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PubMed2000

Superior vena cava syndrome of malignant origin. Which surgical procedure for which diagnosis?

OBJECTIVE: Since some malignancies causing superior vena cava syndrome (SVCS) are only sensitive to a specific treatment regimen, it is crucial to diagnose the underlying pathology in such cases. The aim of the present study was to review the surgical procedures used to establish the aetiology of SVCS of a malignant origin. METHODS: This retrospective study was based on a series of 88 patients referred to surgeons for SVCS, for whom biological and/or endoscopic procedures had failed to establish the diagnosis. On the basis of the results of clinical examination, biological tests and CT-scan presentation, we performed 99 sampling procedures to obtain a diagnosis for all 88 patients. These procedures were the following: biopsy of peripheral adenopathy (n=11), CT-guided biopsy (CTGB; n=23), axial mediastinoscopy (MDS; n=23), anterior mediastinotomy (n=26), anterior mediastinoscopy (n=6), biopsy of the suprascapular mass (n=3), pericardioscopy (n=3), thoracoscopy (n=1), thoracotomy (n=2) and sternotomy (n=1). RESULTS: Per-operative morbidity consisted of one case of massive venous bleeding during MDS requiring a salvage sternotomy to achieve hemostasis. The diagnoses finally established for the 88 patients were non-Hodgkin's lymphoma (NHL) for 36, small cell lung cancer for 25, non-small cell lung cancer for 17, Hodgkin's disease for five, thymoma for three, germ cell tumour for one and sarcoma for one. For the diagnosis of lung cancer, the sensitivities of CTGB and MDS were 85 and 100%, respectively. For the diagnosis of NHL, the sensitivity of anterior mediastinotomy was 95%. CONCLUSION: The surgical diagnostic procedure, chosen on the basis of the clinical presentation and CT-scan, can be performed safely in the case of SVCS, with the same accuracy as in the absence of this syndrome. Among the patients referred to surgeons, NHL is the most frequent aetiology of SVCS, together with small cell lung cancer.

Adenocarcinoma↗
PubMed2001

Significance of a single pulmonary nodule in patients with previous history of malignancy.

OBJECTIVES: To determine the diagnosis, treatment and follow-up in patients with a solitary lung nodule and a previous primary extrapulmonary neoplasm. METHODS: The authors evaluated the charts of 45 patients with an extrapulmonary malignant neoplasm and a solitary pulmonary nodule. The histologic characteristics of the nodule were correlated with those of the extrapulmonary neoplasm. RESULTS: The histology of the nodule was not known preoperatively in 43 cases (93.5%); in the remaining three cases cytologic examination had shown the presence of atypical cells. The majority of pulmonary lesions (73.9%) were found during the follow-up of the previous tumour, but a significant percentage of nodules (17.4%) were found incidentally. Pre- or intraoperative localisation of the nodule was done in 19 cases (41.3%), and was successful in nine cases (47.4%). Thoracoscopy was performed in 44 patients (95.6%). The coincidence between the pathology of the previous tumour and that of the nodule was 41.3% (19/46). The coincidence rate was 100% for the tumours of ovary, prostate, and sarcomas. CONCLUSIONS: The advent of minimally invasive surgical techniques has made a definitive diagnosis likely, providing also therapy with a less painful engagement for the patient and a less cost for the community.

Adult↗
PubMed2003

Less invasive needle thoracoscopic laser ablation of small bullae for primary spontaneous pneumothorax.

