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At least 19 recordsLinked to original sources

PubMed1990

[Treatment of spontaneous pneumothorax by electrocoagulation via a fiberoptic bronchoscope with a hysteroscope irrigation outer sheath as a thoracoscope].

Since 1981 in Yamagata Prefectural Central Hospital, the authors performed electro-coagulation therapy for air leakage from bullae (blebs) via a rigid thoracoscope in 31 patients with spontaneous pneumothorax. Among these patients, this treatment was unsuccessful in 14 patients (45.2%) because of 5 multiple or giant bullae and 9 cases in which it was impossible to visualize the bullae in the mediastinum or because of pleural adhesion. In order to widen the visual field and increase the mobility of the thoracoscope, we employed a fiberoptic bronchoscope with a hysteroscope outer sheath used for irrigation as a flexible thoracoscope. This method makes it possible to examine both mediastinal pleura and adhesive pleural space, and to electrocoagulate bullae which cannot be visualized by a rigid thoracoscope. It was possible to visualize the blebs in all 13 cases with spontaneous pneumothorax in which this examination was attempted. This therapeutic procedure causes the patients less pain and the hospitals more economical because no new thoracoscope is necessary. This method of thoracoscopic therapy of spontaneous pneumothorax using a fiberoptic bronchoscope is more successful, effective, economical and painless than by rigid thoracoscope and should be attempted before thoracotomy.

Adolescent↗

PubMed1979

Thoracoscopy. A safe, accurate diagnostic procedure using the rigid thoracoscope and local anesthesia.

A thoracoscopic examination was performed in 41 patients under local anesthesia in the lateral decubitus position. Prior thoracocentesis (38 patients) and blind biopsy with an Abrams' needle (32 patients) had been nondiagnostic. The initial nine patients were examined with the flexible fiberoptic bronchoscope, yielding a diagnostic accuracy of 56 percent (five cases). This technique was discontinued when two patients had normal findings on biopsies, despite the visual observation of later diagnosed carcinoma. Subsequent thoracoscopic procedures were performed with a rigid 11-mm single-puncture thoracoscope (Storz), which was diagnostic in 28 (88 percent) of the remaining 32 patients. A hemothorax (400 ml) was the only potentially serious complication. Twelve patients were prospectively monitored during the thoracoscopic procedure for changes in cardiac rhythm and oxygen saturation. Sinus tachycardia was the only arrhythmia observed. The mean fall in oxygen saturation was 1.4 percent. We conclude that thoracoscopic examination with the rigid thoracoscope is diagnostically superior to the fiberoptic bronchoscope and is a safe procedure which can be performed under local anesthesia.

Anesthesia, Local↗

PubMed1992

Thoracoscopic resection of 85 pulmonary lesions.

Advances in endoscopic surgical equipment and laser technology have expanded the role of thoracoscopy to include thoracoscopic pulmonary resection. Eighty-five thoracoscopic pulmonary resections were performed on 61 consecutive patients with small lesions (less than 3 cm) in the outer third of the lung. Patients with preoperative histologic evidence of bronchogenic carcinoma were excluded unless there was impairment of cardiopulmonary function, advanced age, or concomitant extrathoracic malignancy. These thoracoscopic pulmonary resections were accomplished with the neodymium:yttrium-aluminum garnet laser (31), endoscopic stapler (29), or both (25). The mean diameter of the lesions was 1.3 cm (range, 0.4 to 2.7 cm). There has been one late death (38th postoperative day) unrelated to the operation. Morbidity consisted of postoperative atelectasis (2), pneumonia (2), bleeding requiring transfusion (1), and bronchopleural fistula of greater than 7 days duration (3). There were no wound problems. The mean period of chest tube drainage was 3.3 +/- 3.0 days. Mean postoperative stay was 5.7 +/- 4.9 days. The pathologic diagnosis was benign disease in 28 patients (interstitial fibrosis/pneumonitis, 15; radiation fibrosis, 1; sclerosing hemangioma, 1; rheumatoid nodules, 1; granuloma, 2; nocardia, 1; infarct, 1; hamartoma, 4; scar, 1; cytomegalovirus pneumonia, 1), metastatic malignancy in 20 patients, and bronchogenic carcinoma in 13 patients. Five patients found at thoracoscopic pulmonary resection to have bronchogenic cancer had adequate pulmonary function and therefore underwent formal segmentectomy (3) or lobectomy (2). Thoracoscopic pulmonary resection was the only operation performed on patients with benign disease, patients with metastatic lesions, and selected patients with limited stage bronchogenic carcinoma at increased risk for thoracotomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗

PubMed1992

Extended thoracoscopic T2-sympathectomy in treatment of hyperhidrosis: experience with 130 consecutive cases.

