Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “THORACOSCOPY”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,783 records · Page 99Linked to original sources
PubMed2001

Lateral approach to laparoscopic repair of left diaphragmatic ruptures.

Video-assisted repairs of traumatic diaphragmatic ruptures have been described where thoracoscopy or laparoscopy in the supine position were used. This study aims to validate a new lateral laparoscopic approach for left diaphragmatic repairs. Six consecutive patients were operated on for left diaphragmatic rupture using a lateral approach (Gagner's position). A series of 362 consecutive patients presenting with abdominal or thoracic trauma with or without diaphragmatic rupture over a 2-year period were reviewed retrospectively. Contraindications for immediate or delayed lateral laparoscopic approach were studied. The lateral approach provided complete visibility of the subdiaphragmatic space, easy reduction of herniated organs, easy thoracic inspection and cleaning, the use of low peritoneal pressure, full range of instrumental motion, and rapid diaphragmatic repair. No operative mortality or morbidity was noted. Altogether, 14% to 50% of the patients with diaphragmatic ruptures were candidates for immediate lateral laparoscopic repair. Associated spleen injury in 50% of the cases was the main contraindication. The lateral laparoscopic approach provides better exposure of the diaphragm on the left side and facilitates the diaphragmatic repair especially with a large herniation. Immediate repair is possible in selected cases (14-50%). There is no contraindication in case of delayed diagnosis.

Abdominal Injuries↗
PubMed2000

Video-assisted thoracoscopic lobectomy reduces cytokine production more than conventional open lobectomy.

OBJECTIVE: We studied cytokine changes after video-assisted thoracoscopic lobectomy and conventional lobectomy in patients with stage IA lung cancer. METHODS: From June, 1997, 20 consecutive patients with stage IA non small-cell lung carcinoma underwent either conventional lobectomy via an open thoracotomy (n = 10) or video-assisted thoracoscopic lobectomy (n = 10). The cytokine concentration in serum and pleural fluid were measured for 6 days postoperatively. RESULTS: Interleukin-6 and interleukin-8 leads peaked at 3 h or 1 day after surgery. Cytokine levels in pleural fluid were more than 100 times higher than corresponding systemic levels. The increase of interleukin-6 in pleural fluid 3 hours after surgery was significantly smaller in video-assisted thoracoscopic lobectomy (3971 +/- 2793 pg/mL for video-assisted thoracoscopic lobectomy vs. 23274 +/- 8426 pg/mL for open lobectomy). There were no significant differences in the serum interleukin-6 and interleukin-8 concentrations between the 2 groups. CONCLUSION: The thoracoscopic approach lessened the increase of cytokines in pleural fluid, but benefits of reduced cytokine production in video-assisted thoracoscopy remain to be clarified.

Carcinoma, Small Cell↗
PubMed2000

Thoracolithiasis.

Thoracolithiasis without any history of chest traumas or interventions is pathologically rare, with only 9 cases including our 2, reported thus far in the literature. Case 1: A 76-year-old man admitted to our hospital had an abnormal shadow in chest radiography that gradually enlarged. Serum carcinoembrionic antigen was slightly elevated during follow-up. A milky white tumor 1.5 cm in diameter with many projections was found in the thoracic cavity and removed by thoracoscopy. Histopathological examination showed the tumor to consist of fibrous tissue with fatty necrosis at the core. Case 2: A 54-year-old woman admitted to our hospital had an abnormal shadow in chest screening radiography in 1998. Transbronchial biopsy showed this shadow to be lung adenocarcinoma. A small trigonal pyramid-shaped milky white nodule 5 mm in diameter was found in the thorax during lobectomy for lung cancer. Histopathological examination showed this nodule also to consist of fibrous tissue with fatty necrosis.

Aged↗
PubMed2000

Unsuspected lung cancer accompanied by catamenial pneumothorax.

