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PubMed2000

Surgical staging of esophageal cancer.

The rising incidence of adenocarcinoma of the esophagus and the poor overall 5-year survival using current treatment regimens make it essential that clinical trials continue to search for more effective regimens for specific stages of esophageal cancer. It is clear from work in non-small cell lung cancer that clinical efficacy for platinum-based chemotherapeutic regimens has shown promise only in specific subsets of patients, such as those with stage IIIa tumors, but no benefit at all for earlier stages. In lung cancer, mediastinoscopy has been shown to be the most accurate method to stage locoregional lymph nodes and is considered to be the gold standard for clinical trials. In esophageal cancer, accurate surgical staging of all locoregional lymph nodes is more complex and may involve abdominal, thoracic, and cervical areas. Molecular evidence of lymph node involvement in esophageal cancer suggests that even histologically negative nodes may harbor micrometastases in a significant number of cases. Laparoscopy and thoracoscopy now offer a more accurate alternative to conventional staging of esophageal cancer. For distal esophageal cancers near the gastroesophageal junction, laparoscopic staging alone may suffice in most cases. Associated costs and the requirement for a surgical procedure should encourage the continued evaluation of new noninvasive modalities and the further evolution of endoscopic ultrasound. Currently, we recommend the application of minimally invasive surgical staging to assess new noninvasive technologies, such as PET scanning, and for use in clinical trials until the definitive approach to staging esophageal cancer is established. We are currently participating in an ongoing multicenter study of thoracoscopic and laparoscopic staging for esophageal cancer.

Endosonography↗
PubMed2000

Staging techniques for lung cancer.

In summary, noninvasive clinical staging techniques aid in stratifying patients into similar prognostic and therapeutic categories. Every patient with presumed non-small cell lung cancer should undergo a thorough history and physical examination, basic routine laboratory testing, PA and lateral chest radiographs, and chest CT scan with upper abdominal cuts to allow evaluation of the liver and adrenals. Recently, FDG-PET scanning has shown tremendous promise in the noninvasive evaluation of the primary tumor, nodal involvement, and metastatic [table: see text] disease. Although valuable, clinical staging has limitations, and when pathologic confirmation of lung cancer is required, minimally invasive techniques, such as bronchoscopy, TTNA, thoracoscopy, anterior mediastinotomy, and cervical and extended mediastinoscopy, may be valuable and simple ways of obtaining tissue.

Adenocarcinoma↗
PubMed2000

[300 videothoracoscopy procedures--personal experience].

Videothoracoscopy and video-assisted thoracic surgery are by now already standard therapeutic procedures in thoracic surgery. The authors submit their experience with the method after 300 thoracoscopic operation at the surgical clinic of the Faculty Hospital in Plzen from the end of 1993 to the beginning of 2000. The main indications for this mini-invasive procedure is the treatment of spontaneous pneumothorax, diagnostic biopsy in pulmonary dissemination of obscure etiology, diagnosis and treatment of pleural exudates and elimination of minor peripheral pulmonary lesions. The authors discuss different surgical procedures in the most frequent diagnoses, their advantages and risks, indication criteria, complications. Attention is also paid to the causes of 10% conversions. In case of treatment of a spontaneous pneumothorax the authors consider videothoracoscopy as the method of first choice, while in case of primary carcinoma of the lungs they recommend the classical procedure. Other possibilities for the wider application of thoracoscopy and its development in their own department include in particular traumatic thoracic surgery.

Humans↗
PubMed2001

Ultrasonic pleural debridement of empyema.

Thoracic decortication is a common procedure for empyema. However, effective dissection without injuring the lung parenchyma is sometimes difficult. We introduce a new technique using an ultrasonic surgical unit (USUTM) to search the dissection plane and simultaneously perform pleural debridement and irrigation with minimal injury of the lung parenchyma. USUTM was used on 5 patients with acute empyema with fibrino-purulent phase and good clinical course was achieved. This procedure facilitates effective pleural debridement under either thoracoscopy or conventional thoracotomy.

Adolescent↗
PubMed2001

[Simultaneous bilateral pneumothorax. Case report].

