Hemotórax espontáneo como forma de presentación de carcinoma de pulmón / Spontaneous haemothoraz as a form of pesentation of lung cancer

El hemotórax espontáneo como forma de presentación de uncarcinoma de pulmón es extremadamente raro, siendo muy pocoslos casos reflejados en la literatura. Hemos tenido la oportunidadde tratar a una paciente de 64 años, no fumadora, cuyo ingresohospitalario fue debido a un hemotórax masivo izquierdo queestaba originado por un carcinoma de células gigantes en lóbuloinferior, como se comprobó en la intervención, y a la que se le pudorealizar una lobectomía inferior izquierda y linfadenectomía (AU)

Haemothorax as a form of presentation of lung cancer isextremely rare, and very few cases have been reported in the literature.We have had the opportunity to treat a 64 year old, nonsmokerpatient, whose hospital admission was due to a massive lefthaemothorax that was originated by a giant cell carcinoma in thelower lobe and confirmed in the intervention. A left lower lobectomyand lymphadenectomy was completed (AU)

Hemotórax espontáneo como forma de presentación de carcinoma de pulmón / Spontaneous haemothorax as a form of presentation oflung cancer

El hemotórax espontáneo como forma de presentación de uncarcinoma de pulmón es extremadamente raro, siendo muy pocos los casos reflejados en la literatura. Hemos tenido la oportunidad de tratar a una paciente de 64 años, no fumadora, cuyo ingreso hospitalario fue debido a un hemotórax masivo izquierdo que estaba originado por un carcinoma de células gigantes en lóbulo inferior, como se comprobó en la intervención, y a la que se le pudo realizar una lobectomía inferior izquierda y linfadenectomía

Haemothorax as a form of presentation of lung cancer isextremely rare, and very few cases have been reported in the literature. We have had the opportunity to treat a 64 year old, nonsmoker patient, whose hospital admission was due to a massive left haemothorax that was originated by a giant cell carcinoma in the lower lobe and confirmed in the intervention. A left lower lobectomyand lymphadenectomy was completed

Corrección del pectus excavatum por cirugía toracoscópica con la técnica de nuss / Correction of pectus excavatum with thoracoscopic surgery using the nuss technique

FUNDAMENTO: El pectus excavatum (PE) constituye ladeformación congénita más frecuente de la pared torácica, conimportantes consecuencias psicológicas y estéticas, además de funcionales.Hasta ahora la técnica más utilizada era la de Ravitch,consistente en la realización de condrectomías subpericóndricasbilaterales de los cartílagos afectos y osteotomías esternales transversalesy posterior estabilización.OBJETIVOS: Presentar nuestra experiencia en el tratamientoquirúrgico del pectus excavatum, siguiendo la técnica de correcciónmínimamente invasiva descrita por Nuss.MATERIALYMÉTODOS: A todos los pacientes se les realizóTAC de tórax con índices de Haller superiores a 3,25. Bajo anestesiageneral y mediante videotoracoscopia se colocó una barra estabilizadorasubesternal, realizando el abordaje mediante dos incisioneslaterales. Los extremos de la barra se fijaron medianteestabilizadores.RESULTADOS: Se trataron 11 pacientes (9 varones, 2 mujeres,rango de edad 10-31 años). El motivo de la intervención fue lacorrección estética. No se presentaron complicaciones intra ni postoperatoriasimportantes y no hubo ninguna muerte. El tiempooperatorio medio fue 58,6 min, el inicio de la deambulación mediafue 4,3 días y la estancia hospitalaria postoperatoria fue 7,2 días(tiempos menores que con la técnica de Ravitch). La complicaciónmás frecuente fue el dolor postoperatorio, bien controlado conanalgesia. Un paciente presentó intolerancia a la barra, siendonecesaria extraerla al año. En el 91% de nuestros casos se obtuvieronunos excelentes resultados estéticos.CONCLUSIONES: Consideramos que la técnica de Nussmínimamente invasiva debe de ser el procedimiento de elecciónpara corregir el pectus excavatum

