Reparación toracoscópica de la atresia esofágica: implicaciones en el pronóstico del paciente / Thoracoscopic Repair of Esophageal Atresia: Implications in the prognosis of the patient

La reparación por toracoscopia de la atresia del esófago se ha constituido paulatinamente en la mejor alternativa terapéutica de los pacientes con esta entidad. Se analizaron 21 pacientes con diagnóstico de atresia esofágica operados por toracoscopia de Noviembre del 2017 a Agosto del 2020. La edad en que se efectuó la cirugía fue de 1 a 15 días de vida, promedio de 4.5. El procedimiento efectuado fue: sección y ligadura de la fistula con anastomosis termino terminal. El tiempo de cirugía fue de 90 a 240 minutos con una media de 158.5 minutos. Las complicaciones postoperatorias fueron: 02 pacientes dehiscencia parcial de la anastomosis, 05 pacientes estrechez de la anastomosis y 01 paciente divertículo traqueal. Hubo 03 pacientes que fallecieron. La reparación toracoscópica de la atresia de esófago es una opción terapéutica eficiente, con una tasa de complicaciones aceptable y una menor mortalidad. (AU)

Thoracoscopic repair of esophageal atresia has gradually become the best therapeutic alternative for patients with this entity. 21 patients with a diagnosis of esophageal atresia operated by thoracoscopy from November 2017 to August 2020 were analyzed. The age at which the surgery was performed was 1 to 15 days old, average 4.5. The procedure was: section and ligation of the fistula with end-to-end anastomosis. The surgery time was 90 to 240 minutes with a mean of 158.5 minutes. Postoperative complications were: 02 patients partial dehiscence of the anastomosis, 05 patients narrowing the anastomosis and 01 patient tracheal diverticulum. There were 03 patients who died. Thoracoscopic repair of esophageal atresia is an efficient therapeutic option, with an acceptable complication rate and lower mortality. (AU)

Feasibility of non-intubated anesthesia and regional block for thoracoscopic surgery under spontaneous respiration: a prospective cohort study

Data about the feasibility and safety of thoracoscopic surgery under non-intubated anesthesia and regional block are limited. In this prospective study, 57 consecutive patients scheduled for thoracoscopic surgery were enrolled. Patients were sedated with dexmedetomidine and anesthetized with propofol and remifentanil. Ropivacaine was used for intercostal nerve and paravertebral block. Lidocaine was used for vagal block. The primary outcomes were mean arterial pressure (MAP), heart rate (HR), oxygen saturation, and end-tidal carbon dioxide partial pressure (ETCO2) at T0 (pre-anesthesia), T1 (immediately after laryngeal mask/nasopharyngeal airway placement), T2 (immediately after skin incision), T3 (10 min after opening the chest), T4 (end of surgery), and T5 (immediately after laryngeal mask/nasopharyngeal airway removal). One patient required conversion to intubation, 15 developed intraoperative hypotension, and two had hypoxemia. MAP at T0 and T5 was higher than at T1-T4; MAP at T3 was lower (P<0.05 vs other time points). HR at T0 and T5 was higher (P<0.05 vs other time points). ETCO2 at T2 and T3 was higher (P<0.05 vs other time points). Arterial pH, PCO2, and lactic acid at T1 differed from values at T0 and T2 (P<0.05). The Quality of Recovery-15 (QoR-15) score at 24 h was lower (P<0.05). One patient experienced dysphoria during recovery. Thoracoscopic surgery with regional block under direct thoracoscopic vision is a feasible and safe alternative to conventional surgery under general anesthesia, intubation, and one-lung ventilation.

