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 1,351 records · Page 75Linked to original sources
PubMed2004

Minimal access extrapleural esophagoesophagostomy.

BACKGROUND/PURPOSE: Minimal access repair of esophageal atresia is gaining acceptance but usually requires a transpleural approach. An extrapleural approach using a 2-cm incision has been described. The purpose of this study was to develop a less-invasive approach to extrapleural esophagoesophagostomy. METHODS: A 5-8 kg nonsurvivor piglet model was used to develop this technique. The extrapleural dissection was performed under direct vision utilizing transpleural thoracoscopy. A 16-gauge needle and a spatula were used to create an extrapleural space that allowed insertion of a 3-mm trocar. An 8F catheter with a 3-mL balloon was inserted through the trocar and inflated to create enough space to exchange it for a 5-mm trocar. A 12F catheter with a 5-mL balloon was inserted through the 5-mm trocar and inflated to enlarge the space. These steps were repeated at each of the 3 extrapleural port sites until one confluent extrapleural space was created that did not communicate with the transpleural port site. Esophagoesophagostomy was then completed within the extrapleural space. RESULTS: Thoracoscopic guidance and balloon dissection facilitated creation of an adequate extrapleural working space. CONCLUSIONS: This new minimal access extrapleural approach offers an attractive alternative to the currently described minimal access approaches to esophagoesophagostomy.

Animals↗
PubMed2004

Case of the missing penny: thoracoscopic removal of a mediastinal coin.

Complications of coin ingestion in children, although rare, include esophageal perforation, tracheoesophageal fistula, esophago-aortic fistula, and death. The authors describe thoracoscopic removal of a mediastinal coin that migrated extraluminally from the esophagus in a 23-month-old girl. Right-sided thoracoscopic exploration using a 3-trocar technique in a modified prone position was used. Coin location was assisted by manipulation of a transorally placed Foley catheter and intraoperative fluoroscopy. The coin was retrieved successfully with no intraoperative or postoperative complications and minimal postoperative pain. This is the first report of successful thoracoscopic removal of a mediastinal coin. Thoracoscopy may be a valuable approach for mediastinal foreign body removal in children.

Female↗
PubMed2006

Perinatal management of congenital cystic lung lesions in the age of minimally invasive surgery.

BACKGROUND: Most congenital cystic lung lesions (CCLLs) do not require in utero or perinatal intervention. The management of asymptomatic lesions is controversial: the theoretical risk of infection and malignancy is offset by whether thoracotomy in asymptomatic children is justified. We examined our recent experience and the role of minimally invasive surgery. METHODS: We analyzed the pre-, peri-, and postnatal findings of all consecutive CCLLs diagnosed between 1997 and 2005. We reviewed records for pre-, and postnatal imaging, management, and outcome. RESULTS: Thirty-five CCLL were diagnosed prenatally. Since 2000, all asymptomatic lesions were removed endoscopically at 6 to 18 months (thoracoscopy for 6 extralobar sequestrations, 3 intralobar sequestrations/congenital cystic adenomatoid malformations, 5 bronchogenic cysts, and retroperitoneal laparoscopy for 2 intraabdominal sequestrations). Congenital cystic adenomatoid malformation elements were present in more than 70%. Two abdominal lesions have regressed, and 2 patients are awaiting intervention. One symptomatic infant underwent thoracotomy for congenital lobar emphysema. CONCLUSIONS: It has been argued that the risks associated with congenital lung lesions (infection and malignancy) justify intervention in the asymptomatic patient. In our experience, all these lesions could be safely removed using endosurgical techniques. Counseling of (future) parents should be updated to include minimally invasive surgery in the management algorithm.

Cystic Adenomatoid Malformation of Lung, Congenita↗
PubMed2006

Intraoperative localization of lymph node metastases with a replication-competent herpes simplex virus.

