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PubMed1993

Thoracoscopy: a useful diagnostic and therapeutic procedure.

This study was performed to review the place of thoracoscopy in the diagnosis and treatment of intrathoracic disorders. A combined retrospective and prospective review was undertaken of the first 50 patients who underwent diagnostic or therapeutic thoracoscopy in Ballarat. Recurrent pleural effusions (29), pneumothoraces (7), or diffuse or localized lung disease (14) were the main indications. Thoracoscopy was performed in conjunction with pleural or lung biopsy, excision of cysts, or pleurodesis. Patient tolerance of the procedure was excellent with minimal postoperative pain. Operative morbidity rates were very low (< 4%). The low mortality rate was related to underlying disease processes. Hospital stay was short. The long-term results were excellent. Adequate tissue was obtained on biopsy in most cases, cure achieved for pneumothoraces, and permanent palliation after talc pleurodesis for malignant effusions approached 80%.

Adult↗
PubMed1993

ICD implantation via thoracoscopy without the need for sternotomy or thoracotomy.

After development of the technique in mongrel dogs, implantable cardioverter defibrillator (ICD) patch and sensing lead implantation was attempted via thoracoscopy, without sternotomy or thoracotomy, in three patients. Two large titanium mesh defibrillator patches and two "screw-in" epicardial sensing leads were applied without difficulty in each of two patients. In a third patient, satisfactory placement of the defibrillator patches could not be achieved via thoracoscopy, necessitating thoracotomy. Defibrillation threshold (DFT), cardioversion energy requirement (CER), and rate and morphology signals in those patients with successful thoracoscopic implantation were comparable to those achieved by open technique. We conclude that ICD patch and sensing lead implantation via thoracoscopy is feasible.

Aged↗
PubMed1981

Thoracoscopy in malignant pleural effusions.

In a consecutive series of 1,000 patients admitted since 1970 for pleural effusions, 215 with undiagnosed chronic effusions (with previous negative cytologic and needle biopsy results) underwent thoracoscopy. The investigation was usually performed under general anesthesia, originally with a 9-mm diameter cold light laparoscope, but, since 1978, with a 7-mm diameter thoracoscope of our design with biopsy forceps connected to a diathermocoagulating device. Thoracoscopy diagnosed 131 of 150 malignant effusions in the series. We observed no false positive results. A repeat pleural cytology and needle biopsy performed the day before thoracoscopy yielded only 41% positive results. The higher yield by our new thoracoscope (97% positive results, versus 78% with the laparoscope) can be accounted for by a better visualization of the pleural space, easier handling of biopsy material, and the systematic use of diathermocoagulation. Complications were rare, minor, and not life-threatening.

Biopsy, Needle↗
PubMed2006

Fluorescein-enhanced autofluorescence thoracoscopy in patients with primary spontaneous pneumothorax and normal subjects.

RATIONALE: The exact site(s) and pathophysiology of air leakage in patients with primary spontaneous pneumothorax (PSP) are unknown. In one patient with PSP, fluorescein-enhanced autofluorescence thoracoscopy (FEAT) has shown areas of parenchymal abnormality unnoticed during white light thoracoscopy (WLT). OBJECTIVES: To prospectively perform and compare WLT and FEAT in patients with spontaneous pneumothorax and in normal subjects. METHODS: One-time FEAT and WLT inspection with systematic mapping of semiquantified lesions in 12 consecutive patients with PSP was compared with one-time FEAT and WLT during sequential bilateral thoracoscopy in 17 control subjects. RESULTS: WLT abnormalities (anthracosis, cobblestone malformation, and blebs/bullae) were more prevalent in PSP. FEAT, however, showed high-grade lesions in PSP only, which often were present at areas that were normal, or that only showed anthracosis at WLT. When blebs/bullae were present, bleb-associated FEAT abnormalities were only present in two. Actual fluorescein leakage was seen in two patients with PSP. CONCLUSIONS: Lungs in patients with PSP show significantly more abnormalities at WLT when compared with normal subjects. High-grade FEAT lesions were exclusively present in PSP, and predominantly at lung zones that appeared normal at white light inspection. These findings suggest that significant parenchymal abnormalities are not limited to lesions visible during WLT, such as blebs and bullae.

Adult↗
PubMed2006

Advanced techniques in medical thoracoscopy.

