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At least 19 recordsLinked to original sources
PubMed1988

Thoracoscopy: assessment of a physician service and comparison of a flexible bronchoscope used as a thoracoscope with a rigid thoracoscope.

The practicality of physicians performing thoracoscopy for diagnostic purposes was assessed in 30 patients with pleural effusions of unknown cause. A rigid thoracoscope was compared with a fibreoptic bronchoscope used as a flexible thoracoscope and the diagnostic adequacy of biopsy specimens obtained with the two instruments assessed. The two instruments were inserted by a physician in the bronchoscopy suite using local anaesthesia. The procedure proved safe, acceptable, and diagnostically effective. The rigid thoracoscope proved a more satisfactory instrument but the fibreoptic bronchoscope, with minor adaptations, may be used for thoracoscopy.

Biopsy↗
PubMed1999

Video-assisted thoracoscopic closure of the delayed bronchial rupture after thoracoscopic resection of mediastinal bronchogenic cyst.

Video-assisted thoracoscopic surgery (VATS) is an effective and less invasive modality for management of mediastinal disorders, but various complications can result from the procedure. This report describes a case of delayed rupture of the bronchus intermedius which occurred on postoperative day 1 after the patient underwent complete thoracoscopic removal of a mediastinal bronchogenic cyst (BC) with pericystic adhesions to the bronchus. The bronchial rupture was successfully treated by conventional surgical instruments through limited thoracotomy with video-assisted thoracoscopic guidance. In recognition of this possibility, VATS for a BC with adhesions should be carefully performed. Additionally, the role of VATS in bronchial repair is beneficial.

Adult↗
PubMed2003

[A thoracoscopic technique with fibrin glue and polyglycolic acid mesh for the injured lung during thoracoscopic operation].

The injury of the lung occurred during thoracoscopic operation, especially, of the fragile, severely emphysematous lung is often difficult to treat. A fibrin glue spraying device in which an air compressor was connected to an intravenous catheter was constructed, and connected to a Dupuloject syringe. Fibrin glue was administered by spraying on the target lesion under a thoracoscopic vision. The procedure was done while the tip of the intravenous catheter was held and manipulated with forceps through a thoracoport. And then, the polyglycolic acid (PGA) mesh that had been cut into small pieces was put on the target lesion with forceps. Fibrin glue was sprayed on the lesion again in the above-mentioned manner. When necessary, the procedure was repeated. Our technique during thoracoscopic operation may be easy to manipulate and be able to apply the target lesion uniformly within a short time with a successful repair.

Aged↗
PubMed1994

[Thoracoscopic anatomy, significance of pathologic findings in thoracoscopic open lung biopsy, and pleural mesothelioma].

To better understand diseases of the thoracic space, pathologic findings of thoracoscopic open lung biopsy are described based on thoracoscopic anatomy and pleural mesothelioma. A positive colloidal iron stain in the plasma membrane of the mesothelial cells indicates the presence of hyaluronic acid, which appeared to decrease the friction between the lung and thoracic cavity. Excess fluid in the pleural cavity was removed from specific sites in the parietal pleura with stomas. We evaluated the pathologic features of 57 video-thoracoscopic open lung biopsies. Specific diagnoses were established in 89%, and of these half were pneumothorax. Nonspecific pathologic changes were found in 11%, of which interstitial pneumonia was the most common. This procedure is useful in taking a large number of specimens for diagnosis, and to evaluate the degree and progress of fibrosis. The differential diagnosis of mesothelioma from pulmonary adenocarcinoma, reactive mesothelial hyperplasia, and sarcoma of the pleura are described. Also, to understand mutations of the p53 tumor-suppressor gene in mesothelioma, mesothelial lesions were studied with immunostaining for p53 antibody (DO-7) and with in situ hybridization for p53 mRNA. In immunohistochemical staining for DO-7, all reactive mesothelial cells were positive, and 75% of mesotheliomas including epithelial, biphasic, and sarcomatous types were positive, and 75% of mesotheliomas including epithelial, biphasic, and sarcomatous types were positive. mRNA for p53 was expressed in all reactive mesothelial cells, and in 55% of allmesotheliomas.