A 45-year-old nonsmoking woman with repeated coughing and dyspnea on effort was admitted to our hospital diagnosed with right-sided pneumothorax on chest X-ray. Chest computed tomography showed neither bullae nor nodules. Chest drainage failed to completely reexpand the lung, necessitating video-assisted thoracic surgery. Thoracoscopy showed pleural thickening in the apical segment without bullae or air leakage, dark-brown pigmentation of the diaphragm, and an unsuspected small nodule about 5 mm in diameter on the diaphragmatic surface of the right lower lobe. Pneumothorax was treated by mechanical abrasion of parietal pleura and upper lobe wedge resection. The lower lobe and nodule were wedge-resected using staplers. The nodule was bronchioloalveolar carcinoma of Noguchi's type B. To improve curability and check for diaphragmatic lesions, right posterolateral thoracotomy was conducted on post-video-assisted thoracic surgery day 28. Aggressive intraoperative lymph node exploration yielded no remarkable histological findings. Nonanatomical lower lobe wedge resection was done and the diaphragm with pinhole-like perforations was partially resected. The resected lung showed no cancerous tissue. Endometrial tissue was histologically confirmed in the resected diaphragm. The patient has remained asymptomatic in 14-month follow-up. This is, to our knowledge, the first lung cancer accompanied by catamenial pneumothorax.

Female↗
PubMed2000

Minimally invasive lung and pleural biopsies using 2-mm and standard thoracoscopic equipment.

Videoendoscopic surgery is commonly used to obtain a definitive diagnosis in a patient with pleural lesions or pulmonary infiltration of unknown etiology. We have performed minimally invasive pleural and lung biopsies, using 2-mm mini-videoscopic instruments supported by standard thoracoscopy via one 11.5-mm port, in 10 patients. These involved 8 patients with diffuse pulmonary infiltration, and two with diffuse pleural thickening. They underwent thoracoscopic pulmonary wedge resection and pleural biopsy using one 11.5-mm port and two or three 2-mm mini-ports. The mean operating time was 37 minutes. This procedure was successful in establishing a definitive diagnosis in each patient. Complications included subacute acceleration in pulmonary infiltration in one patient. No patient complained of pain or discomfort at the 2 mm-thoraco port sites. Healing of this port site resulted in excellent cosmesis. Mini-videoscopic surgery supported by standard thoracoscopic equipment can be used to perform lung or pleural biopsy less invasively than standard thoracoscopic approach.

Aged↗
PubMed1999

A cost-effective thoracoscopic treatment strategy for pediatric spontaneous pneumothorax.

BACKGROUND: Recent data suggest that children have a higher incidence of recurrence than adults after nonoperative treatment of primary spontaneous pneumothorax (PSP). Video-assisted thoracoscopic surgery (VATS) allows efficacious therapy with significantly less morbidity. We attempt to define the most cost-effective clinically efficacious strategy using VATS to manage pediatric PSP. METHODS: We retrospectively reviewed all admissions to a tertiary care children's hospital for PSP between January 1, 1991 and June 30, 1996. RESULTS: Fifteen children had 29 primary or recurrent PSPs. Mean patient age was 14.8 +/- 1.1 years, boy-girl ratio 4:1, median body mass index 18 (normal, 20-25), and 67% of pneumothoraces left sided. All patients were managed initially nonoperatively: 14 with tube thoracostomy drainage and 1 with oxygen alone. Of the children initially managed nonoperatively, 57% had a recurrent pneumothorax, and 50% of these patients eventually developed contralateral pneumothoraces. Nonoperative treatment for recurrence resulted in a 75% second recurrence rate. In contrast, eight children who underwent operative management had a 9% incidence of recurrence. The total for charges accrued in treating 29 pneumothoraces in these 15 patients was approximately $315,000. In the same population, the estimated charges for initial nonoperative therapy followed by bilateral thoracoscopy after a single recurrence would be $230,000. CONCLUSIONS: A cost-effective treatment strategy for pediatric primary spontaneous pneumothorax is tube thoracostomy at first presentation, followed by VATS with thoracoscopic bleb resection and pleurodesis for patients who experience recurrent pneumothorax.