OBJECTIVE: The purpose of this study was to establish a new surgical technique of thoracoscopic laser ablation for the patients of primary spontaneous pneumothorax (PSP) with small bullae, by using endoscopic equipment with a 2-mm diameter. METHOD: According to the size of a bulla identified by high-resolution computed tomography (HRCT), we have a protocol to determine an indication; the conventional video-assisted thoracic surgery (VATS) procedure by both stapler bullectomy and laser ablation to visceral pleura surrounding the bulla (bullae size: greater than 2 cm), or a new VATS procedure using needle shaped thoracoscopy and endoscopic equipment with a 2-mm diameter (needle VATS) by laser bulla ablation alone (bullae size: less than 2 cm). RESULTS: The conventional VATS was performed in 54 patients and needle VATS in 60 patients. In the needle VATS group, operation time was shorter than that of the VATS group (39+/-17 min vs. 56+/-22 min). Use of non-steroidal anti-inflammatory drugs for postoperative wound pain could be reduced in the needle VATS group (3% vs. 56%). There were no complications in the needle VATS group, but three complications (5.6%) in the VATS group, including prolonged air leakage (>4 days) in two and refractory intercostal pain in one. The rate of recurrence after the operation was similar in both groups (3.7% vs. 3.3%). The needle VATS allowed wound healing without a scar and reduced the patient's cosmetic problems. CONCLUSION: The needle VATS procedure for patients with a bulla size less than 2-cm diameter was as useful as the conventional VATS procedure.

Adolescent↗
PubMed2003

Usual and unusual locations of intrathoracic mesothelial cysts. Is endoscopic resection always possible?

OBJECTIVE: Mesothelial intrathoracic cysts are congenital lesions classically located in the anterior cardiophrenic angle (pleuro-pericardial cysts). Locations elsewhere in the thorax are infrequent. The aim of the study was to describe a 10-year, single-institution experience with endoscopic management of mesothelial cysts by video-assisted thoracoscopy (VT) or video-assisted mediastinoscopy (VM), regardless of their location. METHODS: From January 1992 to December 2002, 13 patients (four males and nine females, mean age 49.9 years, range 22-75) underwent surgery for a mesothelial cyst. Information on past history, clinical and radiological presentation, indications for surgery, the surgical procedure and postoperative outcome were collected retrospectively and inserted in a dedicated database. A follow-up visit was performed on December 2002 in all of the patients. RESULTS: In five patients the cyst was in the right cardio-phrenic angle, in three cases it was in the left cardiophrenic angle. Five cysts were located in the mediastinum (right paratracheal space in two cases, anterior mediastinum in one case, paravertebral mediastinum in two cases). Mean lesion diameter was 7.5 cm (+/-4) x 5 cm (+/-2). Cyst density ranged between 1 and 10 Hounsfield units (HU) in 11 patients. It was respectively 38 and 52 UH in the other two patients. All patients were classed ASA 1 or 2 according to the guidelines of the American Society of Anesthesiologists (ASA). Indications for surgery included the presence of symptoms, uncertain diagnosis, practice of a particular sport or professional activity, and radiological evidence of compression of the superior vena cava (namely for the two paratracheal lesions). Eleven patients were operated on by VT. Two patients with a right paratracheal lesions were operated on by VM. Mean operating time was 60+/-14 min (range 45-80). No postoperative complications were recorded. The mean postoperative stay was 4.3+/-1.2 days (5 days for VT and 2.5 days for VM). Pathology studies confirmed the diagnosis of mesothelial cyst in all cases. CONCLUSIONS: Mesothelial cysts have a heterogeneous distribution within the thorax, and nearly 40% are located elsewhere than in the cardiophrenic angle. Endoscopic resection by VT or VM can be proposed as the treatment of choice even for mesothelial cysts in unusual locations.

Adult↗
PubMed1987

Massive idiopathic spontaneous haemothorax. Case report and literature review.

Haemothorax is a well-recognized sequela of chest trauma, ruptured aortic aneurysm, and inadvertent puncture of intrathoracic vessels during cannulation or intercostal chest drain insertions, as well as numerous intrapulmonary, pleural and mediastinal conditions. However, massive idiopathic haemothorax occurring in an otherwise healthy subject is, extremely rare, with only two cases reported so far. We add another case and review the scanty literature for identifiable aetiological and predisposing pathological factors. The pathogenesis is discussed and the management outlined, emphasising the diagnostic and therapeutic value of thoracoscopy.

