Video-assisted Thoracoscopic Surgery In Patients Research Articles

Video-assisted thoracoscopic surgery versus open thoracotomy in pulmonary metastasectomy: a meta-analysis of observational studies.

Pulmonary metastasectomy via a traditional open thoracotomy is effective for the treatment of patients with pulmonary metastases. However, whether video-assisted thoracoscopic surgery (VATS) achieves similar clinical effects in terms of survival rates remains unclear. We conducted this meta-analytic study to compare VATS with open thoracotomy for pulmonary metastasectomy. Relevant studies were identified by searching PubMed from inception to December 2014. The overall and recurrence-free survival rates were measured in terms of hazard ratios (HRs) with VATS and open thoracotomy as the main outcomes. Eight studies were included in our meta-analysis, which included 337 patients in the VATS group and 485 patients in the open thoracotomy group. The overall survival rate in the VATS group was statistically significantly higher than that in the open thoracotomy group [HR, 0.69; 95% confidence interval (CI), 0.55-0.87; P = 0.002]. The VATS group still had a higher overall survival rate after exclusion of the one low-quality study (HR, 0.78; 95% CI, 0.59-1.03), but the result was not statistically significant (P = 0.075). No difference in the recurrence-free survival rate was found between the two groups (HR, 0.86; 95% CI, 0.69-1.08). The subgroup analysis showed no difference between the two groups in either the overall survival rate (HR, 0.72; 95% CI, 0.50-1.04) or the recurrence-free survival rate (HR, 0.79; 95% CI, 0.59-1.08) in patients with metastases from colorectal cancer. VATS is an alternative surgical approach for pulmonary metastasectomy in patients with resectable pulmonary metastases. Further large prospective studies are needed to identify the indications for VATS in patients with pulmonary metastases.

Assessment of the usefulness of video-assisted thoracoscopic surgery in patients with non-tuberculous thoracic empyema.

The purpose of this retrospective study was to investigate the effectiveness and the outcomes of video-assisted thoracic surgery (VATS) treatment and medical therapy (including chest tube drainage, antibiotic treatment) in empyema patients. Thirty-two consecutive patients with thoracic empyema were treated by VATS or tube drainage from 2006 to 2011. An analysis reviewed outcomes between the operation group and the drainage group. In addition, the operation group was divided into two groups for analysis. The drainage period was 15.1±11.3 days in the drainage group and 8.3±4.6 days in the operation group. The length of hospital stay was 22.4±10.0 days in the drainage group and 16.3±5.0 days in the operation group. There were five in-hospital deaths in the drainage group, but no in-hospital deaths in the operation groups. In addition, patients in the early operation group had a significantly shorter hospital stay and postintervention drainage period than patients in the late operation group. VATS for nontuberculous thoracic empyema was more effective than tube drainage and required a shorter hospital stay. The results also indicated that patients who receive early surgical treatment may show better outcomes with late surgical management.

Video-assisted mediastinoscopic resection compared with video-assisted thoracoscopic surgery in patients with esophageal cancer.

The purpose of this study was to explore the indications of radical vedio-assisted mediastinoscopic resection for esophageal cancer. The data of 109 patients with T1 esophageal cancer who underwent video-assisted mediastinoscopic resection (VAMS group) in Third Affiliated Hospital of Soochow University Hospital from December 2005 to December 2011 were collected in the study for comparison with the 58 patients with T1 esophageal cancer who underwent video-assisted thoracoscopic surgery (VATS group) in Zhongshan Hospital, Fudan University. The perioperative safety and survival were compared between the two groups. All operations were successful in both groups. One perioperative death was noted in the VATS group. The incidences of post-operative complications were not significantly different between these two groups, whereas the VAMS group was favorable in terms of operative time (P<0.001) and blood loss (P<0.001), and a significantly larger number of chest lymph nodes were dissected in the VATS group compared with the VAMS group (P<0.001). Long-term follow-up showed that the overall survival was not significantly different between these two groups (P=0.876). T1N0M0 esophageal cancer can be as the indication of VAMS radical resection. VAMS radical resection can be considered as the preferred option for patients with poor pulmonary and cardiac function or a history of pleural disease.

Mediastinal Parathyroid Adenoma With Osteitis Fibrosis Cystica

Mediastinal parathyroid adenomas can be resected by sternotomy or video-assisted thoracoscopic surgery. Robot-assisted thoracic surgical approaches have recently been described. We report robot-assisted thoracic surgical resection of a mediastinal parathyroid in a morbidly obese patient. Additional comorbidities included multiple pathological fractures related to hypercalcemia. Intraoperative parathyroid hormone levels confirmed successful removal of the adenoma. Hungry bone syndrome developed after surgery but eventually resolved. Robot-assisted thoracic surgery avoided the need for sternotomy and associated concerns related to poor bone healing. Robot-assisted thoracic surgery has potential advantages over video-assisted thoracoscopic surgery in patients with obesity because of easier instrument articulation within the thoracic cavity rather than at the chest wall.