A case report of a 44 year-old white man admitted to the surgical unit for a bilateral simultaneous pneumothorax is presented. The pneumothorax occurred on day one after a surgical operation for discal hernia; in the past the patient already presented a right spontaneous pneumothorax at 32 years of age and a left pneumothorax at 37 years of age, both treated with a pleural drainage. A thoracic drain was bilaterally positioned with a good result only in the right side. The persistence of the left pneumothorax induced the authors to perform a postero-lateral thoracotomy bullae excision and pleurectomy with a good postoperative course. After a few months a new right pneumothorax occurred and the patient was treated with a right postero-lateral thoracotomy, bullae resection and pleurectomy. On the basis of the case reported, the authors consider the different opportunities in the treatment of spontaneous pneumothorax in relation to the present knowledges and technologies. Surgical procedure is to be preferred in case of persistence of pneumothorax despite a pleural drain and in case of pneumothorax in high risk subjects. Even if thoracoscopy seems to give better results regarding postoperative pain, it is not always possible with such a method to perform a careful pleurectomy neither to obtain it in all cases (above all in secondary pneumothorax). Every case must then be carefully studied to choose the best treatment at present available.

Adult↗
PubMed2000

Thoracoscopic retrieval of metal rods after penetrating chest injury: case report.

Thoracoscopy has been used for both diagnostic and therapeutic purposes. Its use in the trauma field is rapidly increasing. Here, we present a case of chest trauma that was successfully treated using the thoracoscopic approach. A 43-year-old male patient was brought to our emergency room with a severe right chest wall-penetrating metal-rod injury, which had occurred after falling from a height. The chest X-ray showed an upper right lung lobe injury. Video-assisted thoracoscopic surgery (VATS) was performed for diagnosis of any other associated injury and for management of the penetrating injury. The prognosis was good. We believe that minimal thoracoscopic surgery is an alternative way that provides a more rapid diagnosis, and a less-invasive and safe operation for acute chest trauma patients.

Adult↗
PubMed2001

[Clinical analysis of intrapulmonary lymph nodes].

We encountered 12 cases (9 men, 3 women) of intrapulmonary lymph nodes, discovered by chest radiography or chest CT and identified by thoracoscopic lung biopsy (in 10 cases), open lung biopsy (1 case) or lobectomy (1 case). We also studied the literature related to intrapulmonary lymph nodes in Japanese. Many intrapulmonary lymph nodes were found in the lower lung field, few in the upper lung field. All intrapulmonary lymph nodes were spherical and were located under the pleura, but we were not able in some cases to differentiate them from malignancies by the CT scanfindings. We could not diagnose them or rule out malignancy before surgery. Pathological findings revealed that all of them showed anthracosis. Silicotic changes were found in three cases. We consider that thoracoscopy is useful in making a definite diagnosis if peripheral pulmonary lesions cannot be diagnosed. We emphasize that intrapulmonary lymph nodes should be taken into consideration in differential diagnoses of small nodular lesions in the lung.

Aged↗
PubMed2001

[A case of mucosa associated lymphoid tissue (MALT) lymphoma].

We examined a 49-year-old man, who was referred to our hospital for resection of abnormal findings on the X-ray. Before hospital admission, he was performed TBLB and aspiration biopsy in other hospital, but the results was not decided diagnosis. Because the possibility of the lung cancer was not completely nagated, we performed the tumor resection (partial pulmonary resection) in use of thoracoscopy. The tumor was diagnosed as a MALT (mucosa associated lymphoid tissue) lymphoma at histologically and immunohistologically (CD 79), and resectable lymph node did not detected malignant cell. He has had no evidence of recurrence for 5 months after the operation.

Humans↗
PubMed1999

[Video-assisted thoracic surgery in the management of chest diseases].

OBJECTIVE: To summarize short-term results of video-assisted thoracic surgery for 322 patients with chest diseases in Beijing from October 1992 to October 1998 and discuss the role of thoracoscopy in the diagnosis and therapy of thoracic diseases in China. METHODS: Three hundred and twenty-two patients (273 men and 85 women) underwent video-assisted thoracic surgery for spontaneous pneumothorax (113), lung cancer (83), solitary pulmonary nodules (52), pleural diseases (19), mediastinal tumors (11), myasthenia gravis (5), thoracic trauma (10), esophageal cancer (7), benign esophageal diseases (11), and other indications (11). Data on thoracoscopic procedures, morbidity and mortality, conversion to open procedures were collected for all patients. RESULTS: Three hundred and thirty-nine thoracoscopic procedures were performed in 322 patients. These procedures included blebectomy and pleurodesis (121), wedge resections of pulmonary nodules (57), lobectomy and pneumonectomy (48), pleural biopsies and pleurodesis (52), excision of mediastinal mass (11), thymectomy (5), esophagectomy (6), and other procedures (39). Conversion to thoracotomy was required in 9 patients (0.28%). The overall incidence of postoperative complications was 7.5% (24/322). Two patients died postoperatively. CONCLUSIONS: Video-assisted thoracic surgery is a safe and effective technique in selected patients with chest diseases. The results in this group were similar to those reported previously in North American.