For expert pulmonologists, advanced procedures in medical thoracoscopy are the nonroutine and more complex applications of the method. The main current indications are the treatment of infected pleural space, forceps lung biopsy and sympathectomy. In parapneumonic effusions and empyema, medical thoracoscopy is as a drainage procedure, intermediate between tube thoracostomy and video-assisted thoracoscopic surgery (VATS), which is efficient, significantly lower in cost and avoids surgical thoracoscopy under general anaesthesia. It is essential that it is performed early in the course of the disease and is particularly advisable for frail patients at high surgical risk. The efficacy of forceps lung biopsy has been demonstrated in diffuse lung diseases, whereas results in localised lung diseases and chest-wall lesions have been less positive. However, VATS is currently the preferred approach for these indications. The technique still maintains its efficacy for visceral pleura and peripheral lung biopsy, in particular in the presence of pleural effusion and lung disorders. At the present time, thoracoscopic sympathectomy is minimally invasive and is an accepted intervention for patients with a variety of autonomous nervous system disturbances. Essential hyperhidrosis patients, and well-selected patients with other disorders, can be helped with this procedure, which can also be performed by interventional pulmonologists.

Biopsy↗
PubMed1994

Nd-YAG laser pleurodesis via thoracoscopy. Endoscopic therapy in spontaneous pneumothorax Nd-YAG laser pleurodesis.

From January 1986 to February 1993, 85 patients with spontaneous pneumothorax were treated in our department by a new endoscopic procedure using an Nd-YAG laser beam via thoracoscopy to obtain permanent pleurodesis and to treat the lung lesion responsible for the air leak. The 55 men and 30 women ranged in age from 16 to 51 years (mean age 26 years). Under general anesthesia the thoracoscope was introduced through a 1-cm incision in the anterior axillary line of the fourth intercostal space. In 68 patients small blebs (less than 2 cm in diameter) were detected and successfully resected with low power Nd-YAG laser pulses. In two patients found at thoracoscopy to have lesions larger than 2 cm, the Nd-YAG laser failed to seal the air leak and thoracotomy was performed. Air leaks were not detected at endoscopy in the remaining patients. After treatment of the lung lesions, the parietal pleura was abraded by using the laser energy. There were no side effects. Eighty patients were treated successfully without recurrence (maximum follow-up 86 months). Three other patients developed recurrence of pneumothorax after 5, 6, and 24 weeks, and surgery was considered mandatory in 2 of them. At thoracotomy, in both patients, a small bleb was detected in the lower lobe and resected. The whole upper lobe was strongly adherent to the parietal pleura in the site of previous laser abrasion. The authors conclude that Nd-YAG laser via thoracoscopy should be considered as a viable therapeutic option in patients with spontaneous pneumothorax.

Adolescent↗
PubMed2000

Diagnosis and treatment of mediastinal tumors by thoracoscopy.

OBJECTIVES: Thoracoscopic management of mediastinal tumors is still subject to analysis. Seventy-three patients underwent thoracoscopy for treatment of mediastinal masses and were analyzed retrospectively in order to evaluate the effectiveness and complications of the procedure. METHODS: Between 1983 and 1999, 21 conventional thoracoscopies and 52 video-assisted thoracic surgeries were performed (33 for diagnostic purposes and 40 for therapy). Patient ages ranged from 2 to 81 years (mean, 43.8 years) with a slight predominance of girls and women over men and boys (41 vs 32, respectively). All patients underwent general anesthesia using simple intubation (22 patients) or double-lumen intubation (51 patients). RESULTS: The histologic type of tumors was obtained in all patients. For therapeutic purposes, a change of procedure to thoracotomy was necessary in nine patients. The reasons for this change were tumor size, tumor invasion of nearby structures, difficulties in continuing the dissection, the performance of an upper lobectomy, and suturing the iatrogenic lesion of the diaphragm. Four patients died during the first 30 postoperative days as a consequence of their primary pathology. CONCLUSION: Thoracoscopy was confirmed as an effective diagnostic and therapeutic alternative for the treatment of mediastinal disorders.

Adolescent↗
PubMed2002

Use of thoracoscopy to determine the etiology of pleural effusion in dogs and cats: 18 cases (1998-2001).

OBJECTIVE: To assess use of thoracoscopy to determine causes of pleural effusion in dogs and cats. DESIGN: Retrospective study. ANIMALS: 15 dogs and 3 cats with pleural effusion. PROCEDURE: Medical records were reviewed from 1998 to 2001 for dogs and cats that had exploratory thoracoscopy, biopsy, and histologic analysis to determine the etiology of pleural effusion. Intraoperative and postoperative complications were recorded. Surgical biopsy specimens were evaluated for quantity and quality for providing a histologic diagnosis. RESULTS: Biopsy specimens were deemed adequate in quantity and quality to render a histologic diagnosis in all animals. Etiology of the effusion was neoplasia in 8 animals and non-neoplastic pleuritis in 10 animals. Median survival time of animals with neoplasia was 15 days, whereas those with inflammatory diseases had median survival time of > 785 days. Postoperative pneumothorax was encountered in 2 animals subsequent to pulmonary biopsy. No other major complications were recorded. CONCLUSIONS AND CLINICAL RELEVANCE: Thoracoscopy is a diagnostic option that provides excellent viewing of intrathoracic structures and adequate biopsy specimens with minimal complications. This technique provides a less invasive alternative to thoracotomy for evaluating the etiology of pleural effusion.

