Management of persistent or recurrent pneumothorax with a two millimeter mini-videothoracoscope.
The aim of this study was to assess whether a 2 mm mini-videothoracoscope could be used as a conventional videothoracoscope in the management of pneumothorax. Thirty patients of ages from 15 to 35 years with recurrent or persistent pneumothorax were involved in this study. The subjects consisted of 27 males and three females. The indications for videothoracoscopic surgery were ipsilateral recurrent pneumothorax in 12 (40%), persistent air leakage in 15 (50%), visible bullae in 2 (6%), and 1 bilateral pneumothorax (3%). The mean operation time was 42.9+/-12.9 min. The average number of uses for Endo-GIA was 1.9+/-1.3 times and chest tube indwelling time was 3.8+/-2.7 days. The average amount of keptoprofen (100 mg/2 mL/ampule) used on the first postoperative day was 1.2+/-1.1 ampules. No parenteral opioids were given to the patients for pain control after the procedures. After a follow up of 8 to 20 months, there was only one recurrence among the patients. In conclusion, a 2 mm videothoracoscope, in selective cases, can be successfully used as conventional videothoracoscope to manage persistent or recurrent pneumothorax with cosmetically excellent results. (+info)
Surgery for atrial fibrillation.
Surgical treatment is highly effective in converting atrial fibrillation back to sinus rhythm and significantly prevents thromboembolism postoperatively. Indications for surgery include patients with atrial fibrillation associated with structural heart disease who undergo cardiac surgical procedures, high-risk patients for systemic thromboembolic complications related to left atrial thrombi, patients with failure or recurrence following one or more sessions of catheter ablation, and patients with intolerable symptoms or an impaired quality of life due to atrial fibrillation. The maze and radial procedures cure atrial fibrillation in the majority of patients, however, the procedures are not guided by electrophysiologic findings in individual patients, and thus may include unnecessary incisions in some patients or be inappropriate for other patients. Intraoperative mapping may facilitate determining the optimal procedure for atrial fibrillation in each patient. Surgical procedure for atrial fibrillation consists of isolation of all four pulmonary veins to prevent propagation of the repetitive activation and multiple incisions on the right and left atria to block the reentrant activation. A number of ablation devices have been developed to make a complete conduction block during the past decade. The challenge in atrial fibrillation surgery is in the development and establishment of an off-pump thoracoscopic procedure. Furthermore, intraoperative electrophysiological assessment of the mechanism of atrial fibrillation and verification of conduction block over the ablation line should be established to accomplish a high success rate for atrial fibrillation. (+info)
The autoclavable semirigid thoracoscope: the way forward in pleural disease?
Medical thoracoscopy is a valuable tool in the investigation and management of pleural disease. It has considerable advantages over conventional blind pleural biopsy and video-assisted thoracoscopic surgery. Despite this, the practice of this technique in the UK is limited. Most operators use the rigid thoracoscope, which may be an unfamiliar instrument to respiratory physicians. A semirigid thoracoscope is available but its use has not been possible in the UK as it requires sterilisation with ethylene oxide, which is not approved in this country. The present authors describe herein their experience with the first ever autoclavable semirigid thoracoscope. Medical thoracoscopy using the new instrument was performed in 56 patients between June 2004 and May 2006. All patients had been referred with a unilateral pleural effusion of unknown aetiology, where blind pleural aspiration had failed to yield an answer. Diagnostic samples were taken and talc poudrage performed where appropriate. The instrument was easy to handle and excellent views were obtained. Histologically adequate biopsy samples were obtained in 54 patients. The combination of clinical features, computed tomography findings and thoracoscopic biopsy enabled a definite diagnosis in 49 (90.7%) of these patients. There were no complications. The autoclavable semirigid thoracoscope has immense potential in the diagnosis and management of pleural disease. Its diagnostic yield in pleural disease is comparable to the conventional rigid thoracoscope. It is similar in design to the fibreoptic bronchoscope and respiratory physicians should be able to adapt to its use easily. It is also compatible with existing video processors and light sources available in most endoscopy suites. The fact that this instrument is autoclavable should open the field for its use in the UK as well as in other countries. (+info)
Uniportal video-assisted thoracic surgery for primary spontaneous pneumothorax: clinical and economic analysis in comparison to the traditional approach.
We aimed to verify the clinical and economic effects of uniportal video-assisted thoracic surgery (VATS) in patients with primary spontaneous pneumothorax (PSP) compared to traditional three-port VATS technique. We analyzed 51 consecutive patients (23 three-port VATS and 28 uni-port VATS), treated by bullectomy and pleural abrasion, to detect differences between the two groups with regard to intraoperative management, postoperative course, pain, paraesthesia and costs. Data about pain and paraesthesia were collected by telephonic interview within a minimum follow-up period of six months. Compared to three-port VATS, patients treated by the uni-port VATS were discharged more quickly (3.8 days vs. 4.9 days, P=0.03) and experienced paraesthesia less frequently (35% vs. 94%, P<0.0001). No difference in chronic pain was observed between the two groups (numeric pain score: 0.6 uni-port vs. 1.3 three-port, P=0.2). Compared to three-port VATS, we found a significant reduction in postoperative costs for the patients operated on by the uni-port technique (euro1407 vs. euro1793, P=0.03), without any increase in surgical costs. In conclusion, uniportal VATS appears to offer better clinical (postoperative stay and rate of paraesthesia) and economic (postoperative costs) results than the standard three-port VATS for treating primary spontaneous pneumothorax. (+info)
Non-robotic thoracoscopic internal mammary artery preparation in the pig. A training model.