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At least 163 records · Page 9Linked to original sources
PubMed1996

Multilevel anterior thoracic discectomies and anterior interbody fusion using a microsurgical thoracoscopic approach. Case report.

A video-assisted thoracoscopic microsurgical approach was performed to treat a myelopathic patient with a severe kyphotic deformity caused by chronic nonunion of compression fractures of the T7-9 vertebrae. The kyphotic deformity was treated by combined operative procedures. First, an anterior release was performed using a thoracoscopic technique, sectioning the anterior longitudinal ligament and performing multilevel thoracic discectomies. Next, a posterior reduction and internal fixation of the deformity was achieved using hook-rod instrumentation. Finally, bone graft harvested during the posterior approach was used for interbody fusion via a thoracoscopic approach. Microsurgical thoracoscopic techniques potentially can be used in a variety of spinal surgeries. Compared to transthoracic and posterolateral approaches, this technique presents distinct advantages to treatment of anterior spinal pathology. The small incisions made into the intercostal spaces without retracting the ribs may reduce postoperative pain, shorten the length of hospitalization, and allow early return to activity. The operative techniques used in this case are described in detail. This report demonstrates that thoracoscopic discectomies and interbody fusion are technically feasible and can be effectively performed with acceptable results.

Adolescent↗
PubMed1999

Thoracoscopic sympathetic surgery for hyperhidrosis.

Resectional surgery of sympathetic nerves has been known to be the most effective treatment for essential hyperhidrosis and the application of thoracoscopic electrocauterization has provided a minimally-invasive procedure with the least morbidity and a resultant higher satisfaction rate. This paper describes our experience on the 1,167 cases of thoracoscopic sympathetic surgery for the treatment of essential hyperhidrosis. A total of 1,167 patients (674 males (58%) and 493 females (42%), mean age of 26.4 years with palmar (930), craniofacial (190) or axillary (47) hyperhidrosis underwent thoracoscopic sympathetic surgery from July 1992 to March 1999. Since the T2-4 sympathectomy, first performed in July 1992 for a patient of palmar hyperhidrosis, the operative methods have been altered to achieve a higher satisfaction level with the least complication by adopting less invasive procedures. Our current standard procedures being performed are T3 and T2 clipping for palmar and craniofacial hyperhidrosis and T3,4 sympathicotomy for axillary hyperhidrosis, all using a 2 mm needle thoracoscope. As the surgical procedures have been transited to a less invasive method with limited resection using the newest endoscopic devices, the average operation time and complications such as Horner's syndrome and compensatory hyperhidrosis have gradually decreased and thus the long-term satisfaction rate has been raised up to 98% for palmar hyperhidrosis, 92% for craniofacial hyperhidrosis and 89% for axillary hyperhidrosis. The recurrent cases (14/1167) were treated successfully with reoperations of thoracoscopic sympathetic surgery. The optimal goal of therapy could be achieved by complete elimination of the hyperhidrotic symptom, by decreasing the incidence and degree of compensatory hyperhidrosis through a selective and limited resection, and by adopting the least invasive procedures. Sympathicotomy has provided the advantages of a limited extent of denervation and the resultant decrease of compensatory hyperhidrosis compared to sympathectomy. The reversible method of clipping may be an effective, provisionary means for cases of severe, intractable compensatory sweating. For craniofacial hyperhidrosis, T2 sympathicotomy or clipping has been proven to be superior to the T1 sympathectomy due to the decreased occurrence of Horner's syndrome and T3,4 sympathicotomy providing a satisfactory outcome with less compensatory hyperhidrosis for axillary hyperhidrosis.

Adolescent↗
PubMed1999

Endoscopic palliative treatment of advanced pancreatic cancer: thoracoscopic splanchnicectomy and laparoscopic gastrojejunostomy.