OBJECTIVES: Lymph node status is the most important prognostic factor determining recurrence and survival in patients with mesothelioma and other thoracic malignancies. Accurate localization of lymph node metastases is therefore necessary to improve selection of resectable and curable patients for surgical intervention. This study investigates the potential to identify lymph node metastases intraoperatively by using herpes-guided cancer cell-specific expression of green fluorescent protein. METHODS: After infection with NV1066, a herpes simplex virus carrying green fluorescent protein transgene, human mesothelioma cancer cell lines were assessed for cancer cell-specific infection, green fluorescent protein expression, viral replication, and cytotoxicity. Murine models of lymphatic metastasis were established by means of surgical implantation of cancer cells into the preauricular (drainage to cervical lymph nodes) and pleural (mediastinal and retroperitoneal lymph nodes) spaces of athymic mice. Fluorescent thoracoscopy, laparoscopy, and stereomicroscopy were used to localize lymph node metastases that were confirmed by means of immunohistochemistry. RESULTS: In vitro NV1066 infected, replicated (5- to 17,000-fold), and expressed green fluorescent protein in all cancer cells, even when infected at a low ratio of one viral plaque-forming unit per 100 tumor cells. In vivo NV1066 injected into primary tumors was able to locate and infect lymph node metastases producing green fluorescent protein that was visualized by means of fluorescent imaging. Histology confirmed lymphatic metastases, and immunohistochemistry confirmed viral presence in regions that expressed green fluorescent protein. CONCLUSIONS: Herpes virus-guided cancer cell-specific production of green fluorescent protein can facilitate accurate localization of lymph node metastases. Fluorescent filters that detect green fluorescent protein can be incorporated into operative scopes to precisely localize and biopsy lymph node metastases.

Animals↗
PubMed2004

Pleurodesis in recurrent pleural effusions: a randomized comparison of a classical and a currently popular drug.

STUDY OBJECTIVES: Pleurodesis is generally regarded to give the best palliation in recurrent pleural effusion. Talc is now increasingly recommended but in our department quinacrine has been used successfully for many decades with good results and only minor side effects. It was therefore decided to make a prospective randomized clinical study comparing quinacrine (500 mg) with talc (5 g) with regard to efficacy and safety. METHODS: One hundred and ten eligible consecutive patients with recurrent and or malignant effusions, from 1 March 1996 till 31 March 1999 were randomized to chemical pleurodesis with either talc or quinacrine through a chest drainage tube after medical thoracoscopy. Patients were evaluated with chest radiographs at 2 weeks and 2, 4, and 6 months after pleurodesis. RESULTS: Chi-square test showed 84% power to distinguish between the groups and 10% to determine the primary endpoint. Primary success (fluid production < 50ml/24h within the first 6 days) was 96% of 56 patients with talc and 91% of 54 patients with quinacrine, a non-significant difference (P = 0.46). Quinacrine patients needed a repeated treatment in 31% (17 patients) and talc patients in 7% (4 patients) (P < 0.05). Side effects were minor with no significant difference between the substances. CONCLUSIONS: Both substances are effective. Talc treatment had less often to be repeated. This indicates that the recommendation of talc for pleurodesis is well founded. However, quinacrine is a good alternative.

Antineoplastic Agents↗
PubMed2006

Malignant pleural effusion, current and evolving approaches for its diagnosis and management.

Malignant pleural effusion is a common and debilitating complication of advanced malignant diseases. This problem seems to affect particularly those with lung and breast cancer, contributing to the poor quality of life. Approximately half of all patients with metastatic cancer develop a malignant pleural effusion at some point, which is likely to cause significant symptoms such as dyspnea and cough. Evacuation of the pleural fluid and prevention of its re-accumulation are the main goals of management. Optimal treatment is controversial and there is no universally standard approach. Intervention options range from observation in the case of asymptomatic effusions through simple thoracentesis to more invasive methods such as chemical and mechanical pleurodesis, pleur-X catheter drainage, pleuroperitoneal shunting, and pleurectomy. The best results are reported with thoracoscopy and talc insufflation, with an acceptable morbidity. Development of novel methods to control malignant pleural effusion should be a high priority in palliative care of cancer patients. This article reviews the current, as well as, novel approaches that show some promise for the future. The aim is to identify the proper approach for each individual patient.