THEORY: The pectus excavatum (PE) is the most frequentcongenital deformation of the thoracic wall, with major psychologicaland aesthetic, aside from functional, consequences. Until now,the Ravitch technique has been used, which consists of a bilateral,subperichondrial chondrectomy of the affected cartilage andtransverse, sternal osteotomy and subsequent stabilisation.OBJECTIVES: To present our experience in the surgicaltreatment of the pectus excavatum, using the minimally invasivecorrection technique described by Nuss.MATERIAL AND METHODS: A thoracic CAT-scan was performedon all the patients with a Haller indexes above to 3.25.Under general anaesthesia and using a video-thoracoscope, a stabilisingbar was placed under the sternum, approaching the areawith two lateral incisions. The ends of the bar were fixed with stabilisers.RESULTS: 11 patients were treated (9 men, 2 women, agerange 10-31 years of age). The intervention was carried out for aestheticreasons. There were no major complications during or afterthe intervention; there were no deaths. The average operating timewas 58.6 min; on average, patients were up within 4.3 days and thepostoperative hospital stay was 7.2 days (lower figures that withthe Ravitch technique). The most frequent complication was postoperativepain, which was well controlled with analgesics. Onepatient was unable to tolerate the bar; it had to be removed afterone year. In 91% of the cases excellent aesthetic results wereobtained.CONCLUSIONS:We consider that the Nuss technique is minimallyinvassive and should be the procedure of choice in the correctionof the pectus excavatum

Cirugía torácica mínimamente invasiva: La perspectiva desde un grupo pionero. Resultados y complicaciones / No disponible

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[Video-assisted thoracoscopic thymectomy for the treatment of myasthenia gravis]. / Timectomía videotoracoscópica para el tratamiento de la miastenia gravis.

OBJECTIVE: Traditionally, thymectomy for myasthenia gravis has been performed using either a transcervical approach or a median sternotomy. However, excision of the thymic tissue by video-assisted thoracoscopic surgery is less aggressive and recovery is faster. The aim of this study was to evaluate the usefulness and outcomes of video-assisted thoracoscopic thymectomy. PATIENTS AND METHODS: Over the past 10 years, we have performed 25 video-assisted thoracoscopic thymectomies on patients with myasthenia gravis at our unit. This study included 16 women and 9 men, with a mean age of 48.1 years (range, 14-74 years). Right-side (22 cases) or left-side (3 cases) thoracoscopic surgery was performed, with a mean intervention time of 110 minutes (range, 60-193 minutes). RESULTS: No patient required assisted ventilation for more than 4 hours and the maximum stay in intensive care was less than 24 hours. Complications from surgery included 3 cases of contralateral pneumothorax, 1 pleural effusion, and 2 intraoperative hemorrhages from the thymic vein, all of which were resolved by video-assisted thoracoscopy. Likewise, 3 cases required conversion (due to hemorrhaging in 2 patients and technical difficulties in 1) and 2 required a second thoracoscopic intervention. No deaths occurred and clinical outcome was excellent in 11 cases (medical treatment no longer required), good in 10 (reduced medical treatment), and poor in 4 (no changes). CONCLUSIONS: Video-assisted thoracoscopic thymectomy is effective in the treatment of myasthenia gravis and improves patient recovery. In addition, the excellent surgical view allows the thymectomy to be performed with absolute safety.

[Video-assisted thoracoscopic surgery in 3 cases of adult cystic adenomatoid malformation]. / Tres casos de malformación adenomatoidea quística en el adulto tratados por cirugía videotoracoscópica.

Congenital cystic adenomatoid malformation involving the lung is a rare hamartomatous condition that is usually diagnosed in the neonatal period. The presentation of this malformation in older patients is exceptional and usually manifests in a series of recurrent lung infections affecting a single lobe or segment. The treatment of choice is complete surgical exeresis. This report of 3 cases of late presentation focuses on the surgical approach used and the unusual manifestation of recurrent spontaneous pneumothoraces in 1 patient. The patients were females aged 15, 16, and 25 years with histories of various respiratory diseases (extrinsic asthma, recurrent pneumonias, and pneumothoraces). The patients were referred to us for surgery with suspected diagnoses that were different from the final diagnoses in all cases. All underwent diagnostic video-assisted thoracoscopy to explore the affected hemothorax, and definitive treatment was possible during the procedure for 2 patients (a lobectomy and an atypical segmentectomy) by video-assisted surgery. The third patient underwent lobectomy by lateral thoracotomy after exploratory video-assisted thoracoscopy. Short- and long-term outcomes were excellent for all 3 patients.