A new method of thoracoscopic T2-sympathectomy mentioned in a previous report was used on 36 cases of hyperhidrosis at Tainan Municipal Hospital in Taiwan between October 1, 1989 and July 31, 1990. To reduce the possibility of incomplete resection of sympathetic nerve tracts, including ganglions and their regeneration, the method was modified on August 1, 1990. Thereafter, routine total removal of T2 and T3 sympathetic ganglions, as well as wide lateral incisions of the pleura on the second, third, and fourth rib beds were performed for treatment of hyperhidrosis. This newly modified method, "extended thoracoscopic T2-sympathectomy," can be performed easily by thoracoscopic approach in the treatment of hyperhidrosis palmaris. From August 1, 1990 to May 31, 1991, 130 consecutive cases of hyperhidrosis (56 males and 74 females) ranging in age from 8 to 51 years underwent extended thoracoscopic T2-sympathectomy. In addition to a nearly 100% cure rate of hyperhidrosis palmaris, significant saving in operative time and hospital stay were achieved. High simultaneous cure rate (70.6%) and subjective improvement (17.4%) of excessive sweating of feet (hyperhidrosis plantaris) were also noted in the 109 cases followed up, and complications were minor. Extended thoracoscopic T2-sympathectomy is not only a time-saving method but also a very simple and effective method in the treatment of hyperhidrosis. It is worthy of being propagated worldwide.

Adolescent↗

PubMed1992

Thoracoscopic resection of pulmonary metastases.

OBJECTIVE: To describe the use of thoracoscopic techniques to achieve parenchymal sparing wedge resection of peripheral lung lesions in patients with a history of malignancy, and to describe the morbidity, mortality, and hospital course associated with this approach. DESIGN: Case series. SETTING: University hospital. PARTICIPANTS: Patients with a history of malignancy and lesions on computerized tomography in the outer one third of the lung parenchyma. MAIN OUTCOME MEASUREMENTS: Histologic analysis of resected lung lesions, operative findings, operative time, duration of chest tube drainage and hospital stay, operative morbidity, and mortality. RESULTS: Twenty-one thoracoscopic resections of pulmonary parenchymal lesions were performed on 15 patients. All peripheral lesions identified by computerized tomography were found at thoracoscopy and successfully resected with the Nd:YAG laser (n = 7), an endoscopic stapler (n = 10), or both (n = 4). The mean diameter of the lesions was 0.8 cm (range 0.2 to 1.5 cm). Histologic analysis revealed metastatic disease in 13 patients and benign disease in 2 patients. All resection margins were free of tumor. The mean duration of chest tube drainage and postoperative hospital stay were 1.8 +/- 0.1 and 3.3 +/- 0.1 days, respectively. Mean operative time was 111 min (range 45 to 155 min). One patient who underwent a right thoracoscopic resection developed a transient left vocal cord paresis. There were no other complications and no deaths. CONCLUSION: Thoracoscopy was successful in identifying peripheral lung lesions and allowed for parenchymal sparing resection identical in extent to that performed with open approaches. For select patients with peripheral lung nodules felt to be metastases, thoracoscopic resection may result in reduced morbidity, cost, hospital stay and allow for more rapid institution of therapy for the primary disease.

Adult↗

PubMed2026

Effect of transcutaneous auricular vagus nerve stimulation on postoperative pain in patients undergoing thoracoscopic partial lung resection: a randomized, double-blind, controlled clinical trial.

BACKGROUND: Postoperative pain after thoracic surgery remains common and challenging. Transcutaneous auricular vagus nerve stimulation (taVNS) is a noninvasive neuromodulation technique with potential analgesic effects. This study aimed to evaluate the efficacy and safety of taVNS for postoperative pain management in patients undergoing thoracoscopic partial lung resection. METHODS: Adults undergoing thoracoscopic partial lung resection were randomized to active or sham taVNS. The primary outcome was cough pain intensity at 48h post-surgery, assessed by Numeric Rating Scale (NRS). Secondary outcomes included cough pain at 24h and 72h, resting pain, moderate-to-severe pain incidence, opioid consumption, quality of recovery, postoperative pulmonary complications , chest tube duration, hospital stay, postoperative nausea/vomiting, and adverse events. RESULTS: Among 119 analyzed patients (active n = 60, sham n = 59), active taVNS reduced cough pain scores at 24h, 48h, and 72h postoperatively, as well as resting pain (p < 0.05). It also lowered the incidence of moderate-to-severe cough pain at 24h and 48h, reduced cumulative postoperative opioid use at 24h and 72h, and decreased rescue analgesia on postoperative day 3 (p < 0.05). Active taVNS was associated with a lower incidence of postoperative pneumothorax (p < 0.05). No serious adverse events occurred. CONCLUSION: Perioperative taVNS was associated with a modest analgesic benefit and reduced postoperative opioid requirements after thoracoscopic partial lung resection. The observed reduction in postoperative pneumothorax requires cautious interpretation, and further multicenter trials are needed to determine its clinical utility.