DESIGN: Evaluation of thoracoscopic splanchnicectomy and laparoscopic gastrojejunostomy as endoscopic palliative treatment of advanced pancreatic cancer. PATIENTS AND METHODS: Between November 1993 and September 1998 we performed 16 thoracoscopic splanchnicectomies and 6 laparoscopic gastrojejunostomies in patients with an advanced pancreatic cancer admitted to the Department of Surgery of University Hospital Rotterdam-Dijkzigt. These patients either did not achieve adequate pain control with medication or presented serious problems of gastric outlet obstruction, or both. RESULTS: There were fourteen patients (9 men and 5 women) with mean age of 51.8 years (range 28-83), mean BMI of 21.1 (range 17.2-27.2), ASA score I in 2, II in 11, III in 1. We performed 2 left, 2 right and 4 bilateral thoracoscopic splanchnicectomies, 4 laparoscopic gastrojejunostomies and 2 combined endoscopic procedures (bilateral thoracoscopic splanchnicectomy and laparoscopic gastrojejunostomy). The overall average operation ("skin to skin") time was 86 minutes (range 75-100) for bilateral thoracoscopic splanchnicectomies, 63 minutes (range 60-65) for unilateral splanchnicectomies, 88 minutes (range 65-115) for laparoscopic gastrojejunostomies and 190 minutes (range 180-200) for the combined procedure. Blood loss was insignificant with a median of 50 ml (range 30-150). The conversion's rate to open surgery was 4.5%. There were no intraoperative complications. The overall average postoperative mobilization was in 1.9 days (range 1-4) and the overall median postoperative hospital stay was 7 days (range 2-24). There was no mortality at 30 days after endoscopic procedures and the morbidity rate was 21.4%. The postoperative analgesic requirement was considerably reduced with a successful rate was 83.3%. The resolution of gastric outlet obstruction has been complete in all laparoscopic gastrojejunostomies. CONCLUSIONS: Our results show the feasibility and safety of these minimally invasive approaches such as endoscopic palliative treatment of complications of advanced pancreatic cancer.

Adult↗
PubMed2001

[A case of lung cancer with extensive pleural adhesion, which could be resected by a thoracoscopic middle lobectomy].

A thoracoscopic middle lobectomy was performed for a 78-year-old male with lung cancer associated with extensive pleural adhesion. After peeling off the area of pleural adhesion surrounding the surgical ports by finger, the thoracoscope was inserted into the thorax and then the area of adhesion in the other area was also peeled off under thoracoscope. A pulmonary vein was resected using a stapler. Due to adhesion at the fissures between the lobes, a pulmonary artery and bronchus of the middle lobe were cut from the front of the lung hilum. After that, the fissures between the lobes were also cut using a stapler thus resulting in a complete middle lobectomy. The operation time was 5 hours and 28 minutes, and the intraoperative bleeding was 200 ml. There was no postoperative air leakage, and the chest drain could be removed the day after surgery. In conclusion, even for lung cancer with extensive pleural adhesion, a thoracoscopic lobectomy can still be successfully performed. When a fissure between the lobes is found to adhere, the approach to pulmonary artery and bronchus from the front of the lung hilum is useful for performing a thoracoscopic middle lobectomy.

Adenocarcinoma↗
PubMed2001

[Thoracoscopic lung resection for a peripheral lung cancer by a single surgeon with a voice-controlled robot].

Thirty patients with a peripheral lung cancer underwent consecutive thoracoscopic lung resections with a voice-controlled robot between October 1998 and February 2001. The patients with a high risk such as cardio-pulmonary dysfunction or the patients aged 80 years or older were included. Patients with stage I cancer of the right lung in which lobectomy with lymph node dissection was anticipated were also included. Thirty thoracoscopic procedures were performed by a single surgeon using a voice-controlled robot. Thoracoscopic lung resection by a single surgeon with a voice-controlled robot was achieved in 27 patients. The postoperative follow-up period ranged from 3 months to 42 months. In all patients, thoracoscopic procedures without no need for a human assistant were achieved. There were no survival differences between the wedge resection group and lobectomy group, in the patients having adenocarcinoma and patients having squamous cell carcinoma, and elderly patients and young group patients. Complications related or unrelated to the maneuvers of a voice-controlled robot were not noted. Postoperative complications occurred in 4 patients (atelectasis 2, postoperative dementia 2). All of the events resolved within one week. Thoracoscopic lung resection such as wedge resection or lobectomy by a single surgeon with a voice-controlled robot may be feasible in selected patients with lung cancers. Its application must be confirmed by further studies.