[Giant solitary fibrous tumor of the pleura treated by video-assisted surgery: a case report]. / Tumor fibroso solitario gigante de pleura: un caso tratado por cirugía videoasistida.

Solitary fibrous tumors of the pleura are rare, with unpredictable clinical manifestations. By the time of diagnosis, the size and consistency of the tumor usually preclude the use of minimally invasive surgical techniques. We present a case of a 34-year-old male with a solitary fibrous tumor of the visceral pleura masquerading as a mediastinal tumor. The tumor was removed by video-assisted thoracic surgery.

Tratamiento de la hiperhidrosis palmar por simpatectomía torácica. Resultados inmediatos y calidad de vida postoperatoria / Thoracoscopic sympathectomy for palmar hyperhidrosis. Immediate results and postoperative quality of life

OBJETIVO: La hiperhidrosis palmar primaria localizada es un trastorno en la producción del sudor que resulta social y laboralmente incapacitante. El propósito de este estudio es evaluar los resultados, complicaciones y grado de satisfacción de los pacientes con hiperhidrosis palmar primaria tratados con simpatectomía videotoracoscópica T2-T3 bilateral en el Servicio de Cirugía General y Torácica del Hospital Universitario Virgen Macarena de Sevilla. MATERIAL Y MÉTODO: Se ha realizado un estudio clínico prospectivo histórico de 226 simpatectomías torácicas. La muestra la componen 113 pacientes (47 varones y 66 mujeres) de 14 a 50 años años de edad con hiperhidrosis palmar y axilar primaria, en algunos severa. A todos ellos se les intervino bajo anestesia general practicándoseles simpatectomía videotoracoscópica T2-T3 bilateral. Se presenta un seguimiento mediante cuestionario en relación con la calidad de vida y grado de satisfacción pre y postoperatoria. Se han efectuado análisis de frecuencia y descriptivos de los datos obtenidos sobre la técnica quirúrgica, calidad de vida y cambios posteriores a la cirugía y una prueba no paramétrica de Wilcoxon para dos variables relacionadas para contrastar diferencias significativas entre la calidad de vida pre y postoperatoria con relación a la hiperhidrosis y sus complicaciones. RESULTADOS: El porcentaje de éxito terapéutico ha sido del 100 por ciento. La tasa de complicaciones del procedimiento fue del 14,2 por ciento e incluyó hemotórax en dos pacientes, hemoneumotórax en tres, derrame pleural en dos y mínima cámara aérea apical en 9. De los 106 pacientes a los que se les realizó seguimiento entre 6 y 12 meses mediante entrevista y cuestionario, un 67 por ciento de ellos desarrollaron sudación compensatoria. Un 95 por ciento de estos pacientes refirió mejoría de su calidad de vida, y un 4 por ciento no experimentó ningún cambio en ella, sobre todo al considerar la aparición de la sudación compensatoria. El 97,2 por ciento de los pacientes entrevistados respondieron afirmativamente a la cuestión de si se volverían a operar. CONCLUSIÓN: La simpatectomía videotoracoscópica es un método efectivo para el tratamiento de la hiperhidrosis palmar primaria con bajas tasas de morbilidad y nulas de mortalidad. A pesar de la aparición de cambios posteriores como la sudación compensatoria, presenta una alta tasa de satisfacción y mejora de la calidad de vida de los pacientes (AU)

[Thoracoscopic sympathectomy for palmar hyperhidrosis. Immediate results and postoperative quality of life]. / Tratamiento de la hiperhidrosis palmar por simpatectomía torácica. Resultados inmediatos y calidad de vida postoperatoria.