Humans↗

PubMed2026

Comparison of ultrasound-guided two-point block of the rhomboid intercostal vs. thoracic paravertebral for postoperative analgesia in patients undergoing three-port thoracoscopic surgery: a prospective, randomized, non-inferiority study.

BACKGROUND: The anesthetic characteristics of ultrasound-guided two-point rhomboid intercostal block (RIB) have not been fully established. This study compared the analgesic efficacy of ultrasound-guided two-point RIB with that of two-point thoracic paravertebral block (TPVB) for postoperative pain control and recovery in patients undergoing three-port thoracoscopic surgery. METHODS: Seventy patients aged 18-80 years scheduled for three-port thoracoscopic pulmonary resection were block-randomized in a 1:1 ratio to receive either TPVB or RIB. Both techniques were performed using 10 mL of 0.5% ropivacaine at each injection site. The primary outcome was the numerical rating scale (NRS) pain score at rest 24 h after surgery, with a predefined non-inferiority margin of Δ = 1. Secondary outcomes included NRS at rest and during coughing at 0.5, 2, 4, 12, 18, 24, and 48 h postoperatively, as well as the 24h postoperative Quality of Recovery-40 (QoR-40) score. RESULTS: The final analysis included 34 patients in the TPVB group and 34 in the RIB group. The mean difference in resting NRS scores at 24 h between the two groups was 0.088 (95% CI, -0.377 to 0.553), confirming the non-inferiority of RIB. However, the need for rescue analgesia was numerically greater in the RIB group than in the TPVB group (p = 0.045). The 24-h postoperative QoR-40 scores and cumulative sufentanil consumption within 48 h after surgery were comparable between the groups (both p > 0.05). CONCLUSION: Ultrasound-guided two-point RIB provided postoperative analgesia that was non-inferior to TPVB in patients undergoing three-port thoracoscopic surgery.

Adolescent↗

PubMed1991

Comparative studies using a rigid thoracoscope and fiberoptic bronchoscope to treat spontaneous pneumothorax.

Prior to 1978, the conventional treatment of pneumothorax generally consisted of conservative therapies such as rest, needle puncture, or thoracic cavity drainage; however, when conservative therapies were ineffective or relapse occurred therapeutic approach, 34 percent (11/32) of our patients required a thoracotomy. Consequently, in 1981, we began to use alternative therapies to reduce the need for thoracotomy. In this report, we describe the results of using a rigid thoracoscope and fiberoptic bronchoscope for the treatment of spontaneous pneumothorax. Initially, we treated 31 of 79 patients with a rigid thoracoscope and electrocoagulation therapy. Therapy was effective in 17 (55 percent) of the patients. Only 13 (16 percent) of the 79 patients required a thoracotomy, which represents a 50 percent reduction in incidence. Of the 14 cases in which therapy was ineffective, the major cause of failure was our inability to view a broad thoracic area and treat all blebs with a rigid thoracoscope. Subsequently, we developed a method using a fiberoptic bronchoscope (FB), which allows an unrestricted view of the thoracic area, in combination with electrocoagulation and fibrinogen or thrombin solution (or both) for the treatment of spontaneous pneumothorax. We treated 19 of 39 patients with the FB method. Treatment was effective in 15 (80 percent) of the patients. Only 4 (10 percent) of the 39 patients required a thoracotomy, which is a reduction of over 60 percent in our original incidence.

Adult↗

PubMed1991

Thoracoscopic lung resection: use of a new endoscopic linear stapler.

Recent advances in rigid endoscopic imaging capabilities, light sources, and instrumentation have dramatically expanded the potential role of laparoscopic and thoracoscopic surgery. The recent introduction of an endoscopic linear stapling device has made possible thoracoscopic pulmonary resection. A 28-year-old woman with a history of recurrent pneumothorax, diffuse interstitial fibrosis, and left apical microblebs underwent thoracoscopic lung resection using this new stapling device. A 3 x 5 cm segment of involved lung tissue was removed. Postoperatively, the patient manifested no evidence of air leak and was discharged 48 h after surgery.