Biopsy↗
PubMed1993

[TV-assisted thoracoscopic surgery with a lung forceps combined with thoracoscope under local anesthesia for spontaneous pneumothorax with a persistent air leak--a single access port approach].

TV-assisted thoracoscopic surgery was performed under local anesthesia by through a single access port to control a continuing air leak in spontaneous pneumotorax. A 75-year-old man was admitted with severe dyspnea and right-sided chest pain. The chest X-ray film showed right lung collapse. A right spontaneous pneumothorax was diagnosed and was treated by chest tube drainage. However, the lung did not re-expand because of a continuing air leak and subcutaneous emphysema developed. TV-assisted thoracoscopic surgery was performed under local anesthesia to treat the persistent air leak on day 12. By endoscopy, the ruptured bulla was double-ligated with an Endoloop through a single access port using lung forceps combined with endoscope. The air leak subsequently ceased and the lung re-expanded. This method is minimally invasive and is very suitable for controlling a continuing air-leak causing spontaneous pneumothorax in a patient.

Aged↗
PubMedDate not supplied

Mini-open thoracoscopically assisted thoracotomy versus video-assisted thoracoscopic surgery for anterior release in thoracic scoliosis and kyphosis: a comparison of operative and radiographic results.

BACKGROUND CONTEXT: Combining anterior release and interbody fusion with posterior instrumented fusion is an accepted treatment for severe rigid spinal deformity. Video-assisted thoracoscopic surgery (VATS) and mini-open thoracoscopically assisted thoracotomy (MOTA) are two minimally invasive approaches to the thoracic spine. Both reduce surgical trauma, improve cosmesis and provide effective exposure for release and fusion. Published data and the authors' surgical experience have demonstrated that both techniques are equivalent in degree of release to traditional open thoracotomy, but no comparison between these two minimally invasive alternatives has been published to our knowledge. PURPOSE: This study compared MOTA and VATS under the hypothesis that both result in similar corrections and comparable operative parameters when used in conjunction with posterior instrumented fusion. STUDY DESIGN/SETTING: Retrospective chart review of consecutive case series by two surgeons. PATIENT SAMPLE: Twenty-one (13 female, 8 male) patients underwent MOTA and 24 patients (17 female, 7 male) underwent VATS for anterior release, discectomy and fusion prior to posterior instrumented fusion. OUTCOME MEASURES: Outcomes were measured at a minimum of 1-year follow-up and included radiographic Cobb measurements and operative parameters. METHODS: The indications for surgery included rigid and severe scoliosis or thoracic kyphosis. Data collection included preoperative demographics, number of levels released, primary curve correction, operative time and blood loss. Data were normalized per number of levels released anteriorly. Statistical analysis of results was done using a two-sample t test assuming equal variances with two-tail p values less than .05. RESULTS: More anterior levels were operated on average in the VATS group (6.33 vs. 4.38 levels). Curve correction per anterior level released was similar in both groups (8.7 and 8.8 degrees/level for MOTA and VATS, respectively). There was a significant difference in operative time with MOTA averaging 131.7 minutes and VATS averaging 162.8 minutes. However, a comparison of the operative time per anterior level operated, approached statistical significance in favor of VATS (33.0 vs. 28.4 minutes, p=.08). There was no significant difference in estimated blood loss during the anterior portion of the surgeries. There was a trend toward decreased blood loss per operated level favoring VATS (68.4 vs. 38.9 cc, p=.09). CONCLUSIONS: Both approaches resulted in corrections that compare favorably with open thoracotomy. We suggest that a factor in choosing between these two minimally invasive techniques is the number of thoracic levels requiring release. For four levels or less, MOTA provides an excellent alternative to standard thoracotomy. For five or more levels, VATS provides for excellent exposure of additional levels with the advantages of less operative time and blood loss per operated level.

Adult↗
PubMed2003

Minithoracotomy with simultaneous video-assisted thoracoscopic surgery vs. video-assisted thoracoscopic surgery for spontaneous hemopneumothorax.

