Videothoracoscopy: Improved technique and expanded indications

Coltharp, William H.; Arnold, John H.; Alford, William C.; Burrus, George R.; Glassford, David M.; Lea, John; Petracek, Michael R.; Starkey, Thomas D.; Stoney, William S.; Thomas, Chantal; Sadler, Robert N.

doi:10.1016/0003-4975(92)91434-b

Cited by 87 publications

(25 citation statements)

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“…Videoassisted thoracoscopic surgery has been used extensively by cardiothoracic surgeons. This minimal incisional approach, as compared with thoracotomy, has been associated with substantial clinical benefits, including reduced postoperative pain, shorter intensive care unit and hospital stays, shorter recovery time, faster return to activity, and reduced complication rates, 8,10,20,21,25,27 all of which are critical to the quality of life of cancer patients with metastasis who have a mean survival of 8-12 months. 9,39 The patients in the current study had an average blood loss of 610 ml, which compares favorably with open surgery cases.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive thoracoscopic approach for anterior decompression and stabilization of metastatic spine disease

Kan

Schmidt

2008

FOC

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Object The choices available in the management of metastatic spine disease are complex, and the role of surgical therapy is increasing. Recent studies have indicated that patients treated with direct surgical decompression and stabilization before radiation have better functional outcomes than those treated with radiation alone. The most common anterior surgical approach for direct spinal cord decompression and stabilization in the thoracic spine is open thoracotomy; however, thoracotomy for spinal access is associated with morbidity that can be avoided with minimally invasive techniques like thoracoscopy. Methods A minimally invasive thoracoscopic approach was used for the surgical treatment of thoracic and thoracolumbar metastatic spinal cord compression. This technique allows ventral decompression via corpectomy, inter-body reconstruction with expandable cages, and stabilization with an anterolateral plating system designed specifically for minimally invasive implantation. This technique was performed in 5 patients with metastatic disease of the thoracic spine, including the thoracolumbar junction. Results All patients had improvement in preoperative symptoms and neurological deficits. No complications occurred in this small series. Conclusions The minimally invasive thoracoscopic approach can be applied to the treatment of thoracic and thoracolumbar metastatic spine disease in an effort to reduce access morbidity. Preliminary results have indicated that adequate decompression, reconstruction, and stabilization can be achieved with this technique.

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Section: Discussionmentioning

confidence: 99%

Minimally invasive thoracoscopic approach for anterior decompression and stabilization of metastatic spine disease

Kan

Schmidt

2008

FOC

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“…Nas abordagens endoscópicas, a melhor posicão para o cirurgião espinhal é no lado abdominal do paciente 16,17 ; estando este em decúbito lateral 8,10,14,16,29,30 . O paciente pode ser colocado em decúbito lateral direito ou esquerdo (dependendo do caso em particular), com a mesa um pouco dobrada em um nível discretamente abaixo do gradil costal 12 .…”

Section: Técnicaunclassified

“…McAfee, que é um renomado cirurgião espinhal especialista em cirurgias endoscópicas, enfatiza que todo cirurgião experiente considera que os instrumentos cirúrgicos mais importantes dentro de uma sala de endoscopia torácica são aqueles usados para toracotomia aberta 28 . Consequentemente o paciente deve estar com os campos cirúrgicos colocados de maneira apropriada para permitir essa conversão 29 .…”

Section: Técnicaunclassified

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Cirurgias endoscópicas para a coluna torácica: avaliação crítica

Martins

Neto

1999

Arq. Neuro-Psiquiatr.

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Resumo -Com o advento da tecnologia vídeo-assistida a endoscopia tem assumido importante papel terapêutico na cavidade torácica. Este artigo é uma avaliação crítica da literatura e tem como objetivo demonstrar o estado atual da cirurgia endoscópica direcionada para a coluna torácica. Hérnias discais, deformidades, infecções, tumores, doenças congênitas e traumatismos estão sendo tratados por técnica endoscópica. Na literatura, as vantagens sobre a toracotomia aberta são visibilidade aumentada e reduções em: tempo de recuperação, perda sanguínea, custos, índice de infecção e morbidade pós-operatória. Algumas desvantagens são: intubação seletiva, significativa curva de aprendizado, dificuldades técnicas na operação de crianças muito pequenas, reparação da dura máter e instrumentação. Embora os benefícios sejam aparentemente claros e haja pronunciado grau de entusiasmo, os autores são cautelosos em afirmar que a toracoscopia já é uma alternativa definitiva à toracotomia convencional. A comparação dos resultados entre as técnicas endoscópica e aberta é dificultada pela escassez de estudos comparativos. Os autores, embora otimistas, recomendam análises de mais estudos prospectivos, multicêntricos e randomizados para uma conclusão definitiva. PALAVRAS-CHAVE: endoscopia, toracoscopia, coluna torácica. Endoscopic surgery for thoracic spine: critical reviewABSTRACT-After the development of video-assisted technology, endoscopic techniques have assumed an important therapeutic role into thoracic cavity. This is a literature review article to show the current state of the endoscopy for thoracic spine. Disc herniations, deformities, infections, tumors, congenital disorders and traumatic events have been treated by endoscopic techniques. On reviewing the literature, the advantages over open approaches are: enhanced visualization, shorter recovery time and decreased blood loss, costs, infection rate and post operative morbidity. Some disadvantages are: one lung anesthesia, significant learning curve, and technical problems in operating on small children, repairing the dura and performing instrumentation. Overall benefits are apparently clear. However, despite the high degree of enthusiasm, authors are cautious to state that endoscopic techniques to the spine already represent a definitive alternative to standard techniques. Comparison between endoscopic and open approaches are still difficult because of the lack of appropriate comparative studies. Authors, although optimistic recommend more prospective, multicentric and randomized studies in order to stand a definitive conclusion.KEY WORDS: endoscopy, thoracoscopy, thoracic spine.Tradicionalmente, a abordagem anterior para a coluna torácica vem sendo feita através de uma toracotomia 1 . As cirurgias abertas da parte anterior da coluna espinhal trouxeram importante avanço na recuperação e prognóstico dos pacientes. Entretanto, essa modalidade cirúrgica não é isenta de complicações e morbidade pós-operatória 1-10 ; o trauma cirúrgico na execução da abordagem é considerável 5,11 ...

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“…Video-assisted thoracoscopic surgery (VATS) was first described in the early 1990's. Initial applications included chest exploration, pleural effusion or pneumothorax management, and limited resection of lung nodules [1][2][3][4]. As minimally invasive techniques improved, clinical application of VATS became progressively widespread for more complex procedures.…”

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confidence: 99%