Biopsy↗
PubMed1997

Ambulatory mediastinal biopsy for hematologic malignancies.

OBJECTIVE: We retrospectively evaluated our experience with outpatient surgical biopsy of mediastinal lesions in patients with hematologic malignancies, its cost-effectiveness and ability to allow diagnosis. METHODS: Eighty patients underwent outpatient surgical biopsy of mediastinal lesions related to hematologic malignancies (50 cervical mediastinoscopies, 24 anterior mediastinotomies and six video-assisted thoracoscopies). Eight patients had a superior vena cava syndrome, five had lesions residuing or relapsing after chemo-radiotherapy and six and had been treated with steroids before diagnosis; in five cases the biopsy had been previously performed at other hospitals without achieving a positive diagnosis. RESULTS: Ambulatory mediastinal biopsy allowed diagnosis in all cases. Fifty-one patients had Hodgkin disease, 28 had non-Hodgkin lymphoma and one had chronic lymphatic leukemia. There was no operative mortality. Complications were: pneumothorax and bleeding during mediastinoscopy and wound infection after anterior mediastinotomy. CONCLUSIONS: Mediastinal biopsy can be safely performed on an outpatient basis in selected patients with mediastinal involvement due to hematologic malignancies. Costs were markedly reduced with respect to in-hospital procedures.

Adolescent↗
PubMed1996

Bronchogenic cysts: a review of 20 cases.

OBJECTIVE: All cases of bronchogenic cysts treated in our center are analysed in order to define its clinical and pathological features. These data are used to determine whether surgical treatment in all cases is justified or whether there is a place for conservative treatment. METHODS: We retrospectively studied the medical records and pathology reports of all patients with bronchogenic cysts (n = 20) referred to our clinic between 1975 and 1993. RESULTS: Fourteen patients (70%) were asymptomatic. Six patients had symptoms because of cyst-related complications (infection or compression). In only 15 patients the diagnosis was established preoperatively. In the other five cases a solid tumour was suspected. All patients were treated by either thoracotomy (n = 19) or thoracoscopy (n = 1). The diagnosis was confirmed by histological examination. One cyst turned out to be degenerated into a squamous cell carcinoma. CONCLUSIONS: We conclude that both the risk of developing cyst-related complications and the even smaller risk of malignant degeneration justify surgical treatment in all cases.

Adult↗
PubMed1996

A prospective risk analysis of contemporary thoracic surgery.

OBJECTIVE: The results of surgical therapy can only be accurately judged if the patients' characteristics and their impact on the outcome are known. The purpose of this study was to identify the risk factors of contemporary thoracic surgery, which could serve as a basis for a risk-matched comparison of different surgical techniques. METHODS: The data of 15 patients' undergoing thoracic surgery were prospectively documented. The outcome of the various operative procedures applied was statistically correlated with the access procedure, sex, age, body mass, dignity of underlying disease and six concomitant diseases. RESULTS: Four patients died within 30 days of surgery (mortality: 2.6%). Morbidity comprising all complications (class I) and morbidity comprising only complications of consequence for postoperative therapy (class II) rose with the number of concomitant diseases (50%/0% with no concomitant disease, 89%/33% with more than three concomitant diseases). Univariate testing identified malignant disease (P = 0.002), male sex (P = 0.003), body mass index of less than 20 and more than 27 kg/m of the expected level according to the Quetelet rule (P = 0.013) and a combination of concomitant respiratory and cardiocirculatory disease (P = 0.022) as being associated with class I morbidity. Male sex was significantly coincident with class II morbidity (P = 0.020). Logistic regression analysis demonstrated that these characteristics also had independent influence on class I morbidity (P = 0.022, P = 0.001, P = 0.023, P = 0.028). CONCLUSION: It is concluded that these characteristics are important predictors of morbidity of thoracic surgery. If a non-randomized comparison of the outcome of thoracic operations or different access strategies like thoracotomy or thoracoscopy is intended, at least these patient features should be documented and used as a basis for matching pairs.