Accuracy of helical computed tomography in the detection of pulmonary colorectal metastases

This study assessed the sensitivity of helical computed tomography in the detection of pulmonary metastases in patients with colorectal cancer and the role of video-assisted thoracoscopic surgery in patients with pulmonary metastases. A total of 120 operations for pulmonary metastases were performed in 91 patients with colorectal cancer. All patients received an open thoracotomy that allowed full operative inspection and palpation. Clinical data, including the size and number of pulmonary metastasis, were retrospectively collected. The difference in the number of pulmonary metastases as determined by computed tomography scan and surgical findings was determined and analyzed. Operative findings were consistent with the preoperative computed tomography scan reports in 64 of the 120 operations (53.3%). In 32 operations (26.7%), additional metastatic tumors were identified at open thoracotomy. The sensitivity of helical computed tomography in the detection of colorectal cancer metastatic lesions ranged from 35.5% to 95.5%. Unilateral solitary lesion demonstrated on computed tomography scan was an independent factor for the prediction of additional metastatic lesions (P = .023). The sensitivity of helical computed tomography scan in the detection of pulmonary metastases can reach 95.5% in patients with colorectal cancer with a solitary metastatic lesion. A unilateral solitary lesion demonstrated on preoperative computed tomography scan is an independent factor for prediction of additional metastatic lesions. If feasible, video-assisted thoracoscopic surgery may be justified in patients with colorectal cancer with solitary pulmonary metastases.

Novel method for bulla detection with video-assisted thoracoscopic surgery in patients with spontaneous pneumothorax

Detection of bullae is usually performed during lung inflation with an inspiratory hold in collaboration with anesthetists (conventional method). One cause leading to recurrent pneumothorax is failure to detect the position and extent of bullae under the conventional method. We herein present a novel method for detecting bullae under negative intrathoracic pressure, enabling exploration in the narrow cupola space without lung inflation.

Indications for using video-assisted thoracoscopic surgery to diagnose diaphragmatic injuries after penetrating chest trauma

Background. Video-assisted thoracoscopic surgery (VATS) has been shown to be an accurate method for identifying diaphragmatic injuries (DIs). The purpose of this investigation was to establish specific indications for the use of VATS after penetrating chest trauma. Methods. A retrospective review of all patients undergoing VATS after penetrating chest trauma at a level 1 trauma center over an 8-year period was performed. Logistic regression was used in an attempt to identify independent predictors of DI. Results. One hundred seventy-one patients underwent VATS assessment of a hemidiaphragm, and 60 patients (35%) were found to have a DI. Five independent risk factors for DI were identified from analyzing the patient records: abnormal chest radiograph, associated intraabdominal injuries, high-velocity mechanism of injury, entrance wound inferior to the nipple line or scapula, and right-sided entrance wound. Conclusions. In the largest published series of patients undergoing VATS to exclude a DI, this review identifies five independent predictors of DI after penetrating chest trauma. A diagnostic algorithm incorporating these five factors was designed with the goal of reducing the number of unrecognized DIs after penetrating chest trauma by using VATS for patients at greatest risk for such injuries.

Thoracoscopic procedures for intrathoracic and pulmonary diseases.

Since Jacobaeus performed the first thoracoscopy to explore pleural space and mechanically broke pleural adhesions to facilitate the collapse therapy for pulmonary tuberculosis in 1910, numerous thoracic surgeons have been attempting this technique as a means of accomplishing many intrathoracic procedures previously done through open thoracotomy. As the refinement of video technology has advanced, thoracoscopic surgery has played a very important role in thoracic surgery especially since the early 1990s. Because the advantages of video-assisted thoracoscopic surgery for patients include low post-thoracotomy-related morbidity, cosmetic considerations, low pain, earlier post-operative mobilization, and a shorter operation time in some indications, surgeons have been demonstrating its increasing utility in the diagnosis and treatment of the pleura, lung, mediastinum, great vessels, pericardium, and oesophagus. The most common application of the thoracoscopic approach still remains in the management of pleuropulmonary disease. The indications for the thoracoscopic technique are very broad, but its role in the management of primary lung and oesophageal cancer has yet to be confirmed. Thus, the surgeon who uses the technique in these cancerous diseases should be prudent. In conclusion, these thoracoscopic procedures will play more important roles in the practice of thoracic surgery in the future.