Back to the future: a case series of minimally invasive repair of pectus excavatum with regular instruments / De volta para o futuro: série de casos de reparo minimamente invasivo do pectus excavatum com instrumentos comuns

ABSTRACT Objective: Minimally invasive repair of pectus excavatum (MIRPE) is a surgical treatment for PE. During the procedure, a specialized introducer is used to tunnel across the mediastinum for thoracoscopic insertion of a metal bar. There have been reported cases of cardiac perforation during this risky step. The large introducer can be a dangerous lever in unskilled hands. We set out to determine the safety and feasibility of using regular instruments (i.e., not relying on special devices or tools) to create the retrosternal tunnel during MIRPE. Methods: This was a preliminary study of MIRPE with regular instruments (MIRPERI), involving 28 patients with PE. We recorded basic patient demographics, chest measurements, and surgical details, as well as intraoperative and postoperative complications. Results: Patients undergoing MIRPERI had Haller index values ranging from 2.58 to 5.56. No intraoperative complications occurred. Postoperative complications included nausea/vomiting in 8 patients, pruritus in 2, and dizziness in 2, as well as atelectasis, pneumothorax with thoracic drainage, pleural effusion, and dyspnea in 1 patient each. Conclusions: In this preliminary study, the rate of complications associated with MIRPERI was comparable to that reported in the literature for MIRPE. The MIRPERI approach has the potential to improve the safety of PE repair, particularly for surgeons that do not have access to certain special instruments or have not been trained in their use.

RESUMO Objetivo: O minimally invasive repair of pectus excavatum (MIRPE, reparo minimamente invasivo do pectus excavatum) é um tratamento cirúrgico do PE. Durante o procedimento, utiliza-se um introdutor específico a fim de criar um túnel mediastinal para a colocação toracoscópica de uma barra metálica. Já houve casos relatados de perfuração cardíaca durante essa etapa arriscada. O introdutor grande pode ser uma perigosa alavanca em mãos inábeis. Propusemo-nos a determinar a segurança e viabilidade do uso de instrumentos comuns (isto é, sem contar com dispositivos ou ferramentas especiais) para criar o túnel retroesternal durante o MIRPE. Métodos: Estudo preliminar sobre o MIRPE with regular instruments (MIRPERI, MIRPE com instrumentos comuns), envolvendo 28 pacientes com PE. Foram registrados dados demográficos básicos dos pacientes, medições torácicas e detalhes cirúrgicos, bem como complicações intra e pós-operatórias. Resultados: Os pacientes submetidos ao MIRPERI apresentavam índice de Haller entre 2,58 e 5,56. Não ocorreram complicações intraoperatórias. As complicações pós-operatórias incluíram náusea/vômito em 8 pacientes, prurido em 2 e tontura em 2, bem como atelectasia, pneumotórax com drenagem torácica, derrame pleural e dispneia em 1 paciente cada. Conclusões: Neste estudo preliminar, a taxa de complicações associadas ao MIRPERI foi comparável à relatada na literatura para o MIRPE. A abordagem de MIRPERI tem o potencial de melhorar a segurança do reparo do PE, particularmente para cirurgiões que não têm acesso a certos instrumentos especiais ou não foram treinados para utilizá-los.

Simpatectomía torácica, solución para hiperhidrosis / Toracic Sympathectomy, solution for hyperhidrosis

PREFACE: Videothoracoscopic sympathectomy (VTS) is the gold standard treatment for the upper extremity hyperhidrosis (HH) because it is safe and has good results. OBJECTIVE: To evaluate retrospectively the long term results of VTS for the treatment of HH on 50 operated patients in the Maule Region from the year 2003 to september of 2015. METHODS: For axillary HH a T2 to T4 VTS was performed, and T3 VTS for palmar HH. All the patients were operated bilaterally through 2 axillary ports. The operatory sucess was evaluated through the persistence or not of sweating of the palm and armpit. Also, all the complications associated were registered. RESULTS: The procedure was successful in 96% of the patients, who reached anhidrosis in the palms and armpits. The most common complication was compensatory sweating, minimal to mild in 28% of the patients aproximately, severe only in one case; intense post operatory pain in 3 cases and sympathyc reinervation in 2 cases. There was no Infection, Horner syndrome, inthercostal arthery injury or mortality reported. CONCLUSION: The billateral VTS is an effective and safe procedure to obtain anhidrosis in patients with upper extremity hyperhidrosys.

