Thoracoscopic resection of bilateral metastatic sarcomas causing spontaneous pneumothorax.

Pulmonary metastases from soft tissue sarcomas may present with spontaneous pneumothorax. Metastatectomy via thoracotomy or median sternotomy has been the procedure of choice. We present a patient with bilateral spontaneous pneumothorax secondary to metastatic angiosarcoma where staged video-assisted thoracic surgery using the thoracoscope was used to successfully resect the tumors.

Effects of insufflation on hemodynamics during thoracoscopy.

Thoracic procedures once requiring open thoracotomy are now being performed with video-assisted thoracoscopy. To visualize adequately the intrathoracic structures, creation of an artificial pneumothorax by carbon dioxide insufflation under positive pressures has been advocated. We hypothesized that positive-pressure insufflation during thorascopy would cause significant hemodynamic compromise. Eight healthy female pigs underwent general endotracheal anesthesia and placement of monitoring lines. After placement of a thorascope, baseline hemodynamic measurements were obtained at 0 mm Hg (atmospheric pressure). Measurements were taken randomly at 5, 10, and 15 mm Hg using carbon dioxide insufflation after stabilization at each pressure. Data were analyzed using Page's test for noparametric variables. Insufflation pressures of 5 mm Hg or greater resulted in significant decreases in cardiac index, mean arterial pressure, stroke volume, and left ventricular stroke work index, whereas central venous pressure increased (p < 0.001). Changes in heart rate were not significant. We do not recommend routine positive-pressure insufflation during thorascopy because of the significant hemodynamic compromise in our experimental model.

Video-assisted thoracoscopy: a major advance in diagnosis and treatment of intrathoracic pathology.

The diagnosis and treatment of intrathoracic disease often requires open thoracotomy. Patients who are immunocompromised, have poor pulmonary function, or have coronary artery disease may not tolerate this procedure well. With the advent of small video cameras, fiberoptics, and compatible instrumentation, thoracoscopy is now a viable option to open thoracotomy. This procedure is being performed with increasing frequency, and has achieved excellent results. The intrathoracic image, which previously was only available to the operating surgeon, is captured by a small video camera on the end of the scope. The image is projected simultaneously on several television monitors in the operative suite so that all members of the operative team can see exactly what the surgeon sees. By using such technologies, intrathoracic diagnostic and therapeutic procedures, which previously required some type of open thoracotomy, may now be performed through several small ports placed through diminutive surgical incisions. This article describes three case reports which demonstrate some of the successful applications of video-assisted thoracoscopy, and reviews the diagnostic and therapeutic indications for video-assisted thoracoscopy.