Adult↗

PubMed1992

Imaged thoracoscopic surgery: a new thoracic technique for resection of mediastinal cysts.

Previously, intrathoracic organs have been approached by either thoracotomy or thoracoscopy. A technique, imaged thoracoscopic surgery, using video optics and projection of images on a screen provides another option for the thoracic surgeon. Two patients with mediastinal cysts, one bronchogenic and one esophageal, underwent surgical removal using imaged thoracoscopic surgery. Postoperative pain was markedly reduced, hospitalization shortened, and recovery accelerated. Numerous complex surgical procedures can be performed using imaged thoracoscopic surgery.

Adult↗

PubMed2026

Thoracic paravertebral block with different doses of liposomal bupivacaine versus ropivacaine for postoperative analgesia in single-port thoracoscopic lung surgery: a randomized clinical trial.

OBJECTIVE: To evaluate the analgesic efficacy of thoracic paravertebral block (TPVB) with different doses of liposomal bupivacaine (LB) or ropivacaine in patients undergoing single-port thoracoscopic lung surgery. METHODS: A total of 105 patients scheduled for video-assisted single-port thoracoscopic lung surgery were randomized in a 1:1:1 ratio into three groups: low-dose LB group (group LL), high-dose LB group (group HL), or ropivacaine group (group R). All received ultrasound-guided TPVB at the T5/6 level preoperatively. The primary outcome was the area under the curve (AUC) of NRS of pain at activity (AUC-aNRS) from 1 to 72 h postoperatively. Secondary outcomes included the AUC of NRS of pain at rest (AUC-rNRS) from 1 to 72 h postoperatively, NRS of pain at rest and at activity at 1, 6, 24, 48, and 72 h postoperatively, and the cumulative opioid consumption at 24, 48, and 72 h postoperatively. Additionally, postoperative recovery and adverse events were assessed. RESULTS: AUC-aNRS differed significantly among groups (p = 0.0092), with high-dose LB lower than low-dose LB (p = 0.0071), but not versus ropivacaine. No significant difference was found in AUC-rNRS (p > 0.05). The group-by-time interactions for NRS of pain at rest and at activity were not significant (p > 0.05). Cumulative opioid consumption at 24, 48, and 72 h was lower in group HL versus group LL (all p < 0.017), but not versus ropivacaine. Postoperative recovery and adverse events showed no differences (p > 0.05). CONCLUSION: LB combined with TPVB is not superior to ropivacaine for postoperative analgesia in single-port thoracoscopic lung resection.

Humans↗

PubMed1992

Thoracoscopic Nd:YAG laser resection of a solitary pulmonary nodule.

Advances in endoscopic surgical techniques and laser technology have expanded the role of thoracoscopy. We report a thoracoscopic resection of a benign pulmonary lesion. A 44-year-old man underwent a successful Nd:YAG laser-assisted thoracoscopic resection of a peripheral lung hamartoma. The patient's postoperative course was uncomplicated. Thoracotomy with its attendant morbidity was avoided. Continued success with thoracoscopic resection will have a significant impact on the management of select patients with peripheral, solitary pulmonary nodules.

Adult↗

PubMed1991

Thoracoscopic talc poudrage pleurodesis for chronic recurrent pleural effusions.

OBJECTIVE: To assess the effectiveness of thoracoscopic talc poudrage for the treatment of chronic pleural effusions. DESIGN: Prospective evaluation. SETTING: Kaiser-Permanente Hospital. PATIENTS: Forty-seven consecutive patients with recalcitrant pleural effusions, referred for thoracoscopy. INTERVENTION: Patients received general or local anesthesia; 42 had a 7-mm rigid thoracoscopic examination followed by insufflation of 5 mL of talc. Patients then had chest-tube drainage. MEASUREMENTS: We recorded clinical characteristics, final diagnosis, procedure-related pain and morbidity, days of hospitalization, patient-reported degree of symptom relief, and chest roentgenographic results at 1, 3, and 12 months. All patients were followed for 16 months or until death. MAIN RESULTS: Of 39 evaluable patients, all reported prolonged relief of effusion-related dyspnea. Radiographic results confirmed the elimination of pleural effusions in 34 patients (87%), including all 11 with benign conditions and 23 of 28 (82%) with malignancies. Treatment failed in three patients because of entrapped lung and in two patients with mesotheliomas whose effusions recurred more than a year after treatment. No procedure-related mortality or morbidity was found. Ambulatory patients required hospitalization for a mean of 3.9 days (range, 2 to 11 days). Mild pain was reported by some patients. The mean duration of chest-tube drainage was 2.7 days (range, 1 to 9 days). Patients with malignant disease lived an average of 12.4 months (range, 1 to 61 months) after the procedure. CONCLUSIONS: Thoracoscopic talc poudrage is an effective pleural sclerosing technique and is relatively painless.