Aged↗
PubMed2002

Thoracoscopic approaches to the thoracic spine: experience with 241 surgical procedures.

INTRODUCTION: Microsurgical thoracoscopic approaches to the thoracic spine allow access to the spinal cord, spinal nerves, disc spaces, vertebral bodies, paravertebral soft tissues, and sympathetic chain with minimal invasiveness. METHODS: Between January 1994 and January 2000, 241 thoracoscopic procedures were performed: 164 thoracic sympathectomies, 60 discectomies, 5 neurogenic tumor resections, 8 corpectomies and spinal reconstructions, 2 anterior releases, and 2 biopsies. Cases were reviewed to evaluate the efficacy, surgical results, and complications of the thoracoscopic procedures. RESULTS: An adequate sympathectomy was achieved in all 164 sympathectomies. There was 100% relief of palmar and 95% relief of axillary hyperhidrosis. Reflex sympathetic dystrophy responded poorly to sympathectomy with recurrent pain. Thoracoscopic discectomy achieved complete decompression in 98% of patients. Gross total tumor resection was achieved in all five paraspinal neurogenic tumors. There was no operative mortality. Morbidity compared favorably with open surgical approaches to the thoracic spine. CONCLUSION: Thoracoscopic spinal surgery is an effective technique that provides full, direct access to the ventral thoracic spine. Its morbidity rate appears to be lower than that associated with open thoracotomy. It improves patient comfort and cosmetic results and shortens recovery. This technique has become the authors' surgical approach of choice for removing benign intrathoracic paraspinal neurogenic tumors and central herniated thoracic discs and for performing biopsies and thoracic sympathectomies. The senior author still prefers open surgical approaches for most thoracic corpectomies and spinal reconstruction procedures.

Adult↗
PubMed2002

Thoracoscopic-assisted treatment of thoracic and lumbar fractures: a series of 371 consecutive cases.

OBJECTIVE: Conventional approaches for the treatment of thoracic and thoracolumbar fractures require extensive surgical exposure, often leading to significant postoperative pain and morbidity. Thoracoscopic spinal surgery was performed to reduce the morbidity of these approaches while still achieving the primary goals of spinal decompression, reconstruction, and stabilization. METHODS: Between May 1996 and May 2001, 371 patients with fractures of the thoracic and thoracolumbar spine (T3-L3) were treated with a thoracoscopically assisted procedure. In the first 197 patients, a conventional open anterior plating system was used. The last 174 patients were treated with the MACS-TL system (Aesculap, Tuttlingen, Germany), which was designed specifically for endoscopic placement, thereby significantly reducing operative times. RESULTS: Seventy-three percent of the fractures were located at the thoracolumbar junction. In 49% of patients, mobilization of the diaphragm was performed to expose the fracture, with later repair. Both x-ray canal compromise and neural deficit were present in 15% of patients. In 35% of patients, a stand-alone anterior thoracoscopic reconstruction was performed. In 65% of patients, a supplemental posterior pedicle-screw construct was also placed either before or after the anterior construct. A steep learning curve was present, with an average operating time of 300 minutes in the first 50% of cases and an average of 180 minutes with the MACS-TL system. The severe complication rate was low (1.3%), with one case each of aortic injury, splenic contusion, neurological deterioration, cerebrospinal fluid leak, and severe wound infection. Compared with a group of 30 patients treated with open thoracotomy, thoracoscopically treated patients required 42% less narcotics for pain treatment after the operation. CONCLUSION: A complete anterior thoracoscopically assisted reconstruction of thoracic and thoracolumbar fractures can be safely and effectively accomplished, thereby reducing the pain and morbidity associated with conventional thoracotomy and thoracolumbar approaches. Although the learning curve is steep, the functional and cosmetic benefits to the patient warrant the difficult training process.

Adolescent↗
PubMed2003

[Thoracoscopic bypass from the descending thoracic aorta to the femoral artery. Experimental study and clinical application].