Adolescent↗
PubMed2005

[Long-term outcome of intrapleural fibrinolytic therapy via small-bore catheter drainage in the management of complicated parapneumonic effusion and empyema-a case series].

BACKGROUND AND PURPOSE: Complicated parapneumonic effusions (PPE) and pleural empyemas (PE) are associated with increased morbidity and mortality. Intrapleural fibrinolytic therapy (IFT) has been established, besides video-assisted thoracoscopy (VATS), in the management of PPE and PE. Combination of IFT and small-bore catheter drainage has previously not been investigated. PATIENTS AND METHODS: 15 patients consecutively referred for PPE and PE were managed with simultaneous IFT via small-bore catheter drainage (9, 12, 14 F). In addition to evaluation of primary outcome, lung function testing and radiologic studies were obtained after 3 months to predict potential pulmonary restrictive impairment and residual pleural thickening. RESULTS: Primary outcome of all 15 patients was positive. Only one patient showed a significant residual pleural thickening. None of the patients showed a restrictive lung function pattern. CONCLUSION: Proven applicability of IFT via small-bore catheter drainage seems to be effective in the face of long-term outcome. Further prospective and multicentric studies should be initiated to investigate the practicability of IFT via small-bore catheter drainage.

Adult↗
PubMed2002

[Structural anomalies in lung apices after pneumothorax operation].

INTRODUCTION: Fifty-eight patients (mean age 27 years, range 17-44) with primary spontaneous pneumothorax (PSP) underwent resection of apical bullae and partial apical pleurectomy via mini-thoracotomy or thoracoscopy, in 12 cases bilaterally, between 1982 and 1999. METHOD: After a mean follow-up period of 111 (16-212) months, 26 patients with 31 operated lungs were reassessed by high-resolution CT (HRCT) to demonstrate postoperative morphological changes. RESULTS: Neither relevant clinical symptoms nor recurrence of a pneumothorax were found. However, HRCT revealed new apical bleb formations in 22 (71%) of 31 lungs. Neither the surgical approach, the technique of resection nor giving up smoking could be correlated to the tissue alterations. Surgical excision of the apex of the lung does not stop bleb formation. CONCLUSION: This study confirms earlier results from a different institution, when blebs recurred in 50% of the cases. The presence of these new apical formations neither influenced the clinical outcome nor predisposed to recurrence of PSP. Parietal (partial) pleurectomy seems mandatory to prevent PSP in the long-term.

Adolescent↗
PubMed1996

[Principles of lung volume reduction].

Lung volume reduction (LVR) is a new surgical approach designed to relieve shortness of breath and to improve exercise tolerance in patients with severe lung emphysema. Selection of patients for LVR is based on history, clinical investigation, chest X-ray studies, CT scan, lung perfusion scan, lung function testing, and blood gas analysis. Selection criteria are severe emphysema (FEV1 20-35% pred., TLC > 120% pred., RV > 250% pred.), dyspnea despite optimized medical therapy, abstinence from smoking, acceptable nutritional status and rehabilitation potential. Patients with a uniform pattern of lung destruction benefit far less than those with a more localised pattern (> 30% on chest X-ray or CT scan) with the remaining lung being quite normal and a reduced perfusion of only the damaged areas. Prior to the final decision for LVR, all patients are enrolled in a supervised rehabilitation programme of 4 weeks duration. Some patients benefit so much that LVR can be postponed. The surgical approach of choice is a median sternotomy for bilateral LVR when the upper lobes are the target areas and a bilateral thoracotomy if the lower lobes are mainly affected. When a bilateral procedure is contraindicated, a unilateral approach may be an option. It is not yet clear whether an approach by thoracoscopy allows adequate surgical removal of all affected areas and whether the morbidity is lower. Laser ablation is a further therapeutic option but is much less effective than the surgical resection. Reinforcement of sutures using bovine pericardium strips reduces the chance of a prolonged air leak but is expensive. The results from our institution in 57 patients 1 month after LVR surgery showed the following improvement in dyspnea was a consistent finding in 88% of patients, the 6-min walking distance increased on average by 150 m, the FEV1 by 0.3 1 for unilateral LVR and 0.5 1 for bilateral LVR. The mean PaO2 in ambient air increased 6 mmHg after unilateral and 8 mmHg after bilateral LVR. There was also a significant improvement in respiratory muscle function and a reduction in respiratory drive. A significant improvement in quality of life was documented in 83% of the patients. Major hospital complications are prolonged air leak, pneumonia, and myocardial failure. Three cases of a delayed pneumothorax were observed. Early hospital mortality (< 30 days) was 1.7% and 90 days mortality 3.4%. Few follow-up data are available beyond 1 year, and the long-term benefit of LVR surgery therefore remains to be defined.