Adolescent↗
PubMed1997

Spontaneous pneumothorax from radiographically occult metastatic sarcoma.

We present two cases of spontaneous pneumothorax secondary to metastatic synovial cell sarcoma. Radiographic techniques initially did not suggest lung nodules in either patients; thoracoscopy allowed sequential bilateral detection of small pulmonary metastases in one case and confirmed the diagnosis during treatment of recurrent pneumothorax in the second case. This report underlines that pneumothorax may be the first clinical manifestation of metastatic sarcoma and can occur even if current imaging techniques are not indicative of metastatic disease. In the latter instance, thoracoscopic exploration has to be envisaged in order to rule out the possibility of metastatic lung involvement.

Adult↗
PubMed1998

Video-assisted minimally invasive coronary bypass surgery without cardiopulmonary bypass.

BACKGROUND: There is a growing interest in cardiac surgery towards minimally invasive approach to coronary bypass operations without cardiopulmonary bypass. PATIENTS AND METHODS: From March 1995 to March 1997, 41 patients underwent a single left internal mammary artery (LIMA) to the left anterior descending artery (LAD) coronary grafting without cardiopulmonary bypass through a small left anterior thoracotomy (MIDCABG). The mean age was 61.2+/-8.7 years (range 43-77 years), 28 patients. were male (68.2%) and the redo rate was 4.8% (2/41). In all patients the coronary artery disease involved the LAD, which was occluded in seven patients (17.1%). Thirty-eight patients (96.2%) selected for MIDCABG had a monovascular disease on LAD not suitable for percutaneous coronary angioplasty; two (4.8%) a bivascular disease, and one (2.4%) a trivascular disease. Skin incision was performed in the 4th anterior intercostal space from the left parasternal line for a 10.5 cm length on average. The LIMA harvesting was partially video-assisted by thoracoscopy. RESULTS: The LAD temporary occlusion was achieved with two double 5/0 polypropilene round-LAD sutures. The mean LAD ischemic time was 22+/-8 min (range 4-35 min). No thoracotomy procedure was changed into a sternotomy approach. We had one (2.4%) perioperative AMI; two patients (4.8%) were reoperated for bleeding. All patients underwent a postoperative angiographic reinvestigation within 1 month after surgery. All anastomoses were perfectly patent but two (4.8%). One patient was reoperated via a sternotomy access recycling the LIMA graft, the other one underwent successful PTCA. All patients also underwent an early and mid-term (6 months after surgery) echo-Doppler study of the LIMA flow and patency. At follow-up, performed at a mean of 8.7 months (range 1-23) after discharge, all patients were alive; no one experienced recurrence of angina. All patients also performed a mid-term negative treadmill stress test. CONCLUSIONS: MIDCABG is, in selected patients, reliable and safe, and offers encouraging early and mid-term clinical results.

Cardiopulmonary Bypass↗
PubMed1998

Myocardial revascularization through a mini-thoracotomy with thoracoscopic assistance.

OBJECTIVE: Left internal mammary artery harvesting through a mini-thoracotomy makes gaining the proximal portion of this vessel very difficult and exposes the patient to the risk of chest wall trauma due to excessive spreading of the ribs. The adoption of video thoracoscopic assistance can give several advantages to the procedure. METHODS: With the patient in a 30 degrees left-side-up thoracotomy position, a 8-12 cm anterior thoracotomy is performed in the left fourth or fifth intercostal space. Two thoracoscopic ports are inserted in the third and fourth left intercostal spaces in the midaxillary line. Complete mobilization of the left internal mammary artery is performed with a mixed surgical and thoracoscopic technique. RESULTS: Since July 1996, 12 patients underwent myocardial revascularization with the left internal mammary artery through a mini-thoracotomy, with the aid of video assisted thoracoscopy. There were no deaths or perioperative infarctions. Mean hospital stay was 4 days (3-6). In nine patients a postoperative angiographic study was performed: in all cases the length of the mammary artery pedicle was adequate; one patient underwent a successful angioplasty on a narrowed anastomosis on the left anterior descending artery. In another patient the left internal mammary artery had been grafted to a diagonal branch. In all other cases angiography showed good results. CONCLUSIONS: Thoracoscopic assistance helps achieving complete mobilization of the left internal mammary artery, maximizing its useful length, without an extended thoracotomy.

