ABSTRACT
Background: The term “thoracoscopy” means endoscopy of the interior of the chest. Jacobeus is considered its father wherein in 1910; he used a modified cystoscope to cut adhesions in the pleural cavity. Over past 3 decades, indications and uses of video-assisted thoracic surgery (VATS) were expanded, in early stages, it was mainly of diagnostic purpose with minor thoracic surgeries, but now its use has been expanded to major surgeries such as decortications, pericardial effusion, resection of part or whole lung, and resection of esophagus. Aims and Objectives: In this study, we aimed to highlight the various uses and indications of VATS as empyema decortication, hydatid cyst, bronchiectasis, segmentectomy. The age group, sex distribution, conversion rate of VATS to open thoracotomy, average length of stay, Intercostal tube drainage (ICD) removal and post-operative complications, the culture and sensitivity of the collection, and histopathology reports were considered. Materials and Methods: The study consisted of various cases admitted under pediatric surgery unit of S. S. Institute of Medical Sciences and Research Centre from January 2008 to December 2015, over 78 cases who underwent VATS for various indications were included, in the age group of 1 month till 18 years. Results: Least age to get operated was baby of 1 month and most 17 years, median being 11 years, 50 were males (64.12%), most common indication was empyema 52 (66.67%), and out of 52 cases of empyema, 47 were Stage 2 empyema, 6 early third stage, and 5 late third stage, it was observed that all late third stage patients needed to be converted, 23 (29.5%) were converted into open thoracotomy for various reasons; conversion was considered to be wiser decision rather than complication, other complications were site infection in open cases, bronchopleural fistula which was treated conservatively and bleeding intraoperative. None of 78 cases needed a second surgery, the mean duration of stay in hospital was 12.84 days and 5.45 days was mean number of days ICD in situ; blood loss was intraoperative was very less in cases with VATS about 100 ml, and it was much more in cases which needed conversion to open thoracotomy about 300 ml, prophylactically post-operative blood transfusion was done in 72 cases (92.30%). Culture turned out to be Staphylococcus pneumonia in about 61 cases (78.20%), and histopathology report was fibrinous material in 59 cases (75.64%). Conclusion: To conclude, VATS is a newer and modified method to be used in all major procedures in the thorax; its use can be extended from empyema decortication to lung resection. In our institute, we used it in mostly for empyema decortications in pediatric patients, a safe approach with decreased morbidity and mortality, early recovery while treating empyema with VATS the ability to stage the disease plays a major role and crucial to operate too.
ABSTRACT
CONTEXT: The microsurgical anatomy of the posterior circulation is very complex and variable. Surgical approaches to this area are considered risky due to the presence of the various important blood vessels and neural structures. AIMS: To document the microsurgical anatomy of the posterior circulation along with variations in the Indian population. MATERIALS AND METHODS: The authors studied 25 cadaveric brain specimens. Microsurgical dissection was carried out from the vertebral arteries to the basilar artery and its branches, the basilar artery bifurcation, posterior cerebral artery and its various branches. Measurements of the outer diameters of the vertebral artery, basilar artery and posterior cerebral artery and their lengths were taken. RESULTS: The mean diameter of the vertebral artery was 3.4 mm on the left and 2.9 mm on the right. The diameter of the basilar artery varied from 3-7 mm (mean of 4.3 mm). The length varied from 24-35 mm (mean of 24.9 mm). The basilar artery gave off paramedian and circumferential perforating arteries. The origin of the anterior inferior cerebellar artery (AICA) varied from 0-21 mm (mean 10.0 mm) from the vertebrobasilar junction. The diameter of the AICA varied from being hypoplastic i.e., CONCLUSIONS: The authors have documented the various anomalies as well as the differences of the anatomy in this area in the Indian population as compared to the Western literature.