OBJECTIVE: Descending thoracic aorta to femoral artery bypass (DTAFB) has demonstrated usefulness in the treatment of aorto-iliac occlusive disease but related morbidity and mortality are not negligible. We wanted to determine the feasibility of thoracoscopic DTAFB and to report our clinical experience. MATERIAL AND METHODS: An experimental study was performed on 8 pigs in helicoidal position under general anesthesia with right selective ventilation ). Three trocars were inserted and the descending aorta was dissected ). After tunnelisation of a 6 mm graft, a lateral aortic anastomosis was thoracoscopically performed ) then femoral anastomoses were made. At the end of the procedure, an angiogram and then an autopsy were performed ). Subsequently, three patients were operated, two for thrombosis of a previous aortobifémoral bypass and one for infrarenal aortic hypoplasia. Dissection and graft tunnelisation were performed thoracoscopically ). Then, the aortic anastomosis ) was constructed through a left lateral minithoracotomy (10 cm). RESULTS: One pig died during surgery of acute lung oedema due to the difficulties of selective ventilation. Excluding this case, the average times of surgery and of dissection were respectively 246 (205-325) and 68 minutes (50-90). The average aortic clamping and anastomosing times were 135 (105-220) and 120 minutes (80-210) ). Three aortic tears were noted; one was repaired. Angiogram was normal 5 times; one pig had a minor stenosis and a leak, and another one had a leak. All the anastomoses were patent without stenosis at autopsy; no organ lesion was found. In humans, the procedure was performed with simple postoperative course in 2 patients and a conversion (20 cm long thoracotomy) was necessary for the third due to poorly supported selective ventilation. CONCLUSION: Totally thoracoscopic DTAFB can be performed in pigs. In clinical practice, we recommend the use of a mini thoracotomy. This way, the aortic anastomosis can be performed with aortic clamping time under 30 minutes, reducing the risk of spinal cord ischemia. These results allow to propose mini invasive thoracoscopically assisted DTAFB for the patients for whom laparoscopic access of the abdominal aorta appears to be difficult (calcified aorta, hostile belly.).

Aged↗
PubMed2005

[The advancement of cancer therapy by thoracoscopic approach for esophageal cancer].

The current status of thoracoscopic esophagectomy for esophageal cancer and the advancement of cancer therapy by the thoracoscopic approach are described. At first, in the introduction of this technique, many reports have indicated that postoperative complications of thoracoscopic esophagectomy do not decrease and have no benefit compared with right thoracotomy. However, this technique is able to effectively conserve respiratory function after esophagectomy. Moreover, postoperative respiratory morbidity can be decreased bases of series consisting a large number of patients. The thoracoscopic approach to esophageal cancer can show the detailed anatomy of the mediastinum and contribute to the improvement of safety at esophagectomy. The establishment of a training system is important to achieve the standardization of thoracoscopic esophagectomy in esophagectomy.

Esophageal Neoplasms↗
PubMed2006

[Thoracoscopic radio-frequency ablation therapy for liver surface tumor located under the diaphragm].

It is necessary to select a proper method for radio-frequency ablation (RFA) therapy of the liver tumor. Especially, treating the tumor under the diaphragm is usually difficult to approach by percutaneous puncture. We have done thoracoscopic RFA in 48 cases (43 HCC, 1 adenomatous hyperplasia, and 4 metastatic liver tumors) to treat the tumor located on the surface of the liver under the diaphragma since January 1st, 2000. The average operation time was 237 minutes, the average blood loss was 29.0 ml and the average tumor diameter were 2.6 cm, and the average frequency of coagulation was 4.5 times. The cases which thoracoscopic RFA was possible with diaphragm incision were 27 cases (56%). However, there were 15 cases in which diaphragm incision was difficult by the adhesion under the diaphragm. Moreover, there were six cases with severe adhesion that was impossible by the thoracoscopic operation to convert an open chest method. There were 25 cases, which had some adhesion either in the chest or under the diaphragm, and those adhesions were considered to be related to the previous treatments such as the operation, ablation, and chemotherapy. The average length of the hospital stay post operation was 9.7 days. Only 3 cases (6%) needed additional treatments for tumor where the severe postoperative complication did not occur. Therefore, thoracoscopic RFA for tumor on the liver surface located under the diaphragm is suggested to be a feasible technique. On the other hand, it is necessary to pay attention to two kinds of adhesion taking a critical role for thoracoscopic operation procedures.