Metástases pulmonares em crianças: estamos operando desnecessariamente? / Pulmonary metastases in children: are we operating unnecessarily?

RESUMO Objetivo: determinar, em pacientes pediátricos portadores de neoplasias malignas, as características de nódulos pulmonares identificados à tomografia computadorizada, capazes de diferenciar nódulos benignos de metástases. Métodos: estudo retrospectivo de pacientes submetidos a ressecções pulmonares de nódulos diagnosticados como metástases em um período de sete anos. Achados de tomografia e da cirurgia, assim como resultados dos exames anatomopatológicos foram comparados. Resultados: nove pacientes, submetidos a 11 intervenções cirúrgicas, foram estudados. Entre as variáveis estudadas, apenas o tamanho do nódulo, maior do que 12,5mm provou ser estatisticamente significante para predizer malignidade. Conclusão: esse estudo sugere que, entre as características tomográficas de nódulos pulmonares de crianças portadoras de neoplasias malignas, apenas o tamanho da lesão foi preditor de malignidade.

ABSTRACT Objective: to determine, in pediatric patients with malignant neoplasms, the characteristics of pulmonary nodules identified on computed tomography, as well as the possibility of differentiating benign lesions from metastases. Methods: we conducted a retrospective study of patients submitted to pulmonary resections of nodules diagnosed as metastases in a period of seven years. We compared computed tomography and surgery findings, as well as results of anatomopathological examinations. Results: we studied nine patients submitted to 11 surgical interventions. Among the studied variables, only nodule size greater than 12.5mm proved to be statistically significant to predict malignancy. Conclusion: among the tomographic characteristics of pulmonary nodules in children with malignant neoplasms, only the size of the lesion was a predictor of malignancy.

Local and systemic effects of fibrin and cyanoacrylate adhesives on lung lesions in rabbits

OBJECTIVES: Tissue adhesives can be used to prevent pulmonary air leaks, which frequently occur after lung interventions. The objective of this study is to evaluate local and systemic effects of fibrin and cyanoacrylate tissue adhesives on lung lesions in rabbits. METHODS: Eighteen rabbits were submitted to videothoracoscopy + lung incision alone (control) or videothoracoscopy + lung incision + local application of fibrin or cyanoacrylate adhesive. Blood samples were collected and assessed for leukocyte, neutrophil and lymphocyte counts and interleukin-8 levels preoperatively and at 48 hours and 28 days post-operatively. After 28 days, the animals were euthanized for gross examination of the lung surface, and lung fragments were excised for histopathological analysis. RESULTS: Fibrin and cyanoacrylate produced similar adhesion scores of the lung to the parietal pleura. Microscopic analysis revealed uniform low-cellular tissue infiltration in the fibrin group and an intense tissue reaction characterized by dense inflammatory infiltration of granulocytes, giant cells and necrosis in the cyanoacrylate group. No changes were detected in the leukocyte, neutrophil or lymphocyte count at any time-point, while the interleukin-8 levels were increased in the fibrin and cyanoacrylate groups after 48 hours compared with the pre-operative control levels (p<0.01). CONCLUSION: Both adhesive agents promoted normal tissue healing, with a more pronounced local inflammatory reaction observed for cyanoacrylate. Among the serum markers of inflammation, only the interleukin-8 levels changed post-operatively, increasing after 48 hours and decreasing after 28 days to levels similar to those of the control group in both the fibrin and cyanoacrylate groups.

