Endoscopic Thoracic Surgery Research Articles

Single port endoscopic thoracic sympathectomy with holmium laser for treating palmar hyperhidrosis at Thai Binh Provincial General Hospital

Introduction: thoracoscopic sympathectomy for treating palmar hyperhidrosis often uses 2 ports. Research to evaluate the results of the method using 1 port < 5mm with Holmium Laser fiber.
 Object and Method: Description, prospective.
 Within 2 months from June 2023 to July 2023, 47 patients underwent single port endoscopic thoracic surgery using holmium laser to transect the sympathetic ganglia at T3 level for patients with palm sweating (26 patients) and T3-T4 level for patients with palm and axillary sweating (21 patients). The male-to-female ratio was 44.7% to 55.3%, with an average age of 18 ± 7.4 years (minimum age of 11 years, maximum age of 52 years). Surgical method: A single entry port trocar 14Fr located at the 3rd intercostal space, the posterior border of the pectoralis major muscle between the anterior and midaxillary lines, using a 12Fr endoscopic lens with integrated tunnel for Holmium Laser fiber. Patients were monitored and evaluated for early post-operative results: technical failure requiring the placement of a second port, complications during and after surgery and the degree of improvement in palmar hyperhidrosis, the rate of compensatory hyperhidrosis after 1 month and the patient's quality of life after surgery.
 Results:
 There were no technical failures. The time for transecting the sympathetic ganglion (one side) with Holmium Laser was 78 ± 40.76 seconds. All patients had dry hands after surgery, with two out of forty-seven patients having excessively dry hands. There were no complications during or after surgery, and no patients developed Horner’s syndrome. The average time to discharge after surgery was 30 ± 11.4 hours. Fourteen out of forty-seven patients had compensatory sweating after one month postoperatively at an acceptable level.
 Conclusion: The method of using a port < 5mm with an endoscopic lens integrated with a Holmium Laser fiber tunnel is safe, effective, less traumatic and highly aesthetic.

Overview and Prevention of Complications During Biportal Endoscopic Thoracic Spine Surgery

Objective: Although the unilateral biportal endoscopy (UBE) technique has remarkable advantages, thoracic laminectomy by UBE is technically difficult and can potentially lead to serious complications. By reviewing previous articles on thoracic laminectomy by UBE, we aimed to identify the complications of thoracic laminectomy by UBE and to establish specific surgical strategies to avoid complications.Methods: A literature search was performed using the National Center for Biotechnology Information database using the PubMed/MEDLINE search engine. There are 3 published clinical studies in which at least one of these approaches has been performed.Results: In previous articles, several cases of perioperative complications were observed, including spinal cord injury, hyperalgesia, cerebrospinal fluid leakage, headache or neck pain, insufficient decompression, epidural hematoma, subdural hematoma, excessive facet resection, and delayed spinous process fracture.Conclusion: UBE technique has remarkable advantages, but endoscopic thoracic surgery is technically challenging and has the potential to cause serious complications. For avoidable complications, surgeons should be familiar with prevention methods and pitfalls to minimize complications.

Complications of Endoscopic Thoracic Spine Surgery: Overview and Complication Avoidance

In endoscopic thoracic spine surgery, adaptations of thoracic surgical techniques such as full endoscopic uniportal and biportal surgical techniques have been developed. Full endoscopic uniportal surgery for thoracic disc herniation or thoracic ossified ligamentum flavum (OLF) has been performed via transforaminal and interlaminar approaches. In the case of thoracic OLF or thoracic spinal stenosis, the uniportal interlaminar approach is appropriate. The uniportal interlaminar approach has been used to treat thoracic OLF and has shown good surgical results. Thoracic OLF removal via a biportal endoscopic technique has been developed recently and is described in a few studies. Although endoscopic thoracic spine surgery has significant advantages, complications often occur with this approach. We reviewed the literature to date on the complications associated with endoscopic spine surgery in thoracic pathology. This review emphasizes how to avoid and manage complications. Based on the results of several previous studies, endoscopic thoracic spine surgery could be associated with fewer potential complications than conventional surgery. Endoscopic spine surgery has remarkable advantages; however, endoscopic thoracic surgery is technically challenging and is potentially associated with serious complications. To minimize the risk of avoidable complications, surgeons should be familiar with prevention methods and pitfalls.