Endoscopy↗
PubMed1998

CT-guided methylene-blue labelling before thoracoscopic resection of pulmonary nodules.

OBJECTIVE: Evaluation of the efficiency of our technique of methylene-blue labelling of pulmonary nodules to facilitate thoracoscopic recognition and excision. DESIGN: Patients with a peripheral pulmonary nodule smaller than 2.5 cm and not in contact with the visceral pleura were included. Under tomodensitometric guidance, the nodules were labelled with methylene-blue within hours before thoracoscopic wedge resection. If frozen section revealed a primary bronchial carcinoma, thoracotomy and classical resection were performed during the same anesthesia. RESULTS: Between July 1992 and August 1996, 54 nodules were removed in 51 patients. Labelling was performed between 75 and 270 min before surgery and was complicated in 13 patients (25.4%) by a small pneumothorax without any clinical consequence. Labelling allowed successful thoracoscopic recognition of 50 nodules (92%) and thoracoscopic wedge resection was possible in all but one cases (91%). Five patients (9%) required thoracotomy. Histology showed a benign lesion in 22 cases, a primary lung carcinoma in 17 and a metastases in 15. Twenty of the 22 benign nodules (91%) were removed without thoracotomy. According to the protocol, 13 patients with a primary lung tumour underwent lobectomy during the same session. There was no mortality nor morbidity amongst patients who had thoracoscopy only. CONCLUSIONS: Our technique of labelling peripheral pulmonary nodules with methylene-blue is very effective and is not associated with any relevant complication. Thoracoscopic excision and diagnosis is possible in more than 90% of the cases. We therefore recommend this simple, low-cost and reliable technique for nodules not in contact with the visceral pleura before thoracoscopic wedge resection.

Adult↗
PubMed1998

Video-assisted thoracoscopic surgery: experience with 341 cases.

OBJECTIVE: Until recently, thoracoscopy had been used primarily for diagnostic purposes for more than 80 years in thoracic diseases. In this report we reviewed our video-assisted thoracoscopic surgery experience with 341 cases focusing on indications, operative procedures, complications or failure rates. PATIENTS AND METHODS: Over the last 3 years, we performed 459 video-assisted thoracoscopic procedures. There were 206 male and 135 female patients. RESULTS: The indications were diagnostic in 171 cases, and therapeutic in 170 cases. There were no operative mortality. Non-fatal complications were seen in 15 cases (4.4%). The mean postoperative stay was 5 days. The specific procedures performed were operations on the pleura (237 cases), lung (158 cases), mediastinum (56 cases) and pericardium (four cases). Conversion to thoracotomy was needed in 43 cases (12.6%). Definitive diagnosis was obtained in 100% of patients with pulmonary nodule/mass or diffuse lung disease, and 95.2% of patients with undiagnosed pleural effusions. The success rate of thoracoscopic approach in non-tuberculous thoracic empyema was 87.3%. CONCLUSIONS: Video-assisted thoracoscopic surgery is an ideal procedure in the following situations: (1) undiagnosed pleural effusion, (2) recurrent pneumothorax or bullous lung disease, (3) stage II thoracic empyema, (4) lung cancer staging, (5) peripheral pulmonary nodule, and (6) wedge biopsy for diffuse lung disease.