Adolescent↗
PubMed2001

[Lung contusion--an indication for resection?].

Pulmonary contusion is the most common injury in blunt chest trauma. Parenchymal injury and systemic inflammatory response lead to respiratory insufficiency and secondary pneumonia. Early detection and intervention to minimize progression of lung consolidation with a low threshold for mechanical ventilation optimize treatment results. Between 1990 and 2000 55 thoracotomies or thoracoscopies for chest trauma were performed. In 26 patients pulmonary contusion with hematothorax (n = 13), endobronchial bleeding (n = 9), bronchopleural fistula (n = 6), bronchusruptur (n = 2) or other contusion related injuries (n = 6) was responsible for the thoracotomies. We performed 12 lobectomies, 1 pneumonectomy, 11 parenchymal suture and 2 decortications. Preoperatively a bronchoscopy for the localisation of the bleeding and disclosure of central airway injury is mandatory. The benefit of bronchoscopy guided blocking of the bronchus for endobronchial bleeding is unclear. Video assisted procedures are not useful for massive bleeding or anatomical resections.

Contusions↗
PubMed2001

[Exudative pleurisy in patients with diabetes mellitus].

Peculiarities of clinical course, diagnosis and results of treatment of exudative pleurisy (EP) were studied in 65 patients with diabetes mellitus. According to the data of complex investigation obtained, using clinico-radiological, laboratory, instrumental methods (transthoracic puncture, thoracoscopy with pleural biopsy), pleural tuberculosis was diagnosed in 60% of patients, nonspecific pleuritis--in 21.5%, pleural mesothelioma--in 10.8%, primary pulmonary cancer--in 5 (7.7%). In 26 (40%) patients pulmonary operation was performed to eliminate the main focus of the EP occurrence. Direct dependence of the course, result of treatment of patients with EP from the type, severity and timely diagnosis of the disease was established.

Adolescent↗
PubMed2001

[Therapeutic approach to pulmonary hamartoma patients].

Hamartoma is one of the most common benign tumour of the lung. The authors report their results of the surgical treatment of 17 patients with lung hamartoma. Twelve of them underwent open thoracotomy and 5 video-assisted thoracoscopy. Lobectomy was performed in 6 patients, segmentectomy in 3 and patients atypical lung resection in 8. All of the patients did not have complications.

Aged↗
PubMed2002

[Castleman lymphoma originated from the posterior mediastinum resected thoracoscopically: report of a case].

We report thoracoscopic resection of Castleman lymphoma originated from the posterior mediastinum. The patient was a 19-year-old woman, who was pointed out to show an abnormal shadow in the left upper lung in the chest X-ray photograph. It was diagnosed as a blood-rich posterior mediastinal tumor by dynamic MRI, and thoracoscopic surgery was performed. The tumor was adjacent to the vertebral body of the fourth thoracic vertebra. Although operation involved 2 hours and 40 minutes and 670 ml of bleeding due to a strong adhesion between the tumor and the intercostal muscle and considerable bleeding from the tumor itself, it was successfully removed under thoracoscopy. The tumor was elastic and hard, and 50 x 45 x 25 mm in size. The histopathological diagnosis was a Castleman lymphoma, hyaline vascular type. The postoperative course was satisfactory, and the patient was discharged from the hospital on the 7th postoperative day. Castleman lymphoma originated from the posterior mediastinum tends to bleed considerably during its resection. If a blood-rich posterior mediastinal tumor was found preoperatively, thoracoscopic operation must be advanced carefully keeping this disease in mind.

Adult↗
PubMed2002

Thoracoscopic management of pleural effusions in Kaposi's sarcoma: a rapid and effective alternative for diagnosis and treatment.