BACKGROUND: Spontaneous hemopneumothorax, a life-threatening and rare disorder and complication of primary spontaneous pneumothorax, is regarded as a surgical emergency. We have prospectively investigated the differences in safety and utility between minithoracotomy with simultaneous video-assisted thoracoscopic surgery (MT + VATS) and the video-assisted thoracoscopic surgery approach (VATS) in the treatment of spontaneous hemopneumothorax. METHODS: From Jan 1998 to May 2002, 248 patients with primary spontaneous pneumothorax were treated in our hospital. Among these patients, 12 (4.8 %) spontaneous hemopneumothorax occurred, all in the first episode of spontaneous pneumothorax. After tube thoracostomy, the amount of blood drainage ranged from 500 to 1,500 ml. 8 patients were treated by MT + VATS and 4 by VATS. RESULTS: During surgery, the sources of hemorrhage were all from the torn aberrant vessels between the apical blebs and the parietal pleura. The duration of main surgical procedure (including removal of blood clot in pleural cavity, control of bleeding and blebectomy) was significantly shorter in MT + VATS than in VATS (p < 0.01, Mann-Whitney U). There were no differences between these two groups in postoperative chest tube drainage duration, average postoperative pain score or hospital stay. No relapses occurred in the succeeding 6 months to 4 years. CONCLUSIONS: Spontaneous hemopneumothorax is usually treated as an urgent surgical condition. MT + VATS is an easy accessible and safe procedure that could be applied as an initial treatment method in the patient with spontaneous hemopneumothorax, especially in the treatment of the patients with active hemorrhage and massive blood clot in the thorax.

Adult↗
PubMed2004

Complete versus assisted thoracoscopic approach: a prospective randomized trial comparing a variety of video-assisted thoracoscopic lobectomy techniques.

BACKGROUND: Video-assisted thoracoscopic surgery (VATS) lobectomy does not represent a unified approach, but rather a spectrum of operative techniques ranging from a complete endoscopic thoracotomy to a minithoracotomy. A prospective randomized trial was conducted to compare the differences in these techniques and their results to determine the best of VATS lobectomy for lung cancer. METHODS: This study randomized 39 consecutive patients with clinical stage I lung cancer to undergo either a complete (C-VATS, n = 20) or an assisted (A-VATS, n = 19) VATS approach for pulmonary lobectomy. RESULTS: The operating time was longer (p = 0.002) and blood loss was less (p = 0.004) with C-VATS than with A-VATS. Although there was no significant difference in analgesic use or duration of thoracic drainage between the groups, a shorter hospitalization was observed after C-VATS. Serum peak levels of postoperative inflammatory markers (white blood cell count, C-reactive protein, creatine phosphokinase) were lower with C-VATS and an earlier return to normalization than with A-VATS. CONCLUSION: Various differences exist among the VATS lobectomy techniques, and complete VATS lobectomy as a purely endoscopic surgery may be technically feasible and a satisfactory alternative to the conventional procedure for stage I lung cancer.

Aged↗
PubMed1994

Video-assisted thoracoscopic placement of paravertebral catheters: a technique for postoperative analgesia for bilateral thoracoscopic surgery.

Paravertebral catheters were placed bilaterally through a Tuohy needle under direct video control in a patient undergoing video-assisted thoracoscopic (VAT) surgery for recurrent, bilateral pneumothoraces. Postoperative analgesia was produced by infusing bupivacaine through the catheters. This provided good analgesia. VAT placement of paravertebral catheters is easily accomplished and may be a part of the surgical procedure.

Adult↗
PubMed2002

[Thoracoscopic video-assisted talcum pleurodesis (TTP)--effective treatment of malignant pleural effusion].

INTRODUCTION: Aim of the palliative therapeutic procedure should be a fast, efficient and pain free treatment of the malignant pleural effusions. PATIENTS AND METHOD: Since 1995 the results of malignant pleural effusions treatment were analyzed retrospectively in 46 patients who underwent 51 video-assisted TTP. The most frequent origin of malignant pleural effusion was breast cancer, followed by bronchial carcinoma. Precondition for video-assisted TTP was the verification of a malignant pleural effusion by cytology. RESULTS: Following TTP one patient suffered from pneumonia, two recurrent diseases occurred. Four patients died due to their severe primary malignancy. Average hospitalization was 8 days (3-55). CONCLUSION: Video-assisted TTP is the standard procedure in palliative treatment of malignant pleural effusion; the recurrence rate is low and the technique minimal invasive.