OBJECTIVE: Primary palmar hyperhidrosis is a socially and occupationally debilitating disorder characterized by excessive sweating. The purpose of this study was to evaluate the results, complications, and degree of satisfaction among patients who underwent video-assisted bilateral thoracoscopic sympathectomy of the second and third ganglia (T2-T3) to treat primary palmar hyperhidrosis at the Department of General and Thoracic Surgery of the Hospital Universitario Virgen Macarena in Seville, Spain. MATERIAL AND METHOD: A study of 226 thoracoscopic sympathectomies was undertaken based on case histories and a prospective pre- and postoperative questionnaire survey. The sample was composed of 113 patients (47 males and 66 females), ranging in age from 14 to 50 years, with primary palmar and axillary hyperhidrosis, in some cases severe. Bilateral video-assisted thoracoscopic T2-T3 sympathectomy was performed under general anesthesia in all cases. Follow up included a questionnaire on pre- and postoperative quality of life and degree of satisfaction. Descriptive statistics on the surgical procedure, quality of life, and postoperative changes were compiled and frequency analyzed. A nonparametric Wilcoxon test for paired variables was performed to contrast significant differences between pre- and postoperative quality of life related to hyperhidrosis and its complications. RESULTS: The therapeutic success rate was 100%. Complications were seen in 14.2% of the cases and included hemothorax in two, hemopneumothorax in three, pleural hemorrhage in two, and minimal apical airspace in nine. Of the 106 patients who were monitored over a period of 6 to 12 months through follow-up interviews and questionnaires, 67% developed compensatory sweating, 95% reported improvement in quality of life, and 4% experienced no change in quality of life, mainly because of the emergence of compensatory sweating. Of the patients interviewed, 97.2% said that they would undergo the operation again. CONCLUSION: Video-assisted thoracoscopic sympathectomy for the treatment of primary palmar hyperhidrosis is effective, with low rates of morbidity and no mortality. Despite the appearance of postoperative changes such as compensatory sweating, patient satisfaction with the procedure is high and their quality of life improves.

[Usefulness of video-assisted thoracoscopy for the diagnosis of solitary pulmonary nodules]. / Utilidad de la cirugía videotoracoscópica en el diagnóstico de los nódulos pulmonares solitarios.

OBJECTIVES: Various approaches are used for the diagnosis and treatment of solitary pulmonary nodules (SPN) of unknown origin. New imaging techniques and nuclear medicine have provided more information about SPN, but surgical removal is still the most sensitive and specific way to obtain a correct analysis of the lesion. With video-assisted thoracic surgery (VATS), a histological diagnosis can be obtained without resorting to thoracotomy. In the present study we describe our experience with the diagnosis and treatment of SPN using VATS. MATERIAL AND METHODS: From July 1992 through April 2001, 182 patients were operated on for SPN in our department. DESIGN: Retrospective study. Mean age: 59.2 years (12-78). Sex: 39 women and 143 men. Localization: Visual or instrumental exploration in 102 patients, with palpation in 52 cases and using a hookwire guided by preoperative computed tomography in 25 (with failure in 4 of those cases). Tissue was biopsied during surgery and when the lesion was malignant, oncological excision was performed during the same operation. RESULTS: A firm diagnosis was obtained by VATS for 178 patients (98.3%). For three other patients the surgeon had to take a needle biopsy (Tru-cut) during surgery, and in one case conversion to open surgery was necessary. Histopathology: hamartoma: 11; fibrous nodule: 10; bronchiolitis obliterans: 1; pneumoconiosis: 1; mesenchymal tumor: 3; inflammatory pseudotumor: 14; mucormycosis: 1; tuberculoma:17; lymphoma: 1; carcinoid tumor: 6; metastasis: 22; bronchogenic carcinoma: 95. Mortality was 0.55%, with 1 patient dying from massive pulmonary thromboembolism. Morbidity was 5%, from 9 minor complications. CONCLUSIONS: VATS is an effective approach, with low morbidity and mortality. We consider it to be the technique of choice for the diagnosis of all SPN and for the treatment of some, such as benign nodules and solitary metastases.

Utilidad de la cirugía videotoracoscópica en el diagnóstico de los nódulos pulmonares solitarios / Usefulness of video-assisted thoracoscopy for the diagnosis of solitary pulmonary nodules