Parapneumonic pleural effusion: early versus late thoracoscopy / Derrame pleural parapneumônico: comparação entre toracoscopia precoce e tardia

ABSTRACT Objective: To evaluate the best time to perform thoracoscopy for the treatment of complicated parapneumonic pleural effusion in the fibrinopurulent phase in patients ≤ 14 years of age, regarding the postoperative evolution and occurrence of complications. Methods: This was a retrospective comparative study involving patients with parapneumonic pleural effusion presenting with septations or loculations on chest ultrasound who underwent thoracoscopy between January of 2000 and January of 2013. The patients were divided into two groups: early thoracoscopy (ET), performed by day 5 of hospitalization; and late thoracoscopy (LT), performed after day 5 of hospitalization. Results: We included 60 patients, 30 in each group. The mean age was 3.4 years; 28 patients (46.7%) were male; and 47 (78.3%) underwent primary thoracoscopy (no previous simple drainage). The two groups were similar regarding gender, age, weight, and type of thoracoscopy (p > 0.05 for all). There was a significant difference between the ET and the LT groups regarding the length of the hospital stay (14.5 days vs. 21.7 days; p < 0.001). There were also significant differences between the groups regarding the duration of fever in days; the total number of days from admission to the initiation of drainage; and the total number of days with the drain in place. Eight patients (13.6%) had at least one post-thoracoscopy complication, there being no difference between the groups. There were no deaths. Conclusions: Performing ET by day 5 of hospitalization was associated with shorter hospital stays, shorter duration of drainage, and shorter duration of fever, although not with a higher frequency of complications, requiring ICU admission, or requiring blood transfusion.

RESUMO Objetivo: Avaliar o melhor momento para a realização de toracoscopia no tratamento de derrame pleural parapneumônico complicado na fase fibrinopurulenta em pacientes ≤ 14 anos de idade quanto a evolução e ocorrência de complicações pós-operatórias. Métodos: Estudo retrospectivo e comparativo com pacientes com derrame pleural parapneumônico que apresentavam septações ou loculações à ultrassonografia de tórax e que foram submetidos a toracoscopia no período entre janeiro de 2000 e janeiro de 2013. Os pacientes foram divididos em dois grupos: toracoscopia precoce (TP), realizada até o 5º dia da hospitalização; e toracoscopia tardia (TT), realizada após o 5º dia de internação. Resultados: Foram incluídas 60 pacientes, 30 em cada grupo. A média de idade foi de 3,4 anos, 28 pacientes (46,7%) eram do sexo masculino, e 47 (78,3%) foram submetidos à toracoscopia primária, sem realização de drenagem simples prévia. Os grupos TP e TT foram semelhantes quanto ao sexo, idade, peso e tipo de toracoscopia (p > 0,05 para todos). Observou-se uma diferença significativa quanto à média de duração da internação nos grupos TP e TT (14,5 dias vs. 21,7 dias; p < 0,001). Houve também diferenças significativas entre os grupos quanto ao total de dias com febre, total de dias entre internação e início da drenagem e total de dias com dreno. Oito pacientes (13,6%) apresentaram alguma complicação após a toracoscopia, sem diferença entre os grupos. Não houve óbitos. Conclusões: A TP, realizada até o 5º dia da admissão hospitalar, associou-se a menor duração da internação, menor tempo de drenagem e menor duração da febre, sem estar associada a maior frequência de complicações, necessidade de CTI ou hemotransfusão.

Quiste celómico del pericardio / Pericardial celomic cyst

Con el descubrimiento y el desarrollo de la cirugía de mínimo acceso, la videotoracoscopia no solo se emplea para la confirmación diagnóstica de esta entidad como lo hiciera Otto Pickhardt, en el año 1931, sino que resulta de gran utilidad para su tratamiento con resultados satisfactorios. Se presenta un paciente masculino, de 28 años de edad, con un quiste celómico del pericardio, asintomático, encontrado en una radiografía de tórax de rutina, localizado en el ángulo cardiofrénico derecho. Se interviene quirúrgicamente por vía videotoracoscópica sin complicaciones(AU)

With the discovery and development of minimal access surgery, videothoracoscopy is not only used to confirm the diagnosis of this entity as did Otto Pickhardt, in 1931, it is useful for treatment with satisfactory results. A male patient, 28-year-old with a pericardial coelomic cyst asymptomatic, found in a routine chest X-ray, located in the right cardiophrenic angle is presented. It is surgically intervenes via videothoracoscopy without complications(AU)

Utility of adenosine deaminase (ADA), PCR & thoracoscopy in differentiating tuberculous & non-tuberculous pleural effusion complicating chronic kidney disease.