Adult↗
PubMed2005

[Kirschner wire migration in the contralateral lung after osteosynthesis of a clavicular fracture].

A 59-year-old patient was admitted complaining breathing-dependent pain in the lower right chest and increasing dyspnoea. Diminished breath sounds in the right lung and dullness in the lower right chest were found. Chest x-ray and complementary CT scan showed an intrapulmonary Kirschner wire and a large haematothorax but no pneumothorax. At 6 weeks before admission, the patient suffered a fracture of the medial left clavicle which was treated by closed reduction and percutaneous osteosynthesis with two Kirschner wires. The migrated K-wire and the haematoma were removed by video-assisted thoracoscopy without complications. Migration of Kirschner wires after clavicle fracture osteosynthesis is rare but dangerous. Migrations into the heart, lung, pulmonary vein or the cervical spinal cord have been recorded. Patients with K-wire osteosynthesis should be informed of the risk of wire migration and should undergo regular postoperative follow-ups including radiography every 2-4 weeks.

Bone Wires↗
PubMed2006

[Chest injury. Part II: Management of specific injuries].

Significant injuries to the thorax comprise pneumothorax, rib fractures, lung contusion, cardiac contusion, aortic laceration, ruptured diaphragm, and the very rare injuries to the tracheo-bronchial tree and the esophagus. A surgeon dealing with chest trauma patients needs to be familiar with the indications for and execution of chest tube insertion for thoracic drainage, pericardial puncture, and thoracoscopy and thoracotomy. Interventional techniques are gaining increasing acceptance in the management of major vascular injuries. The vast majority of patients with chest injury do not need an operative intervention, but it is necessary to place a thoracic drain in 10-15% of cases or to perform in a much lower proportion a pericardial puncture or a thoracotomy.

Critical Care↗
PubMed2004

Endoscopic parathyroid surgery: results of 365 consecutive procedures.

In recent years, several series have documented the feasibility of endoscopic approaches for parathyroid diseases. We performed a retrospective study to evaluate the results of endoscopic parathyroidectomy (EP) in the management of our patients with primary hyperparathyroidism (PHPT). During a 5.5 year period (1998-2003), we operated on 644 patients with PHPT. EP was proposed for patients with sporadic PHPT, without associated goiter, and without previous neck surgery in whom a single adenoma was localized by means of sonography and sestamibi scanning. EP was performed by the lateral approach with insufflation for patients with an adenoma located deep in the neck and by a gasless midline approach for patients whose adenoma was located anteriorly. A quick parathyroid (QPTH) assay was used during the surgical procedures. Among 644 patients with PHPT, 279 (43.3%) were not eligible for EP for the following reasons: associated nodular goiter (116 cases), previous neck surgery (52 cases), suspicion of multiglandular disease (31 cases), lack of preoperative localization (61 cases), and miscellaneous causes (19 cases). EP was performed in 365 patients with sporadic PHPT: 339 lateral access, 25 midline access, and one thoracoscopy. The median operating time was 49 minutes (16-130 minutes). Conversion to conventional parathyroidectomy was required in 49 patients (13.4%) for these reasons: missed adenomas (14 cases), difficulty with the dissection (8 cases), multiglandular disease correctly predicted by QPTH (11 cases), false-negative QPTH assay results (4 cases), false-positive sestamibi scan results (11 cases), and 1 false-positive sonography result. One patient presented with definitive recurrent nerve palsy. Three patients remained hypercalcemic, and one other patient had recurrent hypercalcemia. In conclusion, EP can be proposed for more than half of the patients with PHPT. Immediate results of EP are similar to those obtained with conventional parathyroidectomy, but no conclusions can be drawn in terms of the influence of EP on the outcome of the patients operated on for PHPT.