Endoscopy↗
PubMed1999

Video-assisted thoracoscopic treatment of giant bullae associated with emphysema.

OBJECTIVE: Surgical treatment of bullous emphysema has received renewed attention because of recent advances in minimally invasive techniques. We describe our experience in the thoracoscopic management of patients with bullous emphysema over the last 5 years. METHODS: Twenty-five patients (24 male, one female) with a mean age of 57 years with giant bullae associated with various degree of underlying emphysema, were operated on thoracoscopically at our Institution. The severity of the emphysema was classified according to the criteria of the American Thoracic Society: five patients were in stage I (FEV 1 > 50%), eight patients were in stage II (FEV1 35 to 49%) and 12 patients were in stage III (FEV1 < 35%). Nine patients underwent operation to treat complications related to bullae, 12 presented dyspnoea and four were asymptomatic. We performed 23 unilateral and two bilateral staged thoracoscopic procedures. RESULTS: No intraoperative complications developed. Mean operative time was 107+/-25 min. No patient dead. Mean post-operative chest tube duration was 8+/-4.13 days and mean post-operative hospital stay was 11+/-5.76 days. The most frequent post-operative complication was air-leakage that in 12 patients lasted more than 7 days. Pulmonary function tests were obtained 3-6 months after the operation and statistical comparison between pre-operative and post-operative data was performed using Student's paired t-test. We observed best results in I and II stage patients, but also stage III patients experienced clinical improvement and better quality of life. CONCLUSIONS: Our experience supports the safety and effectiveness of video-assisted thoracoscopy for the treatment of giant bullae. Minimally invasive approach is fully justified especially in the group of patients with severe impairment of lung function.

Adult↗
PubMed1999

Morbidity and validity of the hemiclamshell approach for thoracic surgery.

OBJECTIVE: This is a prospective study to evaluate the indications and outcome of the hemiclamshell incision (longitudinal partial sternotomy combined with an antero-lateral thoracotomy) as used for a consecutive series of patients requiring surgery for various thoracic pathologies not ideally approached by postero-lateral thoracotomy, sternotomy or thoracoscopy. METHODS: All patients with a hemiclamshell incision performed between 1994 and 1998 were prospectively analyzed regarding indications, postoperative morbidity and outcome (clinical examination and pulmonary function testing) in order to validate this incision for thoracic surgery. RESULTS: 25 patients (15 men, 10 women) with an age ranging from 16 to 73 years (mean 43 years) underwent a hemiclamshell incision. The indications for the hemiclamshell approach were (1) chest trauma with massive hemorrhage requiring urgent access to the mediastinum and the ipsilateral pleural space (40%), (2) tumors of the anterior cervico-thoracic junction with suspicion of vascular involvement (28%) and (3) lesions involving both one chest cavity and the mediastinum (32%). The 30-day mortality was 8%. One patient suffered a sternal wound infection, mediastinitis and pleural empyema after a gun shot wound, whereas wound healing was uneventful in all other patients. Analgesic requirements for postoperative pain relief were not increased as compared to those following a standard thoracotomy. At 3 months normal sensitivity of the entire chest wall and intact shoulder girdle function was noted in 90% of the patients. Pulmonary function testing showed no restriction due to the hemiclamshell incision. CONCLUSIONS: The hemiclamshell incision is a useful approach in selected patients and does not cause more morbidity or long-term sequelae than a standard thoracotomy.

Adolescent↗
PubMed1997

No-cut thoracoscopic lung plication: a new technique for lung volume reduction surgery.