Adult↗
PubMed2002

The feasibility of anterior thoracoscopic spine surgery in children under 30 kilograms.

STUDY DESIGN: A retrospective comparison of pediatric patients weighing less than 30 kg who underwent thoracoscopic anterior spinal release and fusion for deformity correction. This group was compared to two control groups: patients weighing over 30 kg (thoracoscopic) and patients under 30 kg (open). OBJECTIVE: To determine the efficacy and safety of thoracoscopic anterior spinal release and fusion in small pediatric patients weighing less than 30 kg. SUMMARY OF BACKGROUND DATA: Recently, thoracoscopic methods have been utilized to perform anterior spinal release/fusion in the treatment of pediatric and adult spinal deformity. The safety, efficacy, and technical challenges of thoracoscopic spinal surgery in small children have not been established. METHODS: "Small thoracoscopic children," defined as those under 30 kg who had thoracoscopic spinal surgery, are the main focus of this study. They were compared to "large thoracoscopic children" (>30 kg, thoracoscopic surgery) and "small open children" (<30 kg, open surgery). Preoperative, intraoperative, and postoperative parameters were analyzed. RESULTS: Small thoracoscopic children (n = 33) had greater estimated blood loss/kg body weight (13.6 mL/kg vs. 6.2 mL/kg; P= 0.003), greater chest tube output (27.5 mL/kg vs. 17.1 mL/kg; P= 0.003), and a longer intensive care unit stay (4.2 days vs. 1.5 days; P= 0.001) than did large thoracoscopic children (n = 48). Conversion to an open thoracotomy occurred in one patient from each of the thoracoscopic groups. Small thoracoscopic children required more anesthesia preparation time (79.2 minutes vs. 64.2 minutes; P= 0.002) than the small open children (n = 25). There was no significant difference in estimated blood loss, chest tube output, or intensive care unit stay between these two groups. Additionally, no significant difference was found between the three groups with regard to the number of discs excised, operative time, and total hospital stay. CONCLUSION: Despite the decreased working space within the chest and difficulties of selective intubation, anterior thoracoscopic surgery for spinal release and fusion can be performed as safely in "small" children as in "large" children; however, additional intraoperative challenges should be anticipated. Although the outcomes were similar in the small thoracoscopic children compared to the small open children, the authors believe that very small patients (under 20 kg) should remain a relative contraindication to thoracoscopic surgery, especially during a surgeon's learning curve.

Adolescent↗
PubMed2006

Thoracoscopic spinal fusion compared with posterior spinal fusion for the treatment of thoracic adolescent idiopathic scoliosis.