Adenoma↗
PubMed2005

Inframanubrial parathyroid glands in patients with primary hyperparathyroidism: alternatives to sternotomy.

Deep inframanubrial parathyroid tumors have traditionally been excised through a median sternotomy. With the advent of minimally invasive surgical access, we chose to examine the treatment options and outcomes of patients with inframanubrial mediastinal parathyroid tumors. Patients with primary hyperparathyroidism seen at a university medical center over a 12-year period were retrospectively reviewed. The utility of localization studies, methods of treatment, complications, and outcomes were examined in patients with a parathyroid tumor located in the mediastinum inferior to the manubrium. Patients with parathyroid adenomas located at the thoracic inlet were excluded. Sixteen patients with inframanubrial mediastinal tumors were treated during the study period. Altogether, 81% of the patients had undergone at least one prior neck exploration for primary hyperparathyroidism. Preoperative calcium and parathyroid hormone levels were 12.4 +/- 0.36 mg/dl and 273 +/- 70 pg/ml, respectively. Localization studies identified mediastinal parathyroid adenomas in the following locations: anterior mediastinum (n = 8), middle mediastinum (n = 7), posterior mediastinum (n = 1). Mediastinal computed tomography and technetium-sestamibi scans demonstrated the best sensitivity, 92% and 85%, respectively. Seven patients underwent successful excision of the mediastinal adenoma by transcervical mediastinal exploration with the Cooper retractor. The other patients underwent angiographic ablation (n = 4), anterior mediastinotomy (n = 3), video-assisted thoracoscopy (VATS) (n = 1), and VATS plus thoracotomy (n = 1). The mean hospital stay for the study group was 2.9 +/- 0.7 days. The complication rate was 25%. All patients were normocalcemic after a mean follow-up of 15 +/- 7 months. Most inframanubrial mediastinal parathyroid tumors can be successfully managed without median sternotomy.

Adenoma↗
PubMed2005

Appraisal of surgical treatment for pulmonary metastasis from hepatocellular carcinoma.

The outcome of pulmonary metastasectomy of hepatocellular carcinoma (HCC) was appraised in this study. Twenty patients with pulmonary metastasis from HCCs undergoing pulmonary resection between 1990 and 2003 were included in this study. They had undergone curative treatment for the primary lesion and were candidates for a pulmonary metastasectomy for complete resection. Among the 20 patients, 13 died: 5 from hepatic failure, 5 from respiratory failure, and 2 from brain metastasis due to recurrence of the HCC. One patient died from cardiac failure without HCC recurrence. At the latest observation, three of the seven survivors were doing well without HCC recurrence, and others survived with recurrence. The overall survival rates after the initial lung surgery were 45.3% at 1 year and 23.8% at 3 years, respectively. The survival rates without recurrence were 32.4% at 1 year and 21.6% at 3 years, respectively. A Kaplan-Meier analysis showed that multiple lung surgeries and a negative histologic finding of the liver cut surface were favorable characteristics for survival without recurrence. In conclusion, the selected patients were Candidates for pulmonary metastasectomy after a curative hepatectomy for HCC and could benefit from the complete resection. Also, repeated pulmonary resections through thoracoscopy could result in the long-term survival of patients with pulmonary recurrence of HCC.

Adult↗
PubMed2001

Advances in the staging of intrathoracic malignancies.