OBJETIVOS: Varios tipos de estrategias se emplean para el diagnóstico y tratamiento de los nódulos pulmonares solitarios indeterminados (NPS). Las nuevas técnicas de imagen y de medicina nuclear parecen añadir más información a esta afección, pero aún es la exéresis quirúrgica el método más sensible y específico para obtener un correcto análisis de la lesión. Con la cirugía videotoracoscópica (CVT) se puede conseguir un diagnóstico histológico sin la necesidad de realizar una toracotomía. En este estudio se expone nuestra experiencia en el diagnóstico y tratamiento de los NPS con la CVT. MATERIAL Y MÉTODOS: Desde julio de 1992 a abril de 2001 se ha intervenido a 182 pacientes afectados de NPS en nuestro servicio. Diseño: estudio retrospectivo. Edad media: 59,2 años (límites, 12-78). Sexo: un total de 39 mujeres y 143 varones. Localización: exploración visual o instrumental en 102 pacientes, con palpación en 52 casos y con arpón guiado por tomografía computarizada (TC) preoperatoriamente en 25 (cuatro de ellos fallaron). A todos ellos se les realizó una biopsia intraoperatoria y cuando la lesión fue maligna se les practicó una exéresis oncológica en la misma operación. RESULTADOS: Se ha obtenido un diagnóstico de certeza, por CVT en 178 pacientes (98,3 per cent). En otros 3 pacientes fue necesario practicar biopsia con aguja Tru-cut® durante la CVT y un caso más hubo de convertirse a cirugía abierta. Histopatología: hamartoma, 11; nódulo fibroso, 10; bronquiolitis obliterante, 1; neumoconiosis, 1; tumor mesenquimal, 3; seudotumor inflamatorio, 14; mucormicosis, 1; tuberculoma, 17; linfoma, 1; tumor carcinoide, 6; metástasis, 22, y carcinoma broncogénico, 95. Mortalidad: 0,55 per cent, un paciente por tromboembolia pulmonar masiva. Morbilidad: 5 per cent, nueve complicaciones menores. CONCLUSIONES: La CVT es un abordaje muy efectivo, con baja morbilidad y mortalidad, y en nuestra opinión debe ser la técnica de elección para el diagnóstico de todos los NPS y el tratamiento de algunos, como los nódulos benignos y las metástasis solitarias (AU)

Videopericardioscopia: una nueva exploración para valorar la resecabilidad de los cánceres de pulmón CT4 por invasión vascular / Video-pericardioscopy: a new way to assess resectability of cT4 lung cancers by vascular invasion

Objetivos: Manifestar la utilidad de la exploración intrapericárdica de los vasos pulmonares por videotoracoscopia, para demostrar si su invasión sospechada en la tomografía axial computarizada o resonancia magnética es cierta o no. Pacientes y método: Desde 1993 utilizamos la videotoracoscopia exploradora (VTE) como método de estadificación final y valoración de la resecabilidad en el cáncer de pulmón. La exploración vascular intrapericárdica (videopericardioscopia [VPC]) es el complemento para valorar la resecabilidad en casos cT4. Hemos realizado 20 videopericardioscopias entre 460 videotoracoscopias exploradoras, ante la sospecha de invasión intrapericárdica de vasos pulmonares (19 varones, una mujer; edad media 64,6 años; rango 50-77). En 11 pacientes se sospechaba previamente por la tomografía axial computarizada la invasión hiliar y vascular; en los nueve restantes se comprobó esta invasión en la videotoracoscopia exploradora de valoración de la resecabilidad. La videotoracoscopia exploradora-videopericardioscopia se realiza a través de tres puertas de entrada, ocasionalmente cuatro, por las que se exploran fácilmente los vasos intrapericárdicamente. Resultados: Cinco casos fueron irresecables: cuatro por invasión de la arteria pulmonar hasta su origen y uno por gran invasión de venas pulmonares y aurícula izquierda. Los 15 restantes fueron resecables, y fueron operados por toracotomía posterolateral con disección y ligadura intrapericárdica de los vasos. Cinco de ellos habían sido considerados irresecables en otros hospitales por considerarlos cT4 avanzados en exploraciones de imagen. El tiempo medio de duración de la videopericardioscopia fue de 23 min (rango 16-33); la estancia media postoperatoria, de 48 h en los no resecados, que fueron enviados al tercer día para terapia neoadyuvante. En estos casos sometidos sólo a videopericardioscopia no existieron complicaciones ni mortalidad, y se evitaron 5 toracotomías innecesarias. Conclusiones: La videopericardioscopia permite la correcta estadificación del parámetro T, en aquellos casos en que se sospecha T4, evitando toracotomías innecesarias en los casos irresecables y permitiendo rescatar para cirugía casos dudosos en la tomografía axial computarizada o resonancia magnética. (AU)

[Videocardioscopy: a new way to assess resectability of cT4 lung cancer by vascular invasion]. / Videopericardioscopia: una nueva exploración para valorar la resecabilidad de los cánceres de pulmón cT4 por invasión vascular.

