Advanced techniques in medical thoracoscopy

Tassi, Gianfranco; Davies, Robert J. O.; Noppen, Marc

doi:10.1183/09031936.00014106

Cited by 103 publications

(86 citation statements)

References 78 publications

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“…Prolonged air leak, bleeding, recurrence or persistence of the disease, surgical wound infection and residual pleural space are the most common complications. However, renal insufficiency, deep venous thrombosis, chylothorax, lesion of diaphragm, high response atrial fibrillation by some authors are also mentioned (5,6,8,9,11,18,20,22). In our series the complication rate was 19.7% (14 out of 71 patients): recurrence of disease (four patients), prolonged air leak (three), wound infection (three), hemothorax (three) and in-hospital death (one).…”

Section: Discussionmentioning

confidence: 47%

Video-assisted thoracic surgery in pleural empyema: predictors of complications and treatment failures

Jagelavičius¹,

Jovaišas²,

Matačiūnas³

et al. 2015

AML

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Background. Empyema remains a challenging entity for thoracic surgeons. The aim of this study was to evaluate preoperative predictors for unsuccessful thoracoscopic empyemectomy and postoperative complications.Materials and methods. There were 71 patients prospectively included in the study during the period from January 2011 to June 2014 in whom we performed thoracoscopic empyemectomy. Two main outcomes were evaluated: conversion and complications. Preoperative factors that could predict these outcomes were analyzed.Results. Conversion to open thoracotomy was required in 25.4% of cases. Fourteen (19.7%) patients had postoperative complications. The multivariate analysis showed that the time of illness (odds ratio 1.1; confidence interval 1.1-1.2), normal temperature on admission (odds ratio 11.2; confidence interval 1.5-85.4) and frank pus found on thoracocentesis (odds ratio 6.9; confidence interval 1.6-29.4) had a significant influence on conversion from thoracoscopy to open thoracotomy. Pain (odds ratio 0.01; confidence interval <0.01-0.6), subfebrile temperature on admission (odds ratio 10.1; confidence interval 1.4-73.5), positive pleural culture (odds ratio 8.5; confidence interval 1.0-70.1), Charlson comorbidity index (odds ratio 2.3; confidence interval 1.1-4.8), empyema volume (odds ratio 1.002; confidence interval 1.000-1.005) and empyema density (odds ratio 0.8; confidence interval 0.6-1.0) had a significant influence on postoperative complications.Conclusions. Longer time of illness, normal temperature on admission and frank pus in pleural aspiration increase probability of conversion. No pain, subfebrile temperature, higher Charlson comorbidity index on admission, positive pleural culture, higher volume and lower density of empyema on computed tomography scan increase probability of postoperative complications.

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Section: Discussionmentioning

confidence: 47%

Video-assisted thoracic surgery in pleural empyema: predictors of complications and treatment failures

Jagelavičius¹,

Jovaišas²,

Matačiūnas³

et al. 2015

AML

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“…It does not require general anesthesia and double-lumen intubation, which leads to shorter hospitalization times and yields better cosmetic results. Above all, it is a more advisable procedure in frail patients who have high levels of surgical risk (4,5). Although our study presents a small number of patients, the combined application of gastroscopy and thoracoscopy for the treatment of intrathoracic anastomotic leak may be an effective, safe and minimally-invasive procedure.…”

Section: Discussionmentioning

confidence: 92%

“…The mortality rate is 12-46.2% (1)(2)(3). In general, the effect of conservative treatments, including conventional chest tube drainage, nasogastric decompression and nutritional support, is often poor, particularly in patients with adhesions of the pleural cavity and multiloculated empyema (1)(2)(3)(4). This study describes the combined application of medical thoracoscopy followed by gastroscopy for the treatment of an intrathoracic anastomotic leak in two patients.…”

Section: Introductionmentioning

confidence: 99%

Medical thoracoscopy and gastroscopy for the treatment of intrathoracic anastomotic leakage following esophagectomy