Background & objectives: Pleural effusion is a common occurrence in patients with late-stage chronic kidney disease (CKD). In developing countries, many effusions remain undiagnosed after pleural fluid analysis (PFA) and patients are empirically treated with antitubercular therapy. The aim of this study was to evaluate the role of adenosine deaminase (ADA), nucleic acid amplification tests (NAAT) and medical thoracoscopy in distinguishing tubercular and non-tubercular aetiologies in exudative pleural effusions complicating CKD. Methods: Consecutive stage 4 and 5 CKD patients with pleural effusions underwent PFA including ADA and PCR [65 kDa gene; multiplex (IS6110, protein antigen b, MPB64)]. Patients with exudative pleural effusion undiagnosed after PFA underwent medical thoracoscopy. Results: All 107 patients underwent thoracocentesis with 45 and 62 patients diagnosed as transudative and exudative pleural effusions, respectively. Twenty six of the 62 patients underwent medical thoracoscopy. Tuberculous pleurisy was diagnosed in six while uraemic pleuritis was diagnosed in 20 subjects. The sensitivity and specificity of pleural fluid ADA, 65 kDa gene PCR, and multiplex PCR were 66.7 and 90 per cent, 100 and 50 per cent, and 100 and 100 per cent, respectively. Thoracoscopy was associated with five complications in three patients. Interpretation & conclusions: Uraemia remains the most common cause of pleural effusion in CKD even in high TB prevalence country. Multiplex PCR and thoracoscopy are useful investigations in the diagnostic work-up of pleural effusions complicating CKD while the sensitivity and/or specificity of ADA and 65 kDa gene PCR is poor.

Resección por toracoscopia del teratoma mediastinal / Thorascopic resection of mediastinal teratoma

Los teratomas son tumores de origen embrionario y su localización en el mediastino es infrecuente. El objetivo del presente trabajo es exponer la resección toracoscópica realizada a paciente con teratoma del mediastino. En el Hospital Dr. Carlos J. Finlay, se operó un paciente con diagnóstico de teratoma del mediastino con evolución preoperatoria conocida de seis meses. Se realizó por vía toracoscópica y por tres puertos de trabajo. La exéresis se realizó totalmente por vía toracoscópica. No presentó complicación transoperatoria, ni posoperatoria; tuvo una estadía hospitalaria de dos días, con seguimiento posoperatorio satisfactorio durante seis años. El teratoma de mediastino es una patología infrecuente y puede realizarse su exéresis por la cirugía toracoscópica y sin complicaciones(AU)

Teratomas are tumors of embrionary origin and their location in the mediastinum is uncommon. The objective of this paper was to present the thorascoscopic resection of a mediastinal teratoma. A patient diagnosed with mediastinal teratoma, with six month progression before surgery, was operated on. Thorascoscopic approach and three working ports were used. Exeresis was completely thorascoscopic. Neither transoperative nor postoperative complication was observed. He was hospitalized for two days with satisfactory postoperative follow-up of 6 years. Mediastinal teratoma is an uncommon pathology and may be removed through thoracoscopic surgery without any complication(AU)

Medical Thoracoscopy: A Useful Diagnostic Tool for Undiagnosed Pleural effusion.

Objective. We aimed to assess the role of medical thoracoscopy in patients with undiagnosed pleural effusion. Methods. Patiens presenting with pleural effusion underwent three pleural aspirations. Patients in whom pleural fluid analysis was inconclusive underwent closed pleural biopsy for diagnostic confirmation. Patients in whom closed pleural biopsy was incolcusive underwent medical thoracoscopy using a rigid thoracoscope with a viewing angle of zero degrees was done under local anaesthesia and sedation with the patient lying in lateral decubitus position with the affected side up. Biopsy specimens from parietal pleura were obtained under direct vision and were sent for histopathological examination. Results. Of the 128 patients with pleural effusion who were studied, pleural fluid examination established the diagnosis in 81 (malignancy 33, tuberculosis 33, pyogenic 14 and fungal 1); 47 patients underwent closed pleural biopsy and a diagnosis was made in 28 patients (malignancy 24, tuberculosis 4). The remaining 19 patients underwent medical thoracoscopy and pleural biopsy and the aetiological diagnosis could be confirmed in 13 of the 19 patients (69%) (adenocarcinoma 10, poorly differentiated carcinoma 2 and mesothelioma 1). Conclusion. Medical thoracoscopy is a useful tool for the diagnosis of pleural diseases. The procedure is safe with minimal complications.