OBJECTIVES: To demonstrate the usefulness of intrapericardial inspection of pulmonary vessels by video assisted thoracoscopy (VAT), for determining whether suspicion indicated by computed axial tomography (CAT) or magnetic resonance (MR) scanning is justified or not. PATIENTS AND METHOD: Since 1993 we have used exploratory VAT for final staging and assessment of lung cancer resectability. Intrapericardial vascular exploration (IVE) is a complementary method of assessing resectability in cT4 cases. We have performed 20 IVE among 460 VAT when intrapericardial involvement of pulmonary vessels has been suspected (19 men, 1 woman, mean age 64.6 years, range 50-77). VAT demonstrated invasion for 11 patients with previous suspicion based on hilar and vascular invasion shown by CAT scan; in 9 others such involvement was found during IVE for assessing resectability. VAT-IVE was performed through three or sometimes four entrance approaches, from which intrapericardial vessels were explored easily. RESULTS: Five cases were non-resectable: four due to invasion of the pulmonary artery to its point of origin and one due to extensive invasion of pulmonary veins and the left auricle. The remaining 15 cases were resectable and lesions were removed by posterolateral thoracotomy with intrapericardial dissection and ligature of the vessels. Five had been considered non-resectable by teams at other hospitals where they were classified as advanced cT4 cancers after imaging. The mean duration of IVE was 23 minutes (range 16 to 33); mean postprocedural stay was 48 h in non-resected patients, who were sent for neoadjuvant therapy on the third day. These patients, who underwent only IVE, had no complications and there were no deaths, with five unnecessary thoracotomies avoided. CONCLUSIONS: IVE allows correct staging of the T parameter in patients for whom T4 classification is suspected, avoiding unnecessary thoracotomies in non-resectable cases and allowing for surgical removal in cases where CAT or MR imaging results are unclear.

[The treatment of myasthenia gravis by video thoracoscopic thymectomy. The technic and the initial results]. / Tratamiento de la miastenia grave mediante timectomía videotoracoscópica. Técnica y resultados iniciales.

The primary role of thymectomy for the treatment of myasthenia gravis is currently undisputed. Traditionally, the approach of choice has been sternotomy, although a transcervical route has also been advocated because of its lower rate of associated morbidity. Our department performed thymectomy using a video-assisted thoracoscopic technique in 7 patients (2 men and 5 women) between March 1993 and October 1995. The patients' mean age was 43.4 years (range 20 to 66 years). Complications were few, consisting of 2 cases of pneumothorax due to contralateral opening of the pleura, resolved by pleural drainage. No deaths occurred. Clinical results over periods of observation ranging from 14 to 44 months were excellent in 2 cases of complete remission; good in 3 patients with considerable reduction in drug requirements; and fair in 2 patients who continued to need the same doses of medication throughout the 14 months after thymectomy. The technique we propose is less aggressive than mid-sternotomy, offering incontrovertible advantages and leading to faster. No patient required assisted ventilation for longer than 4 hours and the maximum time spent in the intensive care unit was 24 hours. We therefore suggest that thymectomy to treat myasthenia gravis be performed by thoracoscopy.

Comparative retrospective study of surgical treatment of spontaneous pneumothorax. Thoracotomy vs thoracoscopy.

BACKGROUND: Since May 1992 we have used video-assisted thoracic surgery (VATS) for the treatment of the spontaneous pneumothorax. In this study we review the results obtained with this technique and we compare them with those obtained by conventional surgery (1976-1992). METHODS: 110 patients (98 males and 12 females, age 15-83 years) were operated by VATS, and 627 patients (567 males and 60 females, age 14-89 years) by conventional surgery. The surgical technique and the complications are compared. No one died. RESULTS: Although the number of complications was greater in the first group than in the second one (29.5% vs 15.1%), this is attributed to the lack of experience among surgeons in the first cases; which complications nearly disappeared in the last 60 patients. Less pain, better recovery, and shorter hospital stay resulted. CONCLUSIONS: For us VATS is the ideal technique with which to treat spontaneous pneumothorax.