BACKGROUND: Posterior spinal fusion with segmental instrumentation is the gold standard for the surgical treatment of thoracic adolescent idiopathic scoliosis. More recently, anterior surgery and video-assisted thoracoscopic surgery with spinal instrumentation have become available. The purpose of the present study was to compare the radiographic and clinical outcomes as well as pulmonary function in patients managed with either anterior thoracoscopic or posterior surgery. METHODS: Radiographic data, Scoliosis Research Society patient-based outcome questionnaires, pulmonary function, and operative records were reviewed for fifty-one patients undergoing surgical treatment of scoliosis. Data were collected preoperatively, immediately postoperatively, and at the time of the final follow-up. The radiographic parameters that were analyzed included coronal curve correction, the most caudad instrumented vertebra tilt angle correction, coronal balance, and thoracic kyphosis. The operative parameters that were evaluated included the operative time, the estimated blood loss, the blood transfusion rate, the number of levels fused, the type of bone graft used, and the number of intraoperative and postoperative complications. The pulmonary function parameters that were analyzed included vital capacity and peak flow. RESULTS: The thoracoscopic group included twenty-eight patients with a mean age of 14.6 years, and the posterior fusion group included twenty-three patients with a mean age of 14.3 years. The percent correction was 54.5% for the thoracoscopic group and 55.3% for the posterior group. With the numbers available, there were no significant differences between the two groups in terms of kyphosis (p = 0.84), coronal balance (p = 0.70), or tilt angle (p = 0.91) at the time of the final follow-up. The mean number of levels fused was 5.8 in the thoracoscopic group, compared with 9.3 levels in the posterior group (p < 0.0001). The estimated blood loss in the thoracoscopic group was significantly less than that in the posterior fusion group (361 mL compared with 545 mL; p = 0.03), and the transfusion rate in the thoracoscopic group was significantly lower than that in the posterior fusion group (14% compared with 43%; p = 0.01). Operative time in the thoracoscopic group was significantly greater than that in the posterior group (6.0 compared with 3.3 hours, p < 0.0001). There were no intraoperative complications in either group. Vital capacity and peak flow had returned to baseline levels in both groups at the time of the final follow-up. Patients in the thoracoscopic group scored higher than those in the posterior group in terms of the total score (p < 0.0001) and all of the domains (p < 0.01) of the Scoliosis Research Society questionnaire at the time of the final follow-up. CONCLUSIONS: Thoracoscopic spinal instrumentation compares favorably with posterior fusion in terms of coronal plane curve correction and balance, sagittal contour, the rate of complications, pulmonary function, and patient-based outcomes. The advantages of the procedure include the need for fewer levels of spinal fusion, less operative blood loss, lower transfusion requirements, and improved cosmesis as a result of small, well-hidden incisions. However, the operative time for the thoracoscopic procedure was nearly twice that for the posterior approach. Additional study is needed to determine the precise role of thoracoscopic spinal instrumentation in the treatment of thoracic adolescent idiopathic scoliosis.

Adolescent↗
PubMed2006

Long-term follow-up after thymectomy for myasthenia gravis: thoracoscopic vs open.

PURPOSE: The aim of this study was to determine if patients are in remission or weaning off medication after thymectomy for myasthenia gravis (MG) and to examine the thoracoscopic versus open approaches. METHODS: A retrospective review of all patients who underwent thymectomy for MG at a tertiary referral center between 1992 and 2004 (N = 14). Six patients (42.9%) underwent thoracoscopic resection. Eight patients underwent open resection; 5 (35.7%) had median sternotomy and 3 (21.4%) by transcervical approaches. Follow-up was obtained in 12 (85.7%) of 14 patients by both chart review and telephone. The mean follow-up was 43.0 months (range, 4-111 months). Statistical significance was determined by Student's t test or Fisher's Exact Test. RESULTS: The thoracoscopic group had a mean operating time of 138.8 minutes compared with 139.8 minutes in the open group (P = .9). The thoracoscopic group had a mean estimated blood loss of 7.5 mL compared with 52.5 mL in the open group (P = .02). The mean length of stay for the thoracoscopic group was 1.5 days (range, 1-2 days) and was 10.6 days (range, 3-41 days) in the open group (P = .13). Three (60%) of 5 patients were entirely off medication in the thoracoscopic group at the time of follow-up compared with 3 (50%) of 6 patients in the open group (P = 1.0). In the thoracoscopic group, 5 (83.3%) of 6 were in class 1 to 3 of the DeFilippi classification (complete remission or improved with decreased medication requirements). One patient had no change in symptoms (class 4). In the open group, 5 (83.3%) of 6 were classified as DeFilippi 1 to 3 at the time of follow-up, and one patient had worsening symptoms (class 5). CONCLUSIONS: Both thoracoscopic and open approaches to thymectomy in patients with MG are effective, with more than 80% of patients in both groups in remission or with improvement at the time of follow-up. The thoracoscopic group has the added benefits of decreased estimated blood loss, decreased length of hospital stay, and improved cosmesis. We advocate the thoracoscopic approach for thymectomy in the treatment of juvenile MG.

Adolescent↗
PubMed1998

Comparison of thoracoscopic and open thoracic discectomy in a live ovine model for anterior spinal fusion.