Results of endoscopic thoracic for Post-traumatic pleural empyema treatment at Viet Duc University Hospital

Abstract Introduction: Post-traumatic pleural empyema tends to increase in recent years, related to the severity of chest trauma and postoperative care. There are very few studies on this type of disease. The study aims to describe some etiological, clinical, and paraclinical characteristics and evaluate early results of endoscopic thoracic surgery to treat this disease. Patients and Methods: A retrospective descriptive study of cases with a confirmed diagnosis of post-traumatic empyema and treated by thoracoscopic surgery, at the Cardiovascular and Thoracic Center, Viet Duc university hospital, from January 2017 to April 2021. Results: Including 52 patients, with 46 men - 6 women, the average age was 44.87 years old; the average time from accident to surgery was 31.17 days, the average surgery time was 86.83 minutes; thoracoscopic surgery was 100% successful. Intensive respiratory physiotherapy was performed in 100% of patients; the average postoperative hospital stay was 8.13 days; the most common postoperative complication was wound infection (3.8%); 100% of patients discharged from the hospital were stable, with no mortality. Conclusion: Endoscopic thoracic surgery combined with intensive respiratory physiotherapy after surgery is an effective solution in treating post-traumatic pleural empyema. Keywords: Post-traumatic empyema, chest trauma, endoscopic thoracic.

Results of video-assisted thoracoscopic surgery approach to mediastinal tumor at Viet Duc hospital

Objective: The application of endoscopic surgical treatment of thoracic disease are beginning to flourish in Vietnam. The study aimed to evaluate the results of endoscopic thoracic surgical treatment of mediastinal tumors in Viet Duc Hospital. Methods: The retrospective study describes 50 patients mediastinal tumors were treated with endoscopic thoracic surgery from 12/2007 to 8/2012, of the parameters before, during and after surgery and the anatomy pathological results. Results: of 25 male and 25 female. Mean age 44.76 ± 16.52 (13-78). The main symptom is chest pain on admission (74%). Tumor size 5.893 ± 1.686 cm (2.7 to 11.0). Surgery time 100 ± 24.82 minutes (60-180). There is a case conversed to classical surgery (2%). Number of hospital days 4.48 ± 1.5 days (3-12). No mortality and major complications after surgery. Anatomy-pathological results: 49 cases of benign, 01 malignant cases of stage I (Masaoka). Conclusion: Treatment of mediastinal tumors by endoscopic thoracic surgery is a method of safe and feasible, bring good results after surgery.

Early Video-Assisted Thoracic Surgery (VATS) improves quality of life In complicated Neoplastic Pleural Effusions.

Malignant pleural effusion (MPE) involves advanced cancer disease. Pleural biopsy for endoscopic thoracic surgery allows diagnosis in more than 90% of cases and instrumentation of the pleural space, improving the results of the technique. We performed a retrospective analysis of patients with MPE who underwent a talc chemical pleurodesis. Two groups were formed, one with complicated malignant pleural effusion (CMPE) and another with uncomplicated malignant pleural effusion (NCMPE). In the group with CMPE, "release - expansion maneuvers" were performed. The variables between the two groups were compared for the relevant analysis. We analyzed 28 patients with MPE treated with chemical pleurodesis by endoscopic thoracic surgery. The average age was 62.64 years. Pleural involvement due to breast disease was the most frequent form (46.4%). There was no difference between complication rate (p = 0.31) and the risk of death at 30 days (p = 1.09) with aggressive management of pleural space. The delay pleurodesis indication was related to a higher rate of complications (p = 0.002) and a higher probability of death within 30 days (p = 0.008). The majority of patients return to their daily tasks, with good tolerance to dyspnea following the procedure. In patients with complicated MPE, the "lung-release maneuvers" described above would increase the chances of improving outcomes at low risk. Early chemical pleurodesis improves the quality of life of patients with PND.

"High Frequency/Small Tidal Volume Differential Lung Ventilation": A Technique of Ventilating the Nondependent Lung of One Lung Ventilation for Robotically Assisted Thoracic Surgery.

With the introduction of new techniques and advances in the thoracic surgery fields, challenges to the anesthesia techniques had became increasingly exponential. One of the great improvements that took place in the thoracic surgical field was the use of the robotically assisted thoracic surgical procedure and minimally invasive endoscopic thoracic surgery. One lung ventilation technique represents the core anesthetic management for the success of those surgical procedures. Even with the use of effective one lung ventilation, the patient hemodynamics and respiratory parameters could be deranged and could not be tolerating the procedure that could compromise the end result of surgery. We are presenting our experience in managing one patient who suffered persistent hypoxia and hemodynamic instability with one lung ventilation for robotically assisted thymectomy procedure and how it was managed till the completion of the surgery successfully.

Is small tidal volume with low positive end expiratory pressure during one-lung ventilation an effective ventilation method for endoscopic thoracic surgery?