BACKGROUND: Lung volume reduction surgery (LVRS) using a linear cutting stapler or laser ablation via median sternotomy or thoracoscopy is a current therapy for symptomatic emphysema. The primary causes of morbidity and mortality (as high as 20%) are existing comorbidities and prolonged air leaks secondary to visceral pleural division. We report a novel technique using minimally invasive techniques designed to achieve volume reduction while preserving the visceral pleura. A novel lung grasper and a knifeless stapler are used to permanently plicate lung tissue without cutting visceral pleura. STUDY DESIGN: This prospective analysis involves a consecutive series of patients who had LVRS using this method. Between May 1995 and September 1996, 32 patients underwent 50 unilateral, staged bilateral, or bilateral thoracoscopic lung plication procedures. The indications for LVRS were standard; they included severe limiting dyspnea (forced expiratory volume in one second [FEV1] = 0.68 +/- 0.05), hyperinflated lungs with flattened diaphragms on chest x-ray, and diffuse emphysema seen on chest computed tomography scan. Ventilation and perfusion scanning was used to identify potential ventilation and perfusion mismatch target areas of lung for plication. RESULTS: The right lung was plicated first in 25 of 32 patients (78%), and upper lobe plications predominated (77%). A mean of 9.3 +/- 0.8 staple firings were used for each unilateral plication procedure. There were no perioperative deaths. Two patients (4%) required axillary thoracotomies to repair air leaks. Mean chest tube duration was 6.3 +/- 0.5 days. Median hospital stay was 7 days (range 3-15). An Intensive Care Unit stay was required following 8 procedures (17%). Postoperative morbidity occurred in 18 (39%) of 46 procedures, including 5 cases of atrial fibrillation and 4 persistent (> 7 days) air leaks. A minimum 2 month followup was available for 22 patients (32 of 46 procedures), demonstrating a clear chest x-ray with significant improvement in ipsilateral diaphragmatic contour. Twelve patients had unilateral reduction, and 10 patients had bilateral reduction in either a staged (n = 7) or sequential at one operation (n = 3) fashion. Twenty-five (78%) of 32 procedures were associated with improved pulmonary function, with a mean increase in FEV1, in patients in this subgroup of procedures, of 43 +/- 7% for each ipsilateral plication at a mean followup of 3.8 +/- 0.5 months. For the entire group of 32 procedures, the mean improvement in measured FEV1 was 29 +/- 7%. Supplemental oxygen requirement was significantly reduced in 9 of 16 patients following plication. CONCLUSION: These data suggest that minimally invasive surgical techniques coupled with a no-cut lung plication can achieve significant lung volume reduction with favorable postoperative morbidity and mortality. Lung plication appears to hold promise as an alternative technique of LVRS.

Humans↗
PubMedDate not supplied

The pathogenesis of port-site recurrences.

The major factors underlying the seeding of tumor cells during laparoscopy are mechanical, with CO2 playing only a secondary role. The peritoneal wound is of great importance, especially in advanced tumor stages, when cells are present within the abdominal cavity. Most reported port-site metastases were found within the extraction port when no protective measures were taken. Gasless laparoscopy is no solution to the problem, since numerous port-site metastases have been described after thoracoscopy, during which no C02 is used. The surgeon's role in the seeding of tumor cells is based on tumor perforation, excessive manipulation, and replacement of trocars. This presumably explains the large differences (0% and 21 %) in the reported incidence of port-site metastases. Prospective studies now show that it is possible to keep the incidence of abdominal wall metastases to about 1%-which is comparable to that seen in open surgery-by the use of a meticulous operating technique and preventive measures.

Abdominal Neoplasms↗
PubMed1997

[Videothoracoscopy in the spreading evaluation of bronchogenic cancers].

Mediastinoscopy is often necessary in management of lung cancer. Progress recently achieved in the field of thoracoscopy has led us to introduce videothoracoscopy as a complement to mediastinoscopy in preoperative management of such tumors. From June 1994 to June 1995, 113 patients presenting with stage I-IIIA lung cancer underwent a videothoracoscopy before surgery. No side-effects were observed. Results obtained in this study lead us to conclude that videothoracoscopy is useful before surgery of lung cancer.

Carcinoma, Bronchogenic↗