Catheter Ablation↗
PubMed2006

Thoracoscopic surgery for lung cancer.

Thoracoscopic surgery has raised awareness in minimizing invasiveness in respiratory surgery. In the case of lung cancer, technical difficulties associated with standard curative surgery may not allow the use of a total thoracoscopic procedure. Although thoracoscopic lung cancer surgery is minimally invasive and safe, it demands a high level of skill and care. Surgery is often performed using a small incision and direct vision, with the thoracoscope serving as a light source. However, thoracoscopic surgery is expected to progress further in the near future. In addition, a new surgical system that comprehends both open and video-assisted thoracic surgery (VATS) may gain popularity.

Humans↗
PubMed1995

[Thoracoscopic surgery, current indication and technique].

Thoracoscopy has become an important tool in the diagnosis and management of intrathoracic disease. The development of endoscopic suturing techniques and stapling devices for abdominal surgery dramatically expanded the potential of thoracoscopic surgery. Between 1993 and 1994, 43 patients underwent thoracoscopic surgery. Lung resection were performed on 23 patients for pulmonary nodules and on 9 patients for diagnosis of interstitial lung disease. Extirpation were performed on 2 patients for mediastinal tumor. A procedure done thoracoscopically is far less invasive and the postoperative pain and its consequences are drastically reduced. As endoscopic instrumentation develops, newer operations will become technically feasible. We think that indications for thoracoscopic surgery will expand in developing these techniques in the future, if thoracoscopic surgery is safer and more efficient.

Adult↗
PubMed1994

[Thoracoscopic surgery--is thoracotomy still necessary?].

Thoracoscopic surgery has made substantial progress in recent years due to advances in video-optic systems and the development of new instruments for endoscopic surgery. Currently many interventions which routinely required thoracotomy can be performed thoracoscopically. This includes pleurectomy, decortication, wedge-resection, pericardial window, sympathectomy, biopsy or, in certain situations, resection of a mediastinal tumor. Thymectomy for myasthenia gravis or lobectomy can be performed thoracoscopically as well. The article gives on overview of the current standing of thoracoscopic surgery. The benefit of thoracoscopic surgery is reduced postoperative pain, including diminished impairment of pulmonary function, and hence a shorter hospital stay and a more rapid recovery.

Empyema, Pleural↗
PubMed1993

[Thoracoscopic resection of pleural tumor].

A thoracoscopic operation was safely performed for a case of a intrathoracic tumor. The patient was a 68-year-old male who had been treated for bronchial asthma and recurrent pneumonia. The reason for a successful operation were one-lung-ventilation under general anesthesia, the thoracoscopic electrocautery, the thoracoscopic ultrasonic surgical aspiration system, and thoracoscopic hemoclips. Pathologically the tumor was a benign mesothelioma. The patient was discharged without complications. In the treatment of intrathoracic benign diseases, thoracoscopic surgery is thought to be particularly useful to patients who are at high-risk in conventional thoracic operations due to accompanying respiratory diseases, as well as to patients requiring incisions as small as possible.

Aged↗
PubMed1996

Thoracoscopic pulmonary surgery: indications and results.

OBJECTIVE: To report our experience of thoracoscopic pulmonary operations from May 1991 to May 1994. DESIGN: Prospective open study. SETTING: District hospital, Germany. SUBJECTS: 93 patients who underwent 120 thoracoscopic procedures. INTERVENTIONS: Wedge resection (n = 56), pleural biopsy (n = 21), early decortication (n = 16), partial pleurectomy (n = 9), pleurodesis (n = 5), pulmonary biopsy (n = 4), segmentectomy (n = 3), evacuation of haemothorax (n = 3), biopsy of mediastinal tumor (n = 2), and costal biopsy (n = 1). MAIN OUTCOME MEASURES: Morbidity, mortality, and avoidance of open thoracotomy. RESULTS: Indications for thoracoscopic intervention were: solitary pulmonary nodule (n = 37), recurrent pneumothorax (n = 17), pleural empyema (n = 14), diffuse pulmonary disease/multiple nodules (n = 10), recurrent pleural effusion (n = 11), haemothorax (n = 3), and mediastinal tumour (n = 1). In 29 of 37 patients in whom we attempted resection of a solitary pulmonary nodule we obtained enough tissue for diagnosis, and avoided thoracotomy in 18 patients. Complications included pulmonary embolus (n = 1), recurrent empyema (n = 1), haemorrhage (n = 2), infection of the drain site (n = 3), and two persistent air leaks. One was closed at a second thoracoscopy and the other required open thoracotomy after which he developed pulmonary failure and died. One patient with a haemothorax developed multiple system organ failure and died, and attempted resection of a mediastinal tumour was unsuccessful. Three thoracoscopic procedures had to be abandoned because of dense adhesions. CONCLUSIONS: Thoracoscopic surgery is a safe, well tolerated, and cost effective alternative to open thoracotomy in selected patients.