Reparación toracoscópica de atresia esofágica con y sin fistula traqueoesofágica / Thoracoscopic repair of esophageal atresia with and without tracheoesophageal fistula

Introduction: Esophageal atresia (EA) is the interruption of the continuity of the esophagus, with or without persistent communication with the trachea. Recent advances in surgical techniques have made possible correction with minimally invasive surgery (MIS). Objective: To evaluate the management of thoracoscopic technique in the treatment of EA. Patients and Method: Retrospective analysis of medical records in two centers was carried out between 2007 and 2012. Variables such as gestational age, gender, weight, type of esophageal atresia, malformations, surgery and postoperative complications were recorded. Results: Twenty patients, 15 of them with type III EA, 4 with type I and one unclassifiable, were part of the study. 13 patients underwent ligation, cut of tracheoesophageal fistula and end to end anastomosis. Two underwent laparoscopic gastrostomy and fistula ligation. One patient required conversion and underwent esophagostomy plus gastrostomy. 4 patients without fistula required laparoscopic gastrostomy and aspiration of the proximal esophagus to be able to perform esophageal anastomosis. In the postoperative period, pleural drainage and a transanastomotic feeding tube were installed. Seven patients required esophageal dilations and 4 patients developed stenosis due to reflux. Two had recurrent fistula, one with spontaneous resolution and another with endoscopic resolution. Three children died: two of them due to pathologies not related to surgery and one as a result of limitation of therapeutic effort after fistula patency. Discussion: Esophageal atresia repair with MIS is a safe and effective option with excellent exposure and visualization of anatomic landmarks and little associated morbidity.

Introducción: Atresia esofágica (AE) es la interrupción de la continuidad del esófago, con o sin comunicación con la tráquea. Los avances en cirugía han permitido su corrección con cirugía mínimamente invasiva (CMI). Objetivo: Evaluar el manejo toracoscópico en AE. Pacientes y Método: Revisión retrospectiva de fichas de 2 centros entre 2007 y 2012. Se registraron variables como edad gestacional, sexo, peso, tipo de atresia esofágica, malformaciones, cirugías y complicaciones postquirúrgicas. Resultados: Veinte pacientes, 15 tipo III, 4 tipo I y uno no clasificable. En 13 pacientes se realizó ligadura, sección de fístula tráqueo-esofágica y anastomosis término-terminal. Dos fueron sometidos a gastrostomía laparoscópica más ligadura de fístula. Un paciente requirió conversión y se realizó esofagostomía más gastrostomía. En 4 pacientes sin fístula, se realizó gastrostomía laparoscópica y aspiración del esófago proximal hasta lograr realizar la anastomosis esofágica. En el post-operatorio se instaló drenaje pleural y sonda trans-anastomótica. Siete pacientes requirieron dilataciones esofágicas y 4 desarrollaron estenosis por reflujo. Dos presentaron fístula recidivada, uno con resolución espontánea y el segundo de resolución endoscópica. Tres niños fallecieron: dos por patologías no relacionadas con la cirugía y uno con limitación de esfuerzo terapéutico con repermeabilización de fístula. Discusión: La atresia esofágica reparada con CMI es una opción segura y efectiva en esta serie, permitiendo excelente exposición y visualización de reparos anatómicos, con poca morbilidad asociada.