Hu²,

Rong

et al. 2012

Oncology Letters

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Abstract. Intrathoracic anastomotic leakage following esophagectomy is extremely difficult to manage appropriately. The outcomes of conservative management strategies are often disappointing, particularly in patients who develop adhesions of the pleural cavity and multiloculated empyema. This study describes a novel approach using combined thoracoscopy and gastroscopy in two cases. Thoracoscopy under local anesthesia was used to dissect the septations within the multiloculated empyema and remove the infected focus by direct visualization, and gastroscopy was subsequently performed to place a nasogastric or sump tube around the leak. The outcomes of both procedures were satisfactory: the empyemas almost completely resolved, the anastomotic leak closed quickly and there was adequate lung re-expansion. Accordingly, the combination of thoracoscopy and gastroscopy for the treatment of intrathoracic anastomotic leak post-esophagectomy may be an effective, safe, minimally-invasive, simple and inexpensive procedure. IntroductionIntrathoracic anastomotic leakage is an extremely intractable complication that occurs following esophagectomy, with an incidence that ranges from 1.3 to 5.1% (1-3). The mortality rate is 12-46.2% (1-3). In general, the effect of conservative treatments, including conventional chest tube drainage, nasogastric decompression and nutritional support, is often poor, particularly in patients with adhesions of the pleural cavity and multiloculated empyema (1-4). This study describes the combined application of medical thoracoscopy followed by gastroscopy for the treatment of an intrathoracic anastomotic leak in two patients. The study was approved by the IRB of Sun Yat-sen University Cancer Center. Consent was obtained from both of the patients. Case reportsCase 1. A 58-year-old male patient with middle-third thoracic esophageal squamous carcinoma was confirmed to have an intrathoracic anastomotic leak 10 days after esophagectomy and a right-sided contained empyema 4 weeks after esophagectomy. The condition of the patient did not improve following jejunostomy, conventional chest tube drainage and gastrointestinal decompression for 8 weeks. Gastroscopy (Fig. 1A) confirmed that a large intrathoracic anastomotic leak existed in the posterior right-sided wall of the esophagus. Two nasogastric tubes were then respectively placed into the residual stomach and the sump around the leak. A computed tomography scan was performed prior to thoracoscopy in order to select the incision accurately to facilitate exploration, debridement and drainage. Thoracoscopy was then performed under continuous sedation and local anesthesia. The port was inserted through a trocar via an incision on the right mid-clavicular line, between the second and third intercostal spaces. These adhesions and septations were dissected with biopsy forceps and electrocautery. After removing the infected focus, the anastomotic leak could be observed at the upper pole of the empyema cavity with some refluxed stomach content. The lateral side of th...

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“…Thoracoscopy can also been used in lieu of fibrinolytics to remove adhesions and loculations, suction infected material, and any fibrinous covering of the visceral pleura, thus preventing development of a fibrous peel and trapped lung [19][20][21]. Decortication success is generally better for less complicated pleural infections.…”

Section: Complicated Pleural Infectionmentioning

confidence: 99%

Management options for the complicated pleural space

Hsia

Musani

2013

Curr Respir Care Rep

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Clinicians frequently encounter patients with malignant and benign diseases involving the pleural space.Complications from these disease processes pose clinical challenges that often require a multi-disciplinary management approach. Here we discuss therapeutic options available for complicated diseases of the pleural space, including loculated malignant effusions, complicated pleural infections, hemothorax, nonexpanding lung, pleural thickening, and persistent bronchopleural fistulas. Our objective is to review current literature on management of these complex issues.

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Advanced techniques in medical thoracoscopy

Cited by 103 publications

References 78 publications

Video-assisted thoracic surgery in pleural empyema: predictors of complications and treatment failures

Video-assisted thoracic surgery in pleural empyema: predictors of complications and treatment failures

Medical thoracoscopy and gastroscopy for the treatment of intrathoracic anastomotic leakage following esophagectomy

Management options for the complicated pleural space

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