STUDY DESIGN: The authors undertook a randomized comparison of 30 thoracoscopic and 30 open thoracic discectomies for anterior spinal fusion in a live sheep model. OBJECTIVES: To compare in a live sheep model discectomies performed using a thoracoscopic technique with those using an open thoracotomy technique to validate the efficacy of thoracoscopic disc and end plate removal for potential fusion. SUMMARY OF BACKGROUND DATA: In 1993, Mack and Regan described a technique for video-assisted thoracic surgery that resulted in less morbidity than open techniques. Subsequent reports support the finding that thoracoscopic spinal surgery results in less morbidity. METHODS: Sixty discectomies were performed in 10 live sheep. In each sheep, three randomly selected discectomies were performed thoracoscopically, and, subsequently, three open discectomies were performed. The animal then was killed, and the spine was sectioned and analyzed by computer imaging. RESULTS: Statistical analysis found no significant difference in the amount of disc resected (t' = 1.9639, t0.025, 60 = 2.000, alpha = 0.05). The mean percentage of disc resected was 67.8% (range, 0-92.2%) in the thoracoscopic group and 76.1% (range, 44.9-95.4%) in the open group. More than 50% of the disc was excised in 27 of 30 spines (90%) in the thoracoscopic group and in 29 of 30 (96.7%) in the open group. This difference was not statistically significant (theta 2(0.05, 1) = 3.84, theta 2' = 1.07). CONCLUSION: The findings in this study indicate that the thoracoscopic discectomy technique is equivalent to the open technique in the amount of disc and end plate resected. In addition, these findings suggest that thoracoscopic discectomies provide adequate disc resection to provide for an acceptable fusion rate according to the criteria demonstrated by Bunnell in 1982 and therefore support the efficacy of a thoracoscopic technique for anterior spinal fusion.

Animals↗
PubMed2005

Thoracoscopic surgery in children.

PURPOSE: A minimally invasive thoracoscopic surgery offers several options in diagnosis and surgical treatment in the field of pediatric surgery. We would like to review our surgical experience and to assess the clinical outcomes and problems encountered during thoracoscopic surgery in children and adolescents focusing on children less than 6 years old. PATIENTS AND METHODS: In 1992 and 2003, 977 patients underwent thoracoscopic surgery for chest diseases. Among them, from 1994 to 2003, 71 children and adolescents underwent thoracoscopic surgery. The thoracoscopic surgical procedures were classified into thoracoscopic surgery (TS) and video-assisted thoracic surgery (VATS). TS was performed through three or four trocar ports. VATS was performed through a small chest incision (minithoracotomy) with one or two trocar ports. RESULTS: There was no morbidity or mortality associated with the thoracoscopic surgical procedures. None of the patients required a conversion to standard thoracotomy. The thoracoscopic surgical procedures were feasible in 71 children and adolescents with chest diseases including spontaneous pneumothorax, pulmonary nodules, diffuse pulmonary disease, pulmonary sequestration, and mediastinal tumors, and in those with palmar hyperhidrosis. TS was performed on two of five children with benign diseases including diffuse pulmonary disease and mediastinal bronchogenic cyst. VATS was performed on three children with pulmonary sequestration, lymphoid interstitial pneumonia and mediastinal Ewing's sarcoma. In one child with lymphoid interstitial pneumonia, the thoracoscopic surgery was converted to VATS because adhesion did not allow TS. The TS allowed rapid histological diagnosis and surgical treatment for benign pulmonary diseases and mediastinal cyst. Patients who were suffering from disease-related symptoms obtained complete relief with an uneventful postoperative course and quickly returned to their normal life. A boy who underwent lobectomy showed a normal growth rate for 4 years postoperatively. In the case of malignant chest diseases, the combination of chemotherapy and VATS was an effective treatment strategy. CONCLUSIONS: We considered that the thoracoscopic approach is a rapid and simple method in the therapeutic diagnosis and surgical treatment of children and adolescents, even in children less than 6 years old. Cosmetic benefits were also obtained for girls. However, the most important consideration is the decision on a treatment strategy made by both pediatrician and thoracic surgeon.

Adolescent↗