Thoracoscopic diaphragm repair using abdominal insufflation in a patient with hepatic hydrothorax.

Hepatic hydrothorax refers to significant serous pleural effusion induced by liver cirrhosis, and some reports have suggested that this entity is ascites transferred to the thoracic cavity via a small hole in the diaphragm. There have been a few reports describing radical diaphragmatic repair by suturing the defect. We performed thoracoscopic diaphragmatic repair under abdominal insufflation to clarify the defect points. Air leakage at the diaphragmatic tissue was clearly noted and closed by suturing with polytetrafluoroethylene (PTFE) pledgets. The patient's postoperative course was uneventful, and no recurrence of ascites or hydrothorax has been noted.

Minimally invasive mitral valve repair via right mini-thoracotomy in patient with myelodysplastic syndrome.

BACKGROUND: Cardiac surgery for myelodysplastic syndrome (MDS) patients is challenging because anemia and neutropenia develop as a result of the syndrome, leading to infection and bleeding tendency during surgery. We report the case of minimally invasive mitral valve repair via a right mini-thoracotomy and perioperative use of granulocyte colony-stimulating factor (G-CSF) in a patient with MDS. CASE PRESENTATION: A 77-year-old man with myelodysplastic syndrome (MDS) was referred for surgical treatment for mitral valve regurgitation and underwent a minimally invasive mitral valve repair via a right mini-thoracotomy (MICS mitral procedure). On admission, laboratory results showed a leukocyte count of 1500/µL and neutrophils at 190/µL. Prior to surgery, a subcutaneous injection of granulocyte colony-stimulating factor (G-CSF) was given, based on a diagnosis of MDS by a hematologist. The MICS-mitral procedure using artificial chordae and an annular ring prosthesis was completed without requiring re-exploration for bleeding. Postoperatively, a G-CSF injection was administered and transfusion was required. There was no infection complication and the postoperative course was uneventful. CONCLUSION: A MICS-mitral procedure may be an effective option for MR patients with MDS who require a mitral valve repair to avoid postoperative infection and reduce the incidence of perioperative transfusion.

Intermediate-term oncologic outcomes after video-assisted thoracoscopic thymectomy for early-stage thymoma.

OBJECTIVE: To evaluate the impact on patient survival of video-assisted thoracoscopic surgery (VATS) thymectomy for the treatment of early-stage thymoma, by comparing the intermediate-term oncologic outcomes with outcomes after open thymectomy. METHODS: Eighty-two patients who underwent complete resection of a Masaoka stage I or II thymoma between November 1998 and December 2011 were reviewed. RESULTS: The patients included 32 men and 50 women (median age, 57 years; range, 20-90 years), of whom 44 had stage I thymoma and 38 had stage II thymoma. Seventy-one patients underwent VATS, of whom 4 (5.6%) underwent conversion to open thymectomy; the remaining 11 patients underwent planned open thymectomy. Thirty-six patients underwent total thymectomy and 46 underwent partial thymectomy. Operative mortality was nil. The tumor stage, tumor size, and proportion of patients who underwent total thymectomy were not significantly different between the open and VATS thymectomy groups. The median follow-up period was 49 months (VATS, 48 months; open, 52 months). There was a significant difference between the 2 groups for the estimated 5-year overall survival (VATS, 97.0%; open, 79.5%; P=.041) but not in the estimated 5-year recurrence-free survival. CONCLUSIONS: Our findings indicate that the intermediate-term oncologic outcomes after VATS thymectomy for early-stage thymoma are as favorable as outcomes after open thymectomy. Further follow-up is still required to evaluate the long-term outcomes after VATS thymectomy.