Tratamiento paliativo de los derrames pleurales malignos mediante abrasión química / Palliative treatment of malignant pleural effusions with chemical abrasion

Introducción: el tratamiento del derrame pleural maligno constituye un reto para los cirujanos. Su erradicación permanente ha constituido un largo bregar, y para ello se ha utilizado un numeroso grupo de sustancias. Objetivo: mostrar los resultados del uso de diferentes sustancias químicas para conseguir la fusión de las pleuras en el derrame pleural maligno. Métodos: fueron estudiados 116 pacientes con derrames malignos de pleura tratados mediante toracocentesis y escleroterapia química en el Hospital Universitario Comandante Manuel Fajardo entre enero de 2001 y el 2013. El diagnóstico del 100 por ciento de los pacientes fue clínico e imaginológico, con estudio del líquido pleural. Después de la toma de muestra se evacuó todo el contenido mediante un catéter colector y la instilación de la solución esclerosante. Como agentes irritantes se utilizó bleomicina, tetraciclina, amoxicilina y povidona yodada. Resultados: la causa más frecuente de derrame pleural resultó ser el cáncer de mama, seguido por el de pulmón y el ovario. En el hombre fue más frecuente el cáncer de pulmón y en la mujer el cáncer de mama. Predominó el sexo femenino y, específicamente, la sexta década de la vida. El 52,4 por ciento de los pacientes necesitó dos sesiones terapéuticas y el 15,6 por ciento no presentó recidiva después de la primera sesión. Conclusiones: los resultados fueron similares con todas las sustancias utilizadas. La intervención paliativa logró mejorar la calidad de vida al aliviar los síntomas de los pacientes y disminuir la hospitalización(AU)

Introduction: the treatment of the malignant pleural effusion poses a challenge for the surgeons, its permanent eradication has been a long struggle based on the use of a number of substances. Objective: To show the results of the use of different chemical substances to fuse the pleuras in malignant pleural effusion. Methods: one hundred and sixteen patients with malignant pleural effusions, who were treated with thoracentesis and chemical sclerotherapy at Comandante Manuel Fajardo university hospital from January 2001 through January 2013, participated in the study. Their diagnosis was based on clinical examination and imaging, with additional pleural fluid study. After the sample-taking, a collecting catheter and an instilled sclerosing solution were used to remove the whole pleural content, whereas bleomycin, tetracycline, amoxicillin and povidone iodine acted as irritating agents. Results: the most frequent cause of pleural effusion was breast cancer, followed by lung and ovary cancers. The lung cancer was commonest in men and breast cancer in females. Females and the age of 60 years prevailed. In this group, 52.4 por ciento required two therapeutic sessions and 15.6 por ciento showed no relapse after the first session. Conclusions: the results were similar with all the used substances. The palliative intervention succeeded in improving the quality of life, releasing symptoms and reducing hospitalization(AU)

A modified method using a two-port approach for accessing the hilar vasculature without transferring an endostapler from camera port to utility port during thoracoscopic right upper lobectomy.

For thoracoscopic upper lobectomies, most cutting endostaplers must be inserted through the camera port when using a two-port approach. Access to the hilar vasculature through only the utility port remains a challenge. In this study, we describe a procedure to access the hilar vasculature without transferring the endostapler site during a thoracoscopic right upper lobectomy. A 2.5-cm utility anterior incision was made in the fourth intercostal space. The posterior mediastinal visceral pleura were dissected to expose the posterior portion of the right upper bronchus and the anterior trunk of the right pulmonary artery. The pleura over the right hilar vasculature were then peeled with an electrocoagulation hook. The anterior trunk of the right pulmonary artery was then transected with a cutting endostapler through the utility port firstly. This crucial maneuver allowed the endostapler access to the right upper lobe pulmonary vein. The hilar structures were then easily handled in turn. This novel technique was performed successfully in 32 patients, with no perioperative deaths. The average operation time was 120.6 min (range 75–180 min). This novel technique permits effective control of the hilar vessels through the utility port, enabling simple, safe, quick and effective resection.

Different limited resection of pulmonary lobe methods under the thoracoscopy in the treatment of early nonsmall cell lung cancer occurred in the old age.