Biomarkers, Tumor↗
PubMed2005

Surgical palliative care in thoracic diseases.

Most patients who have end stage thoracic disease have moderate to severe dyspnea. The dyspnea may be the result of the underlying lung disease, localized disease progression, or the accumulation of fluid within the chest. The most effectively treated clinical problem at the end of life is secondary fluid accumulation in the pleural space or pericardial sac. Focused surgical intervention can play an important role in treating effusive disease of the pleura and pericardium. Minimally invasive surgical interventions, such as the use of video thoracoscopy, can relieve dyspnea effectively and improve the quality of life for patients who have end stage thoracic disease.

Disease Progression↗
PubMed2006

Different outcomes between two sides after bilateral sympathetic ganglion interruption for hyperhidrosis.

BACKGROUND: Although the determination of the correct ganglion under direct vision through thoracoscopy by an experienced surgeon is almost unerring, there is still a 4.3% rate of clipping at the unintended level. METHODS: Through the review of the most recent patients (N = 117) with various sympathetic disorders undergoing thoracoscopic sympathetic interruption over different ganglions by clipping, we found that 5 cases were clipped at the unplanned level. The immediate manifestations were the different outcomes between both sides of the face, trunk, and extremities. The postoperative chest radiographs demonstrated the error. RESULTS: All patients received a second operation in which the unintended clip was removed, and a new one was applied to the appropriate ganglion. The results were satisfactory. CONCLUSIONS: Although the authors in this study have the experience of more than 1000 cases of hyperhidrosis, such an error is still inevitable. Luckily, by using the clipping method, the error is detectable and amendable.

Denervation↗
PubMed2004

Management of nephropleural fistula after supracostal percutaneous nephrolithotomy.

OBJECTIVES: Access to complex urinary tract pathology may require supracostal access placing patients at risk for intrathoracic complications. Our objective was to retrospectively review our experience with percutaneous renal surgery with a particular emphasis on identifying the incidence of nephropleural fistula and management of this unusual complication. METHODS: The records of 375 consecutive patients who underwent percutaneous renal surgery between 1993 and 2001 were reviewed. Supracostal access was placed to address the intrarenal pathologic findings most directly in 120 (26.0%) of the 462 tracts, with 87 (18.8%) above the 12th rib, 32 (6.9%) above the 11th rib, and 1 (0.2%) above the 10th rib. RESULTS: Of 375 patients, 4 (1%) developed a nephropleural fistula. Of the 87 with supracostal-12th rib access, 2 (2.3%) developed a nephropleural fistula, and 2 (6.3%) of the 32 with supracostal-11th rib access developed the same complication. The overall incidence of nephropleural fistulas in our patient population per access tract placed was 0.87% (4 of 462 percutaneous tracts), which increased to 3.3% (4 of 120) when considering only supracostal access. All patients were treated conservatively, although 1 patient required thoracoscopy with decortication for persistent pleural effusion. No further sequelae developed in any of the other 3 patients, and all fistulas had resolved at 3 months of follow-up. CONCLUSIONS: As aggressive percutaneous renal surgery with supracostal access to the collecting system becomes more common, the incidence of intrathoracic complications, including nephropleural fistula, may increase. Early recognition and management of a pleural injury is critical to avoid life-threatening situations. Low-morbidity measures are typically successful; however, more aggressive treatment may be required on occasion.

Adult↗
PubMed1992

Endoscopic thoracotomy. A new approach to thoracic surgery.

Thoracoscopy cannot be performed on all patients, but it is the latest application of endoscopy techniques and has many advantages over conventional thoracotomy. Because the procedure is new, not every surgeon may willing to try it, nor are all who try it skilled in the procedure. When successfully performed, it provides the surgical team with the means to eliminate the discomfort and disability patients encounter with a conventional thoracotomy while shortening surgical, anesthesia, and recovery time, and reducing overall patient costs.

Humans↗
PubMed1995

Evaluation of video-assisted thoracoscopic surgery in the diagnosis of diaphragmatic injuries.

