Video-assisted Thoracoscopic Surgery In Management Research Articles

The role of video-assisted thoracoscopic surgery for management of symptomatic pleural effusion after coronary artery bypass surgery: a best evidence topic report.

A best evidence topic in thoracic surgery was written addressing whether video-assisted thoracoscopic surgery (VATS) talc pleurodesis could be justified in patients with pleural effusion (PE) after coronary artery bypass graft (CABG) surgery and no-responded to repeated thoracentesis. Ten papers were identified to answer the question. Of these, two were case-series study including ≥4 patients, 7 retrospective analytical studies, and one observational study but no randomized controlled trial (RCTs) was included in the analysis. The score of the level of evidence was low; only one study presented a level of evidence of 2, 7 studies a level of 3b; and two studies a level of evidence of 4. The incidence of symptomatic post-CABG PE ranged from 2% to 9.7%. Management strategies included medical management, thoracentesis, and/or surgical drainage. Most of the authors treated early and late PE with thoracentesis or chest drainage, while VATS with pleurodesis was reserved only for selected patients with persistent effusion after repeating thoracentesis and/or chest drainage. All studies but one do not include follow-up, thus rendering it difficult to define the real role of thoracentesis or chest drainage as definitive treatments for effusion, given the incomplete data regarding how many patients' effusions recur. Conversely, with follow up reported, no case of recurrence was found after VATS procedure. In patients who underwent delayed VATS, it was common to identify the formation of tenacious peel that trapped the lung. In three cases conversion to thoracotomy was required to decorticate the inflammatory peel that covered the pleura and did not allow the lung re-expansion. However, only five papers showed that VATS for management of post-CABG PEs is safe and efficacious and its use could help to prevent trapped lung through the resection of adhesions and loculations sometimes associated with multiple previous thoracentesis or chest drainage. As the low grade of evidence from the present analysis, future randomized controlled studies are wanted to define the real effectiveness of VATS in this field.

The role of video-assisted thoracoscopic surgery in management of the multiple ground-glass nodules.

We investigated the outcomes of patients with multiple ground-glass nodules (GGNs) to identify the role of video-assisted thoracoscopic surgery (VATS) in diagnosis and treatment. We included patients with multiple GGNs who were qualified for thoracoscopic surgery resection and analyzed the statistics. Fifty-one GGNs were detected in 21 patients. There were 40 pure GGNs and 11 part-solid ones. Around 46 of the 51 lesions were resected via VATS. Four pure GGNs <10 mm and deep in the lung were proceeded with continuous follow-up. One pure GGN measuring 16 mm considered as subnodule and also deep in the lung underwent stereotactic ablative radiotherapy. Resection methods included lobectomy (1), segmentectomy (1), lobectomy + segmentectomy (6), lobectomy + wedge resection (10), and segmentectomy + wedge resection (3). Of the 46 resected lesions, 4 (8.7%) were atypical adenomatous hyperplasia (AAH), 23 (50%) were adenocarcinoma in situ(AIS), 15 (32.7%) were minimally invasive adenocarcinoma (MIA), 2 (4.3%) were invasive adenocarcinoma, one was pulmonary sclerosing hemangioma, and one was nonspecific fibrosis. Intersegmental lymph node metastasis was found in one of the 21 patients. No postoperational complication occurred in any of the patients. Multiple GGNs were generally independent primary lung cancers, mainly including AAH, AIS, MIA, rather than intrapulmonary metastasis. VATS was superior to thoracotomy for less invasive and shorter hospital stay.

Simultaneous Posterior Fusion with Video Assisted Thoracoscopic Surgery (VATS) for Treatment of Kyphotic Deformities in Prone Position. A Series of 86 Cases

Background Data: The traditional position of the patient during VATS procedureis the lateral decubitus. This make the surgeon oriented to the field since this thesame position of the traditional thoracotomy and make it easy for conversionto open surgery if needed. Prone position; although may be difficult; has theadvantage of performing two major procedures; posterior fusion and anteriorreconstruction by at same time with minimized morbidity and mortality.Purpose: To evaluate the efficacy and safety of VATS in management of differentdorolumbar spine pathologies.Study Designs: Prospective clinical case study.Patients and Methods: Eighty six cases of kyphotic deformities due to variouspathologies (28 cases of fractures, 42 infection, 16 tumors) were treated bysimultaneous posterior fusion techniques and anterior reconstruction by VATSusing bone grafts, cages and spacers while the patient is in prone position. Themean follow up of the patients was 26.1 months. All patients were evaluatedradiographically preoperatively, postoperatively and at the end of follow upusing Cobb angle. Radiographs at the final follow up were assessed for fusion.VAS was used to evaluate pain of the thoracoscopic mini incision. All caseswere assessed neurologically by Frankel grading system and Denis pain scorefor back pain at the end of follow up. Operative time, intra and postoperativecomplications and blood loss were reported.Results: The mean age was 40.3 years. The regional Cobb angle improved from34.7° preoperatively to 11.6° postoperatively. Most of patients had improvedon both Frankel grading system and scores of pain. There was no indication toconvert any case to open procedure. No serious intraoperative complicationoccurred but one case of massive bleeding due to injury of one intercostal vesselthat has been controlled thoracoscopically. The postoperative complicationsincluded chest infection, delayed lung inflation, intercostals neuralgia andtransient neurological deficits.Conclusion: VATS using limited mini-incison provide an excellent and safeapproach for management of dorsolumbar pathologies. Prone position facilitateshandling of the spine both anteriorly and posteriorly at the same time to get themaximum benefit offered by both approaches without excessive morbidity tothe patient. (2012ESJ020)