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   2007| October-December  | Volume 3 | Issue 4  
    Online since January 29, 2008

 
 
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CME ARTICLES
Thoracoscopic management of empyema thoracis
Michael A Wait, Daniel L Beckles, Michelle Paul, Margaret Hotze, Michael J DiMaio
October-December 2007, 3(4):141-148
DOI:10.4103/0972-9941.38908  PMID:19789675
Appropriate management of empyema thoracis is dependent upon a secure diagnosis of the etiology of empyema and the phase of development. Minimal access surgery using video-assisted thoracoscopy (VATS) is one of many useful techniques in treating empyema. Complex empyema requires adjunctive treatment in addition to VATS.
  10,092 414 1
Endoscopic thoracic sympathectomy for hyperhidrosis: Technique and results
CS Cina, MM Cina, CM Clase
October-December 2007, 3(4):132-140
DOI:10.4103/0972-9941.38907  PMID:19789674
Outline: We review the clinical features of hyperhidrosis and the range of treatments used for this condition. We describe in detail the technique of endoscopic sympathectomy. We summarize studies that have reported results of endoscopic sympathectomy. We present new data highlighting the difference in quality of life between patients with hyperhidrosis and controls.
  9,712 336 3
Anesthesia for thoracoscopic surgery
ID Conacher
October-December 2007, 3(4):127-131
DOI:10.4103/0972-9941.38906  PMID:19789673
Anesthesia for thoracoscopy is based on one lung ventilation. Lung separators in the airway are essential tools. An anatomical shunt as a result of the continued perfusion of a non-ventilated lung is the principal intraoperative concern. The combination of equipment, technique and process increase risks of hypoxia and dynamic hyperinflation, in turn, potential factors in the development of an unusual form of pulmonary edema. Analgesia management is modelled on that shown effective and therapeutic for thoracotomy. Perioperative management needs to reflect the concern for these complex, and complicating, processes to the morbidity of thoracoscopic surgery.
  8,722 449 3
Thoracoscopic resection for esophageal cancer: A review of literature
Joris JG Scheepers, Donald L van der Peet, Alexander AFA Veenhof, Miguel A Cuesta
October-December 2007, 3(4):149-160
DOI:10.4103/0972-9941.38909  PMID:19789676
Esophageal resection remains the only curative option in high grade dysplasia of the Barrett esophagus and non metastasized esophageal cancer. In addition, it may also be an adequate treatment in selected cases of benign disease. A wide variety of minimally invasive procedures have become available in esophageal surgery. Aim of the present review article is to evaluate minimally invasive procedures for esophageal resection, especially the approach performed through right thoracoscopy.
  7,674 386 1
Video assisted thoracic surgery in children
Rasik Shah, A Suyodhan Reddy, Nitin P Dhende
October-December 2007, 3(4):161-167
DOI:10.4103/0972-9941.38910  PMID:19789677
Thoracoscopic surgery, i.e., video assisted thoracic surgery (VATS) has been in use in children for last 98 years. Its use initially was restricted to the diagnostic purposes. However, with the improvement in the optics, better understanding of the physiology with CO2 insufflation, better capabilities in achieving the single lung ventilation and newer vessel sealing devices have rapidly expanded the spectrum of the indication of VATS. At present many complex lung resections, excision of mediastinal tumors are performed by VATS in the experienced centre. The VATS has become the standard of care in empyema, lung biopsy, Mediastinal Lymphnode biopsy, repair of diaphragmatic hernia, etc. The article discusses the indications of VATS, techniques to achieve the selective ventilation and surgical steps in the different surgical conditions in children.
  7,228 343 3
ORIGINAL ARTICLE
Thoracoscopic excision of mediastinal cysts in children
Prashant Jain, Beejal Sanghvi, Hemanshi Shah, SV Parelkar, SS Borwankar
October-December 2007, 3(4):123-126
DOI:10.4103/0972-9941.38905  PMID:19789672
Aim: Thoracoscopy offers great advantages when compared with open surgery in terms of postoperative pain and pulmonary complications. Considering the benign nature of most of the mediastinal cysts, thoracoscopy is safe and feasible with minimal morbidity. The purpose of this article is to review our experience with four cases of mediastinal cysts resected successfully within a period of one year by thoracoscopy. Materials and Methods:The cases of mediastinal cysts operated by thoracoscopic excision in K.E.M. Hospital, Mumbai from November 2005 to December 2006 were reviewed. The age varied from six months to 10 years. The patients presented with respiratory distress or recurrent lower respiratory tract infection. All patients underwent Chest X-ray and CT scan thorax to delineate the location of the cyst and its relationship with adjacent vital structures. Two patients had anterior and two had posterior mediastinal cyst. The ports were placed depending on the location of the cyst on the CT scan, following the principles of triangularization. The cysts were excised mainly by blunt dissection. Results: All the patients were successfully managed by thoracoscopic surgery. None of them had intraoperative complications. Dissection in patient with history of recurrent respiratory tract infection was difficult because of adhesions. Intercostal drain was removed within 48hrs and the patients were discharged on the fourth postoperative day. Conclusions: Thoracoscopy in mediastinal cysts is a safe and effective procedure with low morbidity and a shorter hospital stay.