BackgroundThe present study will focus on the rationale for the use of small tidal volume with 6 cmH2O positive end expiratory pressure (PEEP) with the changes of arterial oxygen tension, plateau airway pressure, and static lung compliance during one lung ventilation for endoscopic thoracic surgery.MethodsForty-three patients were intubated with a double-lumen endobronchial tube. After positioning the patients in the lateral decubitus, one-lung ventilation was started with 100% oxygen, tidal volume 10 ml/kg without PEEP; arterial oxygen tension, plateau airway pressure, and static compliance were checked as baseline values (T0). Fifteen minutes later, same parameters were measured (T15). The tidal volume had changed to 6 ml/kg with 6 cmH2O PEEP. Fifteen minutes later, the same parameters were measured (T30).ResultsOxygen tension had decreased at T15 (282.1 ± 83.4 mmHg) compared to T0 (477.2 ± 82.4 mmHg) (P < 0.0001), but was maintained at T30 (270.4 ± 81.9 mmHg). There was no difference in peak inspiratory pressure at T15 or T30 compared to T0, plateau airway pressure was increased at T15 and T30 (P < 0.05) and static lung compliance was decreased at T15 and T30 (P < 0.0001).ConclusionsIn carrying out one-lung ventilation for thoracic surgery using an endoscope, the addition of a PEEP of 6 cmH2O in the dependent lung, while reducing the tidal volume of 6 ml/kg, both oxygen tension and lung compliance are maintained without increasing the plateau airway pressure. Protective lung ventilation is useful for one lung ventilation.

Full‐length phrenic nerve transfer as the treatment for brachial plexus avulsion injury to restore wrist and finger extension

The functional restoration of wrist and finger extension after complete brachial plexus avulsion injury remains an unsolved problem. We conducted a prospective study to elucidate a new method for resolving this injury. Six patients with complete brachial plexus avulsion injury underwent a new surgical procedure in which the full-length phrenic nerve was transferred to the medial portion of the radial nerve at the level of the latissimus dorsi insertion via endoscopic thoracic surgery. In 5 patients, extensor carpi ulnaris and extensor carpi radialis strength recovered to Medical Research Council grade ≥M3, and in 4 patients extensor digitorum strength recovered to ≥M3. Neurotization of phrenic nerve to the medial portion of the radial nerve at the level of latissimus dorsi insertion is a feasible means of restoring wrist and finger extension in cases of complete brachial plexus avulsion injury.

Hand prehension recovery after brachial plexus avulsion injury by performing a full-length phrenic nerve transfer via endoscopic thoracic surgery

The functional recovery of hand prehension after complete brachial plexus avulsion injury (BPAI) remains an unsolved problem. The authors conducted a prospective study to elucidate a new method of resolving this injury. Three patients with BPAI underwent a new procedure during which the full-length phrenic nerve was transferred to the medial root of the median nerve via endoscopic thoracic surgery support. All 3 patients were followed up for a postoperative period of > 3 years. The power of the palmaris longus, flexor pollicis longus, and the flexor digitorum muscles of all 4 fingers reached Grade 3-4/5, and no symptoms of respiratory insufficiency occurred. Neurotization of the phrenic nerve to the medial root of the median nerve via endoscopic thoracic surgery is a feasible means of early hand prehension recovery after complete BPAI.

Videothoracoscopic surgery

Although thoracoscopy has been used for diagnostic and minor therapeutic procedures for many years, there have been few reports of its use in performing major intrathoracic procedures which have traditionally required formal thoracotomy. We report our initial experience in this field. Fifty patients (M:F = 1.63:1, mean +/- SD age = 41.8 +/- 20.4 years, range = 14-80) underwent 54 endoscopic intrathoracic operations. The procedures carried out included wedge excision of solid pulmonary mass (10), pleurectomy (25), lung biopsy (14), and miscellaneous procedures (5). Under general anaesthesia a laparoscope attached to a video monitor was introduced into the chest. One or two additional stab incisions were made as needed for the introduction of standard surgical or endoscopic instruments and staplers. There were no deaths. One patient developed a second pneumothorax 7 days after endoscopic pleurectomy, necessitating open pleurodesis. All patients were discharged home between 2 and 11 days after surgery (mean +/- SD = 3.8 +/- 2.0 days). Endoscopic thoracic surgery is a safe and useful technique for certain cases. It merits further investigation and assessment.

Endoscopy assisted microthoracotomy: initial experience.

Although thoracoscopy has been used for diagnostic and minor therapeutic procedures for many years, there have been few reports of its use in performing major intrathoracic procedures, which have traditionally required formal thoracotomy. Twenty one patients (M:F 1.2:1; mean (SD) age 47.1 (18.8), range 17-75 years) underwent endoscopic intrathoracic surgery. Eight had unidentified peripheral masses on the chest radiograph, eight required lung biopsy, and five had recurrent or persisting pneumothoraces. Under general anaesthesia a laparoscope attached to a video monitor was introduced into the chest. One or two additional stab incisions were made as needed for the introduction of standard surgical or endoscopic instruments and staplers. There were no complications or deaths, though one patient developed a second pneumothorax seven days after endoscopic pleurectomy, necessitating open pleurodesis. All patients were discharged home from two to six days after surgery (mean (SD) 3.7 (1.2) days). Endoscopic thoracic surgery is a safe and useful technique for certain cases. It merits further investigation and assessment.