Adolescent↗
PubMed1996

[Thoracoscopic wedge resection of small pulmonary nodules--evaluation of Endofinger and colored collagen injection techniques for localization of pulmonary nodules].

We analyzed problems occurring during thoracoscopic resection of small pulmonary nodules less than 2.0 cm in size and evaluated the Endofinger and colored collagen injection techniques, which are new methods for localization of pulmonary nodules. The Endofinger is a device for thoracoscopic palpation and the colored collagen is a long-lasting point marker, composed of 1.0% athelocollagen, methylene blue and contrast medium. Twenty five consecutive patients (male: female = 13:12, mean age 59.0 years) underwent thoracoscopic wedge excision of pulmonary nodules. The mean diameter of the nodules was 1.3 cm (range: 0.4-2.0 cm) and the mean distance from the pleural surface to the nodules, as assessed by CT scan, was 1.1 cm (range: 0-3.8 cm). Methods of pulmonary nodule identification were thoracoscopic inspection only (4 cases), palpation through min-thoracotomy (13 cases), Endofinger (2 cases) and Endofinger with colored collagen injection guided by CT scan (6 cases). In all cases where location was difficult to identify, the nodule diameter was less than 1 cm and the distance from the pleural surface to the nodule was greater than 1 cm. The Endofinger and colored collagen injection techniques have made it easier to localize small pulmonary nodules, decreasing the frequency of cases where additional thoracotomy is necessary. Seven of 25 nodules were revealed to be so-called early peripheral lung cancers, but no relapses were found in any of these cases following pulmonary resection. The new Endofinger and colored collagen injection techniques are useful in the localization of small pulmonary nodules, making thoracoscopic wedge resection of help in early diagnosis and treatment of pulmonary malignancy.

Biopsy↗
PubMed1996

[Thoracoscopic surgery].

Recent advances in endoscopic equipment and refinement of thoracoscopic techniques and increased experience with thoracoscopy have expanded the application of this procedure for lung cancer. Thoracoscopic treatment for malignant pleural effusion, sampling of hilar and mediastinal lymph nodes, wedge resection of the lung and thoracoscopic lobectomies and pneumonectomies have been reported in many institutes. Our findings demonstrate the feasibility of performing major video-assisted thoracoscopic pulmonary resections with less postoperative morbidity. This report describes present role of video-assisted thoracoscopic surgery for early lung cancer.

Endoscopy↗
PubMed1997

[Thoracoscopic cutting needle biopsy].

We presented a new method of percutaneous cutting needle biopsy under the thoracoscope. Percutaneous cutting needles for lung tumor have been abandoned because the risk of hemorrhage, death, and pneumothorax is much greater with these instruments than the computed tomographic guided needle aspiration. On the other hand, thoracoscopic stapled lung wedge resection is easy to obtain a good sample for any lung disease, but should be needed two or three staples, and waste a time, in the case following lobectomy was needed for malignancy. This thoracoscopic cutting needle biopsy was easy to obtain a specimen for the frozened section diagnosis. Under the view of thoracoscope, percutaneous cutting needle biopsy is safety, saving the cost for staples and easy to control the bleeding from the lung. The indication of this thoracoscopic cutting needle biopsy is the case that could not obtain the precise diagnosis by the preoperative biopsy and imaging diagnosis might be suspicious a malignant tumor.

Biopsy, Needle↗