  5,353 344 5
PERSONAL VIEWPOINT
(Video Assisted) thoracoscopic surgery: Getting started
Tamas F Molnar
October-December 2007, 3(4):173-177
DOI:10.4103/0972-9941.38912  PMID:19789679
Thoracoscopic surgery without or with video assistance (VATS) is simpler and easier to learn as it seems to be. Potential benefits of the procedure in rural surgical environment are outlined while basic requirements and limitations are listed. Thoracoscopy kit, thoracotomy tray at hand, patient monitoring, proper drainage system, pain control and access to chest physiotherapy are the basic requirements. Having headlight, bronchoscope, Ligasure and mechanical staplers offer clear advantages but they are not indispensable. Exploration and evacuation of pleural space, pleurodesis, surgery for Stage I and II thoracic empyema are evidenced fields of VATS procedures. Some of the cases can be performed under controlled local anesthesia. Acute chest trauma cannot be recommended for VATS treatment. Lung cancer is out of the scope of rural surgery.
  5,390 295 2
HOW I DO IT
Technique of the transcervical-subxiphoid-videothoracoscopic maximal thymectomy
Marcin Zielinski, Lukasz Hauer, Jaroslaw Kuzdzal, Witold Sosnicki, Maria Harazda, Juliusz Pankowski, Tomasz Nabialek, Artur Szlubowski
October-December 2007, 3(4):168-172
DOI:10.4103/0972-9941.38911  PMID:19789678
Background: The aim of this study is to present the new technique of transcervical-subxiphoid-videothoracoscopic "maximal"thymectomy introduced by the authors of this study for myasthenia gravis. Materials and Methods: Two hundred and sixteen patients with Osserman scores ranging from I-III were operated on from 1/9/2000 to 31/12/2006 for this study. The operation was performed through four incisions: a transverse 5-8 cm incision in the neck, a 4-6 cm subxiphoid incision and two 1 cm incisions for videothoracoscopic (VTS) ports. The cervical part of the procedure was performed with an open technique while the intrathoracic part was performed using a video-assisted thoracoscopic surgical (VATS) technique. The whole thymus with the surrounding fatty tissue containing possible ectopic foci of the thymic tissue was removed. Such an operation can be performed by one surgical team (the one team approach) or by two teams working simultaneously (two team approach). The early and late results as well as the incidence and localization of ectopic thymic foci have been presented in this report. Results: There were 216 patients in this study of which 178 were women and 38 were men. The ages of the patients ranged from 11 to 69 years (mean 29.7 years). The duration of myasthenia was 2-180 months (mean 28.3 months). Osserman scores were in the range of I-III. Almost 27% of the patients were taking steroids or immunosuppressive drugs preoperatively. The mean operative time was 201.5 min (120-330 min) for a one-team approach and it was 146 (95-210 min) for a two-team approach (P < 0.05). While there was no postoperative mortality, the postoperative morbidity was 12%. The incidence of ectopic thymic foci was 68.4%. The rates of complete remission after one, two, three, four and five years of follow-up were 26.3, 36.5, 42.9, 46.8 and 50.2%, respectively. Conclusion: Transcervical-subxiphoid-VTS maximal thymectomy is a complete and highly effective treatment modality for myasthenia gravis. The need for sternotomy is avoided while the completeness of the operation is retained.
  5,439 229 3
EDITORIAL
Thoracoscopic surgery
HS Bhanushali
October-December 2007, 3(4):121-122
DOI:10.4103/0972-9941.38904  PMID:19789671
  3,660 303 -
LETTERS TO EDITOR
Empyema gall bladder and laparoscopic cholecystectomy
Iqbal Saleem Mir
October-December 2007, 3(4):178-178
DOI:10.4103/0972-9941.38913  PMID:19789680
  3,292 222 -
Authors' reply
Arshad M Malik, AA Laghari, KA Talpur, A Memon, Q Mallah, JM Memon
October-December 2007, 3(4):178-179
DOI:10.4103/0972-9941.38914  PMID:19789681
  2,681 134 -
2004 Journal of Minimal Access Surgery
Published by Wolters Kluwer - Medknow
Online since 15th August '04