Animals↗
PubMed1999

[Video-assisted thoracoscopy for resecting solitary pulmonary nodules].

The objective of this study was to evaluate the usefulness of video assisted thoracoscopy in the resection of solitary pulmonary nodules. Thirty-three patients with solitary pulmonary nodules diagnosed by video assisted thoracoscopy were enrolled prospectively. A preoperative computed tomography scan was obtained for each patient. Harpoons were implanted preoperatively to locate the lesion in patients whose tumors were in the parenchyma. When endoscopic resection proved impossible in five patients, the surgeon resorted to thoracotomy. All were diagnosed after the procedure. One was a case of pulmonary lymphoma, 2 were primary adenocarcinomas of the lung, 2 were oat-cell cancers, 1 was Wegener's disease, 4 were tuberculomas, 3 involved pulmonary infarction and 20 were single pulmonary metastases. Patients who needed thoracotomy required more days of postsurgical drainage (p < 0.05). The size of resected nodules ranged from 0.4 to 6 centimeters. Preoperative positron emission tomographs were available for four patients. No perioperative (< 30 days) mortality occurred and morbidity consisted of one case of prolonged airway leak (> 7 days). Use of video-assisted thoracoscopy reduced perioperative morbidity and hospital stay.

Adolescent↗
PubMedDate not supplied

Video-assisted thoracoscopy in the management of recurrent spontaneous pneumothorax in the pediatric population.

BACKGROUND AND OBJECTIVES: The purpose of the present study was to evaluate the application of video-assisted thoracoscopy in the management of recurrent spontaneous pneumothorax in the pediatric population. PATIENTS AND METHODS: Between 1995 and 1997, four patients with recurrent spontaneous pneumothorax were treated. Ages varied from 14 to 17 years. There were three males and one female. Two patients had spontaneous pneumothorax twice, and the other two had it three times. Three patients had primary spontaneous pneumothorax, and the fourth one had spontaneous pneumothorax secondary to cystic fibrosis. Computerized tomography of the chest demonstrated blebs in two patients, and in the other two it was suggestive of apical blebs but not definitive. All patients had failed treatment by tube thoracostomy. Video-assisted thoracoscopy demonstrated blebs in all patients. Removal was easily accomplished with an endoscopic automatic stapling device. The procedure was completed with mechanical pleurodesis, multiple intercostal blocks and intrapleural bupivacaine for control of pain. RESULTS: All patients had a quick and uneventful recovery. Follow-up ranged from one to three years. There were no complications or subsequent recurrences of the pneumothorax. CONCLUSIONS: Video-assisted thoracoscopy is a safe and effective technique in recurrent spontaneous pneumothorax. It allows for accurate identification and removal of the blebs, with quick recovery, minimal discomfort and good cosmetic results.

Adolescent↗
PubMed2003

[Thoracoscopy in surgery of thoracic wounds].

One hundred and sixty-eight thoracoscopic operations were performed in patients with closed (47.5%) and open (52.5%) trauma of the chest. Thoracoabdominal injuries were diagnosed in 23.9% patients. Thoracoscopic surgeries were performed in 79.8% patients, surgeries from the mini-approach - in 17.3%. Injuries uncorrectable by endosurgically were diagnosed during thoracoscopy in 2.9% patients. Indications for urgent thoracoscopy in thoracic injuries are the following: 1) middle and small hemothorax or hemopneumothorax; 2) suspicion for heart wound; 3) suspicion for diaphragm injury; 4) tense pneumothorax. Surgical policy and technique of endosurgeries in open thoracic trauma are optimized. Up-to-date surgical policy based on thoracoscopy permitted us to improve results of surgical treatment: to reduce lethality by 4.7%, number of complications - 2.9 times and completely avoid unjustified 'diagnostic' thoracotomies. Mini-invasive surgical methods promoted early rehabilitation of patients with trauma of the chest.

Emergencies↗
PubMed2005

A case of diffuse pleural mesothelioma in which contralateral exploratory thoracoscopy assisted the selection of therapy.

Diffuse pleural mesothelioma is a rare condition with a poor prognosis. Recent reports have indicated that extensive surgery combined with chemotherapy and radiotherapy prolongs the survival of selected patients with early disease. Thoracoscopy allows complete visualization of the pleural cavity and provides high-quality biopsy samples. We present a case of successful diagnosis of bilateral pleural mesothelioma by thoracoscopy. It is important to observe the contralateral pleural cavity by thoracoscopy to confirm the presence or absence of a tumor before considering extrapleural pneumonectomy for mesothelioma.

Aged↗
PubMed1991

Diagnostic thoracoscopy in a patient with a pleural mass.