Kaposi's sarcoma (KS) is one of the most common causes of pleural effusion in patients with acquired immunodeficiency syndrome (AIDS). Pleural effusions due to KS carry a high morbidity and mortality. Their treatment is difficult, and they respond poorly to chemical pleurodesis. Even systemic chemotherapy against KS has little effect on the pleural effusions. Commonly, repeated therapeutic thoracentesis or chest tube drainage is required. We present a case of advanced KS with bilateral pleural effusions. We believe this is the first reported case in which medical thoracoscopy with talc pleurodesis has been shown to achieve adequate control of the effusions.

Adult↗
PubMed2002

History of minimally invasive spine surgery.

Patients prefer minimally invasive techniques because such techniques reduce recovery times and provide cosmetic benefits. Reviewing the history of minimally invasive surgery helps us understand the advances in spine surgery. Minimally invasive spine surgery has adopted techniques from several fields to better treat spinal disorders. Minimally invasive spine surgery has been influenced by advances in lasers, endoscopy, and image guidance systems. Discogenic disorders have been treated by using chemonucleolysis, automated percutaneous discectomy, and intradiscal thermoablation. Endoscopic techniques have been used to treat spinal disorders. Thoracoscopes and laparoscopes have been used to perform anterior release of scoliotic or kyphotic deformities and to perform transthoracic microsurgical discectomies. The role of spinal thoracoscopy has expanded to include corpectomy, vertebral reconstruction with internal fixation, hardware application, and resection of neurogenic, spinal, and paraspinal tumors. Advances in interbody fusion cage technology have generated a great deal of interest in laparoscopic techniques. Image-guided systems are widely used in intracranial surgery and have been adapted to facilitate screw placement since the middle 1990s. The use of image-guided systems for pedicle screw placement has improved placement accuracy. The system relies on precise localization of the pedicles with computed tomography. Minimally invasive surgery is designed for "conventional" operations involving extensive anatomic dissections performed via small incisions; it yields shorter recovery times and less morbidity.

History, 20th Century↗
PubMed2002

Minimally invasive spine instrumentation.

OBJECTIVE: We discuss the instrumentation used with minimally invasive spine surgery. METHODS: Minimally invasive surgery has revolutionized all areas of surgery. The use of endoscopes permits surgical maneuvers to be performed through small incisions. RESULTS: Video-assisted thoracoscopic surgery can be used for a variety of spinal indications. The nerve roots and the spinal cord can be decompressed, bone grafts can be placed for interbody fusion and vertebral body reconstruction, and internal fixation devices can be applied to stabilize the spine. Thoracoscopy can be used to perform thoracic sympathectomies, to resect thoracic disk herniations, to biopsy thoracic vertebral body lesions, to release complex spinal curvatures for the reduction of scoliosis, to perform vertebrectomies, to resect tumors, to debride infections, and to treat spinal fractures. Laparoscopic techniques have been applied to the lumbar spine. Laparoscopic procedures have been used for anterior and posterior approaches to the lumbar spine. Anterior arthrodesis has been performed by laparoscopic insertion of the Bagby and Kuslich cages into the L4-5 and the L5-S1 intervertebral disc spaces. Laparoscopic retroperitoneal techniques have been used for anterior plating to fixate the anterior column rigidly to restore stability. In addition, the posterolateral approach has been used for pedicle screw fixation of the lumbar spine using endoscopic techniques. CONCLUSION: Minimally invasive techniques have been used successfully for treating spinal disorders. With the use of endoscopic techniques, a spine surgeon can perform complex spinal instrumentation through small portals, thus reducing morbidity for the patient.

Humans↗
PubMed2002

[Surgical management of acute empyema].

Basic principles apply to the management of all forms of acute empyema: investigation and treatment of the underlying infection, drainage of purulent collection, obliteration of the space, and treatment of the associated intercurrent medical conditions. From July 1999 to May 2001, we performed surgical treatment in 11 patients for acute empyema. There were 4 cases of the fibrinopurulent phase and 7 cases of the organizing phase. Surgical procedure was 7 open thoracotomies and 4 thoracoscopies. The mean operating time was 154.2 +/- 36.6 minutes and blood loss during surgery was 344.7 +/- 274.8 ml. There was no procedure-related morbidity. In conclusion, early aggressive surgical approach is a feasible method for treatment of acute empyema.

Acute Disease↗