VATS lobectomy is a respected modality of anatomic lung resections nowadays. Video-assisted lobectomies without rib extractor fulfi l all current requirements for minimally invasive lung resections. This type of an anatomic pulmonary resection with a targeted treatment of hilar structures doesn't traumatize the intercostal space by using rib retractor. Videothoracoscope serves to visualize the surgical fi eld on the screen. Assisted VATS (aVATS) lobectomy is a procedure using 3-5 cm working incision. Fully endoscopic resection (VTS) or complete VATS lobectomy (cVATS) are operations performed only through ports, without working incision. The authors supplement the article with a videorecord of VATS lobectomy general technique (Fig. 4, Ref. 11). Text in PDF and video www.elis.sk. KEY WORDS: video-assisted thoracoscopic surgery, VATS lobectomy, general technique.
The increasing number of patients with refractory angina prompted a search for an effective and safe therapy to improve the quality of their life. New evidence in the pathophysiology of an ischemic myocardium and investigation of the impact of thoracic sympathectomy suggests sympathetic denervation seems to be a possible alternative method for the treatment of refractory angina pectoris.
Abstract:Background: Constituent part of radical lung resection for lung cancer is a dissection of mediastinal lymph nodes. Lymphadenectomy is a standard procedure in an assessment of clinical stage of the disease. The aim of the study was to map metastasizing of bronchogenic non-small cell lung carcinoma into homolateral mediastinal lymph nodes and to assess the importance of mediastinal lymphadenectomy for exact staging and survival. Results: Tumors in right upper lobe metastasized in 45.5 % into group 1 nodes (stages N1-N4) and group 3 nodes (stages N7) and in 9 % into group 4 nodes (stages N8-N9). Tumors of the right middle lobe metastasized in 100 % into group 3 nodes (stage N7).Tumors of the right lower lobe metastasized in 87.5 % into group 3 nodes (N7) and in 12.5 % into group 4 nodes (stages N8-N9). Tumors of the left upper lobe metastasized in 9.0 % in group 1 nodes (stages N1-N4), in 82 % into group 2 nodes (stages N5-N6) and in 9.0 % were found skip metastases into group 4 nodes (stages N8-N9). Tumors of the left lower lobe metastasized in 26.7 % in group 4 nodes, 46.6 % into group 3 nodes, in 20,0 % into group 2 nodes and in 6,7 % into group 1 nodes. Conclusion: Systematic mediastinal lymphadenectomy is crucial for determining the stage of the disease according to the TNM classifi cation. Systematic lymphadenectomy is essential for the diagnosis of stage IIIa disease and setting of additional therapy that prolongs survival (Ref. 17). Full Text in PDF www.elis.sk.
Operations in the pleural cavity are connected with circulatory
changes in pulmonary circulation and general changes of
hemodynamics. These changes are influenced by the position of
patient’s body on the operation table and by the introduction of
artificial pneumothorax. Thoracoscopy is an advanced surgical
approach in thoracic surgery, but its hemodynamic effect is still
not known. The aim of the present study was to compare the
hemodynamic response to surgeries carried out by open
(thoracotomy – TT) and closed (thoracoscopy – TS) surgical
approach. Thirty-eight patients have been monitored throughout
the operation – from the introduction of anesthesia to completing
the surgery. Monitored parameters were systolic blood pressure
(BPs), diastolic blood pressure (BPd), O2 saturation (SaO2),
systolic blood pressure in pulmonary artery (BPPAs), diastolic
blood pressure in pulmonary artery (BPPAd), wedge pressure
(PW), central venous pressure in right atrium (CVP), cardiac
output (CO) and total peripheral resistance (TPR). No significant
difference has been found in hemodynamic response between TT
and TS groups. Significant changes of hemodynamic parameters
occurring during the whole surgical procedure were detected in
both technical approaches. The most prominent changes were
found after the position of patients was changed to the hip
position (significantly decreased BPs, BPd, MAP, SaO2 and BPPAs)
and 5 min after the pneumothorax was established (restoration
of the cardiac output to the initial value and significant decrease
of the TPR). It can be concluded that the thoracoscopy causes
almost identical hemodynamic changes like the thoracotomy.
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