Thoracoscopy is useful for diagnosing and treating pleural and parenchymal intrathoracic disease. The role of thoracoscopy is especially evident in patients who pose a high risk for thoracotomy. Although used in the past for diagnosis and occasional treatment of pleural adhesions, it is not a frequently used procedure. With double lumen endotracheal tubes for selective collapse of one lung, there seems to be an increasing role for thoracoscopy in diagnosis and management of pleural disease. With the use of new endoscopic linear staples, treatment as well as diagnosis of intrathoracic diseases will be possible in the future.

Aged↗
PubMed2006

[The value of thoracoscopy for diagnosis and management of refractory hepatic hydrothorax].

OBJECTIVE: To study the value of thoracoscopy for diagnosis and management of refractory hepatic hydrothorax (HH). METHODS: Twenty-six patients with refractory HH were enrolled in this study. Twenty-four of them underwent therapeutic thoracoscopy to achieve pleurodesis by application of talc poudrage. RESULTS: Nineteen of the 26 patients had dilated chest wall veins, 6 had dilated azygos veins, and 16 had diaphragm blebs. Of the 24 patients who received pleurodesis via thoracoscope, 14 cases showed complete response, and 8 showed partial response. Mild chest pain and temperature elevation were the most complaints during or after the procedure. Liver function abnormalities were the most serious side effects after pleurodesis. During the follow-up period ranging from 6 months to 3 years, 1 patient died of upper gastrointestinal hemorrhage and encephalopathy in 1 month, 3 patients died of hemorrhage in 6, 12, 18 months respectively, and 1 case experienced recurrence in 18 months. CONCLUSIONS: Defects in the diaphragm seemed to be the main cause for the development of HH. Pleurodesis achieved by thoracoscopy and talc poudrage was effective in the treatment of HH, but complications and impaired liver functions should be considered.

Adult↗
PubMed1990

[Diagnostic and therapeutic thoracoscopy in spontaneous and traumatic pneumothorax].

224 thoracoscopies were performed to patients with spontaneous and traumatic pneumothorax. Curative thoracoscopy (diathermocoagulation, laser coagulation) was performed in 93 patients, in 42 patients medical glues were used. Out of 93 patients who had been subjected to curative thoracotomy endoscopic operations gave no effect in 5 patients only. Complications after thoracoscopy were noted in 4 patients (2 patients had exudative pleurisy, 2 patients had subcutaneous emphysema).

Adolescent↗
PubMed1990

[Results of thoracoscopy in localized lung and chest wall diseases].

On the basis of 109 thoracoscopic examinations--out of a total number of 1,014 thoracoscopies performed between 1981 and 1986 at our Department--carried out to investigate localised disorders of the lungs and wall of the chest, the diagnostic effectiveness of the method for this indication has been examined. The lesions involved were 59 pulmonary foci, and 50 localised changes involving the wall of the chest, thoracic spine or diaphragm. With the aid of thoracoscopy, the diagnosis proved possible in 83% of the disorders of the chest wall, in comparison with only 46% in the case of the pulmonary lesions, since the focus is often not sufficiently sub-pleural in location, or else pleural adhesions that presented impaired the view. On the basis of the high diagnostic yield in localised diseases of the thoracic wall, thoracoscopy should be considered for this indication in particular, when clarification of the situation is not possible with radiological procedures, and surgery appears unnecessary or not feasible.

Humans↗
PubMed1989

[The history and development of thoracoscopy].

The development of thoracoscopy is closely connected with the history of the artificial pneumothorax, of pleural suction drainage and of endoscopy. After its introduction in 1910 by Jacobaeus thoracoscopy was at first used mainly for therapeutic purposes (thoracocausty). With the onset of drug treatment of tuberculosis and the end of the area of pneumothorax therapy thoracoscopy was increasingly used as a diagnostic method. Today it is second in importance only to fibre bronchoscopy in pneumology.

Europe↗
PubMed1989

[Indications for thoracoscopy in secondary spontaneous pneumothorax].

Secondary spontaneous pneumothorax (SP) is an indication for thoracoscopic exploration and treatment just like primary SP. The same guidelines apply to both. During the last 12 years a total of 243 patients with SP were admitted to our Department of Pneumology; of these, 156 = 62.2% were treated by thoracoscopy. We employed an operation method described by Youmans et al. that we modified for thoracoscopy, namely, pleural abrasion. The relative number of thoracoscopies rose during 1975-1980 from 47% of all SP to 75% during 1981-1986. The relapse quota was 5.4% (total value); of the operated patients, only 3 suffered a relapse (1.2%). Since our department is the only one for diseases of the lung for a total population of 537,000, we can assume that these relapse rates can be-if at all-only slightly falsified by referrals to hospitals located in other Federal Lands.

Drainage↗