Conventional staging of lung and esophageal tumors has consisted of a thorough history and physical examination, screening laboratory studies, computed tomography, and radionuclide imaging. Newer modalities including positron emission scanning, endoscopic ultrasonography, minimally invasive surgery (laparoscopy and thoracoscopy), and immunohistochemical staining of lymph node tissue. The role of these techniques are subject to much current debate, and they may ultimately add information that is valuable for staging and optimally treating patients with intrathoracic malignancies.

Carcinoma, Non-Small-Cell Lung↗
PubMed1999

Thoracoscopic surgery for spontaneous pneumothorax.

Spontaneous pneumothorax in apparently healthy individuals is a relatively common occurrence. The management of patients with spontaneous pneumothorax remains controversial. With the advances in thoracoscopic techniques and instrumentation, video-assisted thoracic surgery (VATS) is now accepted by many as the procedure of choice for surgical treatment of spontaneous pneumothorax. We report our combined experience with 757 patients who suffered from recurrent or persistent spontaneous pneumothorax treated by VATS over a 5-year period. Surgical indications included persistent air leak (n = 165), recurrence (n = 325), radiologically demonstrated huge bulla (n = 12), spontaneous hemopneumothorax (n = 13), incomplete expansion of the lung (n = 212), and bilateral involvement (n = 30). Several surgical procedures were undertaken, based on the thoracoscopic findings: endoscopic stapled bullectomy (n = 312), argon beam coagulation (n = 6), endoscopic suturing (n = 52), and endoloop ligation (n = 352). In 49 cases, mechanical or chemical pleurodesis was the only procedure performed. There were no mortalities or intraoperative hazards. Complications consisted of wound infections (n = 16), localized empyema (n = 2), chest wall bleeding (n = 1), and persistent air leaks (bulla type III) (n = 31). The median duration of the operation was 55 minutes (15-160 minutes), and the average postoperative hospital stay was 4.5 days (range 0-27 days). There were 16 recurrences (2.1%), after a mean follow-up of 30 months (range 1-60 months). Seven patients had recurrence from 9 to 17 months after stapled bullectomy. All the remaining patients had recurrence after failed pleurodesis. On the basis of our results, we conclude that video-assisted thoracoscopic management allows effective, safe performance of standard surgical procedures, avoiding a formal thoracotomy incision. We consider thoracoscopy the treatment of choice for patients with pneumothorax requiring surgical therapy.

Adolescent↗
PubMed2000

New surgical strategy for gastroduodenal ulcer: laparoscopic approach.

Although peptic gastroduodenal ulcers are rarely treated surgically today, when surgery is required a laparoscopic approach is possible with its well known advantages. The most widely used technique is vagotomy by various modalities. Training in laparoscopy requires good instrumentation to avoid complications. Vagotomy can be truncal and bilateral via laparoscopy or thoracoscopy, which is the easiest and quickest procedure; moreover, the sequelae are less important and less frequent, as has been reported. It can also be highly selective or mixed, such as the Taylor procedure; and large series have been reported with good results. Gastric resection is rarely used for peptic ulcers, although it is feasible laparoscopically; it requires a large experience. Long-term results of laparoscopic vagotomy are now available and have indicated the same results as are attained with open surgery.

Duodenal Ulcer↗
PubMed1996

[Differential diagnosis of multiple pulmonary coin lesions. Lymphomatoid granulomatosis].

In addition to metastasis, the differential diagnosis of multiple pulmonary nodules also includes tuberculosis, sarcoidosis, and silicosis. Rarer diseases such as amyloid tumors, rheumatic nodules and plasma-cell granulomas can be the cause of this finding. This depends on the clinical manifestation. Based on clinical findings of lymphomatoid granulomatosis, the problems in diagnostics using bronchoscopy, mediastinoscopy and thoracoscopy are outlined. Etiology, morphology and differential diagnosis of lymphomatoid granulomatosis versus necrotizing inflammatory or neoplastic lesions are discussed. Treatment and prognosis are described.

Biopsy↗