unable to tolerate lobectomy. Video assisted thoracoscopy may prove useful in wedge excision for patients with poor pulmonary reserve.

Aged↗
PubMed1996

The thoracoscope as diagnostic tool for solid mediastinal masses.

BACKGROUND: Despite the accuracy of percutaneous biopsy of mediastinal masses under CT scan or sonographic control, there is still a need for surgical biopsy because of difficult location or because of insufficiency of the percutaneous biopsy, especially for those tumors requiring an immunological classification. METHODS: The thoracoscopic approach to mediastinal masses is an alternative to the usual surgical biopsies performed through thoracotomy, sternotomy, or anterior mediastinotomy. The procedure is performed under general anesthesia and one-lung ventilation. RESULTS: In a series of 47 cases, a histological diagnosis was obtained in 44 cases (93.6%). There was one hemorrhagic complication requiring thoracotomy (2.1%). The mean postoperative duration of stay was 3.2 days. CONCLUSIONS: Thoracoscopy is the method of choice in case of failure or contraindication of percutaneous biopsy. There is still a role for mediastinoscopy in treating paratracheal lymph nodes.

Adult↗
PubMed1995

Anterior thoracoscopic epiphysiodesis in the treatment of a crankshaft phenomenon.

We report our first performance of a multiple anterior thoracoscopic epiphysiodesis in the treatment of a crankshaft phenomenon. In the last 2 years, video-assisted thoracoscopy has been introduced as a new therapeutic technique in the field of spinal diseases. Its use has been most documented in the treatment of vertebral abscesses and disc herniations, while its performance in treating deformities is less known. The patient in our case was an 11-year-old boy with a 7-year history of aggressive left thoracic idiopathic scoliosis that had previously needed three subcutaneous instrumentations and finally a Cotrel-Dubousset-instrumented arthrodesis. Following these operations, a continuous clinical and radiographical evolution of the curve was recorded and an anterior T6-T11 video-assisted thoracoscopic epiphysiodesis was therefore performed. The patient did not need postoperative narcotics; Argyle chest tubes were removed after 48h with only 150ml of serohaematic drainage, no blood transfusion was required. One year after the intervention, we found a well-consolidated T6-T11 arthrodesis with no evolution of the deformity. The endoscopic technique allowed us to perform an extensive anterior arthrodesis using only three small incisions, with a reduction of bed-confinement to 3 days and reduced postthoracotomy pain.

Arthrodesis↗
PubMedDate not supplied

Thoracoscopic resection of mediastinal cystic schwannoma.

Mediastinal cystic schwannoma is of very rare occurrence. Our patient came with chest pain of 6 months duration. Abnormal shadow on chest x-ray was found. A sharp dissection space was evident by computed tomography (CT-scan) and magnetic resonance imaging (MRI) between the tumor, the left pulmonary artery, and the descending aorta. The patient underwent surgical removal using thoracoscopic surgery. Postoperative discomfort was markedly reduced and hospitalization short. We can conclude that interventional thoracoscopy is a safe, well-tolerated procedure, with excellent therapeutic potentials.

Diagnostic Imaging↗
PubMed1994

A simple technique for thoracoscopic resection of lung tumors.

Mainly incited by the bushfirelike spread of endoscopic operative techniques in general surgery, thoracoscopy has become the object of new interest in the field of thoracic surgery. Location and resection of lung tumors are problematic for several reasons and so far not standardized. The main problems are pointed out. A new technique together with the instruments and their advantages is demonstrated. Future aspects are discussed.

Humans↗
PubMed1996

Spontaneous pneumothorax in a patient with systemic sclerosis.

A 28-year-old woman developed spontaneously a right- sided pneumothorax, the leading clinical symptom of an as yet undiagnosed systemic sclerosis. The diagnosis was confirmed by Raynaud's phenomenon, microstomia, arthralgia, distal oesophageal dysfunction and antinuclear antibodies. Initial treatment with pleural suction was followed by thoracoscopy and segmental pulmonary resection. Spontaneous pneumothorax is a rare complication in patients with systemic sclerosis, most likely caused by the rupture of subpleural cysts.

Adult↗
PubMed1997

Thoracoscopic enucleation of an esophageal leiomyoma with balloon dilator assistance.

In consideration of the fact that procedures performed thoracoscopically cause less operative trauma and postoperative pain than those performed through an open thoracotomy, we believe that thoracoscopy should replace thoracotomy for the extraluminal transthoracic resection of benign esophageal tumors. We describe herein a new videothoracoscopic technique for performing the enucleation of an esophageal leiomyoma with balloon dilator assistance. The use of the balloon dilator facilitates separation of the tumor from both the mucosal and muscular layers of the esophagus, and may help to prevent perforation.

Adult↗
PubMed1998

Subcarinal neurogenic tumor: report of a case.

We present herein the rare case of a 63-year-old man in whom a subcarinal tumor, demonstrated by enhanced chest computed tomograms (CT), was subsequently confirmed to be a neurilemmoma by histological examination following tumor resection through a diagnostic thoracoscopy. Magnetic resonance imaging (MRI) and transesophageal ultrasonogram findings excluded the possibility of malignant lymphoadenopathy. As the patient was also found to have an elevated level of the squamous cell carcinoma (SCC) tumor marker which did not resolve postoperatively, close follow-up will be required.

Humans↗