BACKGROUND: Injury to the diaphragm from penetrating or blunt thoracoabdominal trauma is notoriously difficult to diagnose. Chest radiography, computed tomography scan, contrast studies, diagnostic peritoneal lavage, and laparoscopy are inadequate; thus, celiotomy is commonly performed in patients with suspected diaphragmatic injury. We compared the diagnostic accuracy of video-assisted thoracoscopic surgery (VATS) with that of exploratory celiotomy in the evaluation of diaphragmatic and thoracoabdominal injury. PATIENTS AND METHODS: Hemodynamically stable patients admitted to a level I trauma center with blunt or penetrating injury to the lower chest or abdomen underwent VATS and subsequent celiotomy under the same general anesthetic. Intraoperative thoracoscopic findings were blinded to the abdominal surgeons. RESULTS: Twenty-six patients were enrolled in the study over a 12-month period. Diaphragmatic injuries were identified in 8 patients (31%). Videothoracoscopy identified all eight injuries in these patients. Six of the 8 patients (75%) with diaphragmatic injuries sustained associated injury to intrathoracic or intra-abdominal organs. There was no mortality and no procedure-related morbidity. There were no missed injuries in patients who underwent VATS. CONCLUSIONS: Video-assisted thoracoscopy is a safe, expeditious, and accurate method of evaluating the diaphragm in injured patients, and is comparable in diagnostic accuracy to exploratory celiotomy.

Adolescent↗
PubMed2000

[Surgery for primary hyperparathyroidism in 1998. Apropos of 66 patients and 3 methods of approach].

STUDY AIM: The aim of this prospective study was to assess the advantages and disadvantages of cervicotomy, selective lateral approach and video-assisted surgery in the treatment of primary hyperparathyroidism (HPT 1). PATIENTS AND METHODS: During 1998, 66 patients were operated on for HPT 1 in the same center. There were 48 women and 18 men (mean age: 58 years, range: 21-84), familial HPT 1 or MEN1 excluded. The interventions were performed via classical cervicotomy (n = 32), via selective lateral approach (n = 8) and were video-assisted (n = 25). A mediastinal adenoma was removed via cervicotomy and another one via left thoracoscopy. The procedure was associated with intraoperative parathormone (PTH) quick-assay. Calcium testing was controlled before leaving the hospital and 2 months later. RESULTS: A double adenoma and 65 single adenomas were confirmed by pathological report. Circulating PTH levels, 20 minutes after removal of the adenoma, always decreased significantly. In video-assisted procedures, there were 11 conversions to open cervicotomy (44%) and morbidity consisted of one case of laryngeal nerve paralysis. At the end of the study, all patients except one had a normal calcium level. CONCLUSION: Video-assisted parathyroidectomy is feasible but requires a preoperative localisation of the adenoma and intraoperative PTH quick-assay. Its main benefit in cervical adenoma is to reduce the scar and in mediastinal adenoma to avoid sternotomy. With the elective approach, results are similar to those of video-assisted surgery and the procedure is much easier to perform. Classical cervicotomy is still the best option in case of previous cervicotomy, of simultaneous thyroidectomy, of negative preoperative imaging and in elderly patients less concerned about cosmetic benefit.

Adenoma↗
PubMed2000

Thoracoscopic treatment of primary chylopericardium.

The development of video-assisted thoracoscopy has changed the practice of thoracic surgery. This report describes a 20-year-old man who successfully underwent thoracoscopic thoracic duct ligation and partial pericardiectomy for primary chylopericardium. We recommend a right-sided thoracoscopic approach to the thoracic duct in the lower thoracic cavity.

Adult↗
PubMed2000

Thoracoscopic plication of diaphragmatic eventration using endostaplers.

Unilateral diaphragmatic eventration and paralysis require plication in cases of progressive dyspnea on exertion and recurrent respiratory infection. The patient, a 40-year-old woman, who had complained of worsening dyspnea on exertion and elevation of the left diaphragm on chest radiographs for 4 years, underwent plication by thoracoscopy with knifeless endostaplers. Improvements in pulmonary functions and dyspnea on exertion have been maintained for 14 months.