OBJECTIVES: The objective was to explore clinical effect of limited resection of lung lobe under the thoracoscopy in the treatment of early nonsmall cell lung cancer occurred in the old age. METHODS: A total of 150 patients with nonsmall cell lung cancer in the old age is treated by limited resection of lung lobe under thoracoscope. It can be divided into segmental resection group and wedge resection group by surgical methods, to make a comparative analysis of operation time, intraoperative blood loss, hospital stays, and complications during the perioperative period. And there will be postoperation follow‑up on survival, relapse and death situation etc., RESULTS: 10 cases are changed to make other operation because of maladaptation to limited resection, and a total of 140 patients have undergone limited resection. Operation time and hospital stays of wedge resection group are shorter than those of segmental resection group (P < 0.05); compared with the bleeding and indwelling drainage tube time in two groups, differences have no statistical significance (P > 0.05). Compared with cases of complications, recurrence and death for groups of segmental resection and wedge resection group, the differences have no statistical significance (P > 0.05). CONCLUSION: Limited resection of lung lobe in the early treatment of nonsmall cell lung cancer occurred in the old age under the thoracoscopy is safe and feasible.

Two-incision approach for video-assisted thoracoscopic sleeve lobectomy treating the central lung cancer.

BACKGROUND: We review our experiences with video‑assisted thoracoscopic surgery (VATS) sleeve lobectomy with bronchoplasty for nonsmall‑cell lung cancer, using only two incisions. The aim of this study was to evaluate the technical feasibility and safety of surgical approach. MATERIALS AND METHODS: From January 2013 to January 2014, we completed 15 cases of VATS sleeve lobectomy with bronchoplasty in our hospital. The patients underwent sleeve lobectomy with bronchoplasty at the following locations: right upper lobe (n = 4), right lower and middle lobes (n = 1), left lower lobe (n = 5), and left upper lobe (n = 6). The operation consisted of VATS anatomic sleeve lobectomy with bronchoplasty combined with systematic lymph node dissection, using only two incisions. RESULTS: The patients underwent sleeve lobectomy with bronchoplasty were no postoperative complications. Median operative time was 183 min; median bronchial anastomosis time was 39 min; median blood loss was 170 ml. Pathological examination showed 12 squamous cell carcinomas and 3 adenocarcinoma. Median postoperative chest tube drainage duration was 4.5 days, and median hospital stay was 6.9 days. CONCLUSIONS: Video‑assisted thoracoscopic surgery sleeve lobectomy with bronchoplasty is a feasible and safe surgical approach, using only two incisions. This way of operation can promote the development of surgical technology.

Computed Tomography Guided Percutaneous Injection of a Mixture of Lipiodol and Methylene Blue in Rabbit Lungs: Evaluation of Localization Ability for Video-Assisted Thoracoscopic Surgery

Preoperative localization is necessary prior to video assisted thoracoscopic surgery for the detection of small or deeply located lung nodules. We compared the localization ability of a mixture of lipiodol and methylene blue (MLM) (0.6 mL, 1:5) to methylene blue (0.5 mL) in rabbit lungs. CT-guided percutaneous injections were performed in 21 subjects with MLM and methylene blue. We measured the extent of staining on freshly excised lung and evaluated the subjective localization ability with 4 point scales at 6 and 24 hr after injections. For MLM, radio-opacity was evaluated on the fluoroscopy. We considered score 2 (acceptable) or 3 (excellent) as appropriate for localization. The staining extent of MLM was significantly smaller than methylene blue (0.6 vs 1.0 cm, P<0.001). MLM showed superior staining ability over methylene blue (2.8 vs 2.2, P=0.010). Excellent staining was achieved in 17 subjects (81%) with MLM and 8 (38%) with methylene blue (P=0.011). An acceptable or excellent radio-opacity of MLM was found in 13 subjects (62%). An appropriate localization rate of MLM was 100% with the use of the directly visible ability and radio-opacity of MLM. MLM provides a superior pulmonary localization ability over methylene blue.