The use of videoassisted thoracic surgery in lung cancer: evaluation of resectability in 296 patients and 71 pulmonary exeresis with radical lymphadenectomy.

OBJECTIVE: To outline the usefulness of videothoracoscopic and videoassisted surgery in the final staging, resectability evaluation and treatment of lung cancer, and its possible advantages over thoracotomy. PATIENTS AND METHOD: Videothoracoscopy was performed on 296 patients suffering from lung cancer. Patient selection criteria are described, as well as techniques for the different kinds of resections. Postoperative care and patient follow-up is also detailed. RESULTS: Of the 296 patients 189 were operated on by open surgery after final staging and resectability evaluation. A total of 30 were considered unresectable by videothoracoscopic exploration, five cases needed exploratory thoracotomy to determine the resectability and in the remaining 72 cases the pulmonary resection was performed by videoassisted surgery: 21 pneumonectomies, five bilobectomies and 46 lobectomies. Three patients were rescued for surgery, after it was proven by intrapericardical videothoracoscopic exploration that the pulmonary artery was free at this level. The mean hospital stay was 48 h for the videothoracoscopic exploration and 6.8 days for the major lung resections. There were ten patients with complications (14%). The perioperatory mortality (30 days) was three cases (4.2%). The outcome (3-40 months follow-up) at the end of the study period was 62% patients alive and free of disease. DISCUSSION: The applications of videothoracoscopic and videoassisted surgery in the treatment of lung cancer are considered: final staging, resectability evaluation, nodule biopsy and major resections with mediastinal lymphadenectomy. Their advantages include minimized pain, better cosmetic results, a shorter hospital stay and fewer complications.

[An assessment of the resectability of lung cancer by exploratory video thoracoscopy]. / Valoración de la resecabilidad del cáncer de pulmón mediante videotoracoscopia exploradora.

We describe our experience using exploratory video-assisted thoracoscopy (EVT) to definitively evaluate resectability in patients with lung cancer who are candidates for surgical resection. In a single procedure we performed full visual and surgical exploration of the pleural cavity, lung, mediastinum, as well as of the pericardial cavity when required. The technique was used in 151 patients. Resection was judged non viable in 18 (11.9%) and performance of exploratory thoracotomy was deemed unnecessary. In 3 cases thoracotomy proved necessary for exploration. Nineteen patients were treated by video-assisted surgery; standard thoracotomy was used to resect 111. Morbidity and mortality were null in the group undergoing EVT in whom resection was judged viable. We conclude that EVT should be used in all patients with lung cancer who are being considered for surgery before a thoracotomy is performed. EVT can be performed as part of the same surgical act, as it supposes a savings in exploratory thoracotomies (amounting to 11.9% in our series).

[Left splanchicectomy with videothoracoscopy for the control of pain in cancer of the esophagogastric union with invasion of the celiac plexus]. / Esplacnicectomía izquierda videotoracoscópica para el control del dolor en el cáncer de unión esofagogástrica con invasión del plexo celíaco.

Blockade of the celiac plexus and the splanchnic nerves to combat abdominal pain can be achieved by percutaneous injection of local anesthetics or alcohol, or by thoracotomy. We describe the technique for performing splanchnicectomy with video-thoracoscopy in palliative surgery for cancer of the esophagogastric union, discussing the excellent results obtained immediately in 2 patients.

[Treatment of spontaneous pneumothorax in patients over 70 years of age]. / Tratamiento del neumotórax espontáneo en pacientes mayores de 70 años.

Forty-eight patients over the age of 70 with spontaneous pneumothorax (SP) are analyzed. The severity of the clinical picture is conditioned by the presence of earlier lung lesions, particularly related to emphysema, and by the degree of respiratory failure prior to SP. Treatment guidelines are listed. Pleural drainage/aspiration, applied in all cases, was of no avail in 69%. Tetracycline was injected into the pleural space of 23 patients, with failure recorded in 35%. Talc was applied by thoroscopy in 5 patients, to no avail. Video-assisted endoscopic surgery was carried out in 4 patients, with good results in 3. Surgery with access by lateral thoracotomy was carried out in 20 patients, with a single failure that was explained by the patient's condition.