Video-Assisted Thoracoscopic Surgery for Resection of Lung Metastases

Resection of indeterminate pulmonary lesions in patients with a history of malignancy is indicated, as the presence of metastases will provide prognostic information and often dictate further therapy. Pulmonary metastasectomy also improves survival in select patients with favorable tumor histologies. We reported the results of video-assisted thoracoscopic surgery (VATS) resection of indeterminate lung nodules in 72 patients with a history of malignancy. All lesions identified on preoperative high-resolution CT scan were found at surgery with visual inspection, digital palpation, or (in 13 cases) CT-guided needle localization. All lesions were resected nonanatomically with a rim of normal parenchyma, as is done with open techniques; 63 patients were found to have metastases and 9 patients had benign disease. There was no mortality, minimal morbidity, and decreased hospital stays in patients undergoing VATS resection compared with historical control subjects. These data and other reports have led to the widespread use of VATS for patients undergoing resection to establish a diagnosis. The role of VATS in patients with favorable tumor histology and limited tumor burden for whom metastasectomy may result in a survival advantage remains controversial. Improved image resolution with spiral CT scans and digital palpation, combined with intraoperative ultrasound examination of the lung, may decrease or eliminate the number of lesions missed with a VATS approach. The role of therapeutic VATS metastasectomy remains to be defined. Thus, this procedure currently should be used only in clinical trials.

Video-assisted thoracoscopic surgery in patients previously treated for intrathoracic lymphoma

Video-assisted thoracoscopic surgery in patients previously treated for intrathoracic lymphoma

The Role of Video-Assisted Thoracoscopic Surgery in the Management of Pulmonary Tuberculosis

Tuberculosis remains a major health problem worldwide. The current role of video-assisted thoracoscopic surgery (VATS) in the management of this condition is unclear. We reviewed our experience over a 36-month period from a single institution. Thirty-seven patients (26 male, 11 female, with age ranging from 22 days to 71 years), in whom the final diagnosis was tuberculosis, underwent VATS procedures. There were 12 pleural biopsies, 3 decortications, 12 wedge lung resections, 5 drainages of empyema, and 5 lobectomies. All the patients were studied prospectively. There were no mortality or intraoperative complications. The overall median postoperative hospital stay was 4 days (range, 2 to 35 days). Postoperative parenteral narcotics requirement (mean, 310 mg meperidine hydrochloride [Pethidine]) was significantly less than a historic group of 30 patients who underwent conventional thoracotomy for lung resection or empyema drainage for tuberculosis (mean, 875 mg). Postoperative complications include 2 persistent air leaks over 7 days (5.4%) and 1 wound infection (2.7%). We conclude the following: (1) VATS is safe and effective in achieving the diagnosis of tuberculosis through pleural biopsies or wedge lung resection of indeterminate pulmonary nodules; it is particularly useful for those patients who are debilitated, thus making them poor candidates for conventional open surgery; (2) in patients with trapped lung or tuberculous empyema, VATS could achieve full lung reexpansion with minimal morbidity; and (3) therapeutic lung resection using VATS in patients with tuberculosis is technically demanding and potentially hazardous. Its role is, at present, limited.

Video-assisted thoracoscopic surgery--indications, results, complications, and contraindications.

In recent times minimally invasive surgery has secured a firm place among the therapeutic options in thoracic surgery. The experience and results gained from video-assisted surgery on 109 patients between January 1, 1992 and July 31, 1993 are critically discussed. The procedure could be completed thoracoscopically on 94 of them. A change of method was necessary nine times for technical reasons and six times for oncological reasons (two times due to metastasis, four times due to bronchial carcinoma). A total of 154 individual operations were conducted. Sixty-three patients with recurrent spontaneous pneumothorax were successfully treated. The relapse rate was 1.5%. With the exception of three rethoracotomies (one due to postoperative hemorrhaging and two to persistent fistula) no significant complications occurred. Further indications included capsulated pleural empyema (n = 1), persistent hematothorax (n = 2), pleurectomy for malignant pleural effusion (n = 2), pleural tumors (n = 3), pulmonary parenchyma (n = 2), interstitial lung diseases (n = 3), bullous emphysema (n = 2), peripheral lung nodules (n = 18), mediastinal tumors (n = 8), and sympathectomy (n = 2). The advantages of video-assisted thoracoscopic surgery for patients include cosmetic considerations, low pain, earlier postoperative mobilization, and for some indications, a shorter operation period. The significant disadvantages for the surgeon are the loss of binocular vision as well as the impossibility of intraoperative palpation.