Adult↗
PubMed2000

Minimally invasive esophagectomy.

BACKGROUND: Open esophagectomy can be associated with significant morbidity and delay return to routine activities. Minimally invasive surgery may lower the morbidity of esophagectomy but only a few small series have been published. METHODS: From August 1996 to September 1999, 77 patients underwent minimally invasive esophagectomy. Initially, esophagectomy was approached totally laparoscopically or with mini-thoracotomy; thoracoscopy subsequently replaced thoracotomy. RESULTS: Indications included esophageal carcinoma (n = 54), Barrett's high-grade dysplasia or carcinoma in situ (n = 17), and benign miscellaneous (n = 6). There were 50 men and 27 women with an average age of 66 years (range 30 to 94 years). Median operative time was 7.5 hours (4.5 hours with > 20 case experience). Median intensive care unit stay was 1 day (range 0 to 60 days); median length of stay was 7 days (range 4 to 73 days) with no operative or hospital mortalities. There were four nonemergent conversions to open esophagectomy; major and minor complication rates were 27% and 55%, respectively. CONCLUSIONS: Minimally invasive esophagectomy is technically feasible and safe in our center, which has extensive minimally invasive and open esophageal experience. Open surgery should remain the standard until future studies conclusively demonstrate advantages of minimally invasive approaches.

Adult↗
PubMed2000

Buttressing the staple line in lung volume reduction surgery: a randomized three-center study.

BACKGROUND: The intention of buttressing the staple line in lung volume reduction surgery is to reduce air leaks and to shorten the hospital stay. A randomized three-center study was carried out to test this hypothesis. METHODS: Sixty-five patients with a mean age of 59.2 +/- 1.2 years underwent bilateral lung volume reduction surgery by video-assisted thoracoscopy using endoscopic staplers (ET 45B; Ethicon Endo-Surgery, Cincinnati, OH) either without or with bovine pericardium for buttressing (Peri-Strips Dry; Bio-Vascular, Inc, Saint Paul, MN). There were no differences between the control and treatment groups in lung function, degree of dyspnea, and arterial blood gases before and 3 months after LVRS. RESULTS: Seven patients (3 in the treatment group) needed a reoperation because of persistent air leak. The median duration of air leaks was shorter in the treatment group (0.0 day [range, 0 to 28 days versus 4 days [range, 0 to 27 days); p < 0.001), confirmed by a shorter median drainage time in this group (5 days [range, 1 to 35 days] versus 7.5 days [range, 2 to 29 days); p = 0.045). Hospital stay was comparable between the two groups (9.5 days [range, 6 to 44 days] versus 12.0 days [range, 5 to 46 days]; p = 0.14). CONCLUSIONS: Buttressing the staple line significantly shortens the duration of air leaks and the drainage time. As hospital stay did not differ significantly between the two groups, cost-effectiveness may depend on the local situation.

Adult↗
PubMed2000

Three-dimensional video-assisted thoracoscopic pericardiectomy.

Video-assisted thoracic surgery has proven to be safe and effective for the diagnosis and management of pericardial disease. Three-dimensional (3-D) video imaging technology has been developed to allow the laparoscopic surgeon more precision and efficiency in advanced laparoscopic cases. This case report describes the marriage of 3-D video imaging and thoracoscopy that allowed performance of a technically difficult pericardiectomy without incident. Our aim is to describe the use of state-of-the-art 3-D video imaging to allow success in difficult cases.

Adult↗
PubMed2001

Minimally invasive Ivor Lewis esophagectomy.

Ivor Lewis esophagectomy consists of a laparotomy and right thoracotomy for resection of the intrathoracic esophagus. Recent advances in minimally invasive surgical technology have allowed surgeons to apply laparoscopy and thoracoscopy to perform esophagectomy. However, there have been few reports that describe a totally minimally invasive Ivor Lewis esophagectomy. We present a case of combined laparoscopic and thoracoscopic resection of the distal third esophagus with an intrathoracic esophagogastric reconstruction for esophageal carcinoma.

Adenocarcinoma↗