Adult↗

PubMed1992

Thoracoscopic treatment of spontaneous pneumothorax without pleurodesis: a preliminary report.

Laparoscopy has shown to be associated with less morbidity than laparotomy. General surgeons are realizing that procedures so far performed through traditional incisions can be equally performed effectively by laparoscopy. Likewise it is apparent that some thoracic procedures are amenable to thoracoscopic approach. With the development of new instrumentation thoracoscopy is effective for the treatment of spontaneous pneumothorax. Pleurodesis seems to increase the morbidity associated with the thoracoscopic procedure and may reduce its effectiveness. Results of 17 consecutive cases of spontaneous pneumothorax treated thoracoscopically without pleurodesis are herein presented. No significant complications were encountered and no recurrences have been identified so far. Pleurodesis was omitted chiefly because it increases the morbidity of thoracoscopy.

Adolescent↗

PubMed1979

[The value of thoracoscopic sympathectomy in the treatment of Raynaud's syndrome].

On the basis of a follow-up period lasting at least 6 years concerning 23 patients, in whom on account of a Raynaud-syndrome a thoracoscopic sympathicotomy in the region Th 2-5 was carried out in most cases bilaterally in two sessions, in comparison with the sympathicectomy performed in major surgery can be established:no mortality, no serious complications, duration of stay in hospital 5-7 days, no absolute healing. In a follow-up period of the same length in an approach of major surgery absolute healings are possible, but only in 35%. This gain is loaded by a longer stay in hospital of at least 10 days and a mortality of 4.3% as well as by a complication rate of 6-41%, to which in 8-13% of the cases a Horner-syndrome comes. Therefore, before an approach in major surgery a thoracoscopic intervention is to be tried. The thoracoscopic operators should strive for a sympathectomy with destroy of the ganglia Th 2 and 3 instead for a sympathicotomy.

Humans↗

PubMed1992

Thoracoscopic lung biopsy.

Progress in instrumentation and techniques developed for laparoscopic surgery have paved the way for a resurgent interest in thoracoscopic procedures. Traditional thoracoscopy was limited by access, restricted visualization, and surgical devices. Recent cases provided an opportunity to successfully perform thoracoscopic pulmonary wedge excisions using state-of-the-art technology and instruments adapted from laparoscopy. These preliminary cases provided an opportunity to modify and adapt these techniques to thoracic procedures. Video thoracoscopy is rapidly evolving in both methods and instrumentation.

Adult↗

PubMed1992

Preliminary experience with thoracoscopic surgery.

Thoracoscopic surgery was accomplished in 12 patients utilizing thoracoscopic instruments and a stapler. Five patients were treated for recurrent, spontaneous pneumothoraces, for which blebectomies were done; three patients for pulmonary nodules, for which wedge resections were done; one patient for cryptogenic pleural effusion; one patient for debridement of an empyema cavity; one patient for traumatic bronchopleural fistula; and one patient with AIDS for interstitial lung disease. All patients were done under general anesthesia in the lateral decubitus position and were prepped and draped for a standard thoracotomy. They underwent endobronchial double-lumen ventilation so that the ipsilateral lung could be deflated to create a working space. In addition, insufflation of 4 to 5 mmHg was also used. Trocars were placed using a blunt technique. The mid-axillary trocar was at about the eight intercostal space and was used for the endoscope, and then additional trocars were placed, usually on the anterior axillary line and posterior axillary line at about the fifth intercostal space. If adhesions were encountered, the lung was grasped atraumatically with a clamp or retractor used to give counteraction, and the adhesions were lysed with shears or electrocautery. After a thorough exploration of the hemithorax involved, the area of pathology was grasped with the clamp, which was used for countertraction. Through a 12 mm trocar, a stapler was introduced and fired. This staples and also transects on a 3 cm length. Several firings were usually necessary to remove the pathology, which, if malignant, was placed in a retrieval bag.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1992

Imaged thoracoscopic lung biopsy.

Imaged thoracoscopic surgery is a technique utilized to operate on the intrathoracic organs without making a formal thoracotomy incision. Eleven patients underwent lung biopsy with this procedure and each had markedly reduced postoperative pain. Each patient resumed preoperative activity levels within one week of discharge from the hospital. Besides thoracotomy and thoracoscopy, imaged thoracoscopic surgery provides another option for approaching the intrathoracic organs.

Adult↗