Experiences and challenges of thorcoscopic lung surgery in the pediatric age group.

BACKGROUND: We report a single-center study of minimally invasive thoracoscopic lung surgery with pediatric patients. METHODS: We performed a retrospective analysis of patients who underwent thoracoscopic lung surgery between 2004 and 2013. The procedures were divided into anatomic and non-anatomical lung resections. RESULTS: Seventy-six patients with a mean age of 6.5 years (range: 7 days-17 years) and a mean weight of 11 kg (range: 2.6-56.0 kg) received thoracoscopic lung surgery for tumor metastases (n = 20), sequestration/congenital adenomatoid malformation (19), cysts (12), aspergillomas (7), bullae (5), middle lobe syndrome (3), bronchiectasis (3), emphysema (2), and other reasons (5). Twenty-nine anatomical lung resections (Group I: lobectomies, segmentectomies) and 47 non-anatomical lung resections (Group II: wedge resections, lung tissue-sparing surgery) were performed. In 6 cases, preoperative CT-guided coiling was used to localize the lung lesions. Specimen removal was achieved using a widened (2 cm) trocar site. The operating times of Group I patients were longer compared than those of Group II patients (means: 154 and 68 min, respectively); conversion rates (8 versus 2), chest tube insertion rates (100% versus 51%), and postoperative ventilation (48% versus 13%) also differed. CONCLUSION: Thoracoscopic anatomical lung resections appear to be safe and effective in infants and children. In congenital lung diseases, the key to success is the intraoperative destruction of space-occupying lesions. Limitations exist in cases with infectious adhesions. Non-anatomical lung resections are technically easier and should remain standard in pediatric surgery. Limitations exist in cases of metastases, which are deep within the parenchyma and are not visible on the lung surface.

Sedación en procedimientos y situaciones especiales / Sedation in special procedures and situations

Numerosas técnicas diagnósticas y terapéuticas precisan sedoanalgesia para poder ser realizadas de una forma segura y confortable para el paciente. Especial interés para el intensivista tienen la cardioversión eléctrica, la colocación de dispositivos implantables de estimulación cardiaca, las técnicas endoscópicas o la realización de procedimientos quirúrgicos a pie de cama. En la presente revisión el Grupo de Trabajo de Analgesia y Sedación de la SEMICYUC ofrece recomendaciones para administrar analgesia y sedación en esas situaciones (AU)

Numerous diagnostic techniques require sedation and analgesia in order to be performed in a safe and comfortable way for the patient. Several of the most notable points of interest for the critical care specialist are the electrical cardioversion, the placing of implantable cardiac stimulation devices, the endoscopic techniques and the performing of bedside surgical procedures. In this current revision, the SEMICYUC Task Force for Sedation and Analgesia describes recommendations and best practices for administering sedation and analgesia in these situations (AU)

Utilidad de la videotoracoscopia en el tratamiento de los derrames pericárdicos / Utility of videothoracoscopy in the treatment of pericardial effusions

Introducción. La técnica de elección en el manejo quirúrgico del derrame pericárdico es todavía discutida. Se han descrito diferentes abordajes (toracotomía, vía subxifoidea y toracoscopia), pero ninguno cumple los objetivos básicos del tratamiento quirúrgico de esta patología: resolución inmediata del derrame con tasas de recurrencia nulas, alta capacidad diagnóstica y bajas tasas de morbimortalidad. El objetivo de este estudio es describir la utilidad de la videotoracoscopia en el manejo de los derrames pericárdicos.Pacientes y métodos. Un total de 32 derrames pericárdicos fueron drenados mediante una pericardiectomía parcial videotoracoscópica; 9 casos fueron de origen urémico, 9 neoplásicos, 9 idiopáticos, 3 de pospericardiotomía y 2 de origen infeccioso. Se tomaron nuestras del derrame, del pericardio y de cualquier otra lesión relevante para su estudio postoperatorio.Resultados. No hubo mortalidad intraoperatoria. Tres pacientes murieron en el primer mes postoperatorio, uno por neumonía y otros dos por shock séptico no relacionado con el procedimiento quirúrgico. La morbilidad postoperatoria fue del 6 por ciento (dos casos de derrames pleurales). En los 23 restantes, y tras un período medio de seguimiento de 29 meses, ningún derrame recurrió. Durante el seguimiento a largo plazo de estos pacientes, 6 fallecieron por evolución de la enfermedad neoplásica subyacente. Por otra parte, la técnica nos permitió identificar la etiología de dos derrames inicialmente clasificados como idiopáticos.Conclusiones. La viodeotoracoscopia es una técnica adecuada en el manejo del derrame pericárdico debido a su combinación de alta capacidad diagnóstica, alta efectividad y bajas tasas de recurrencia y morbimortalidad. (AU)

Atualização: revascularização miocárdica minimamente invasiva / Minimally invasive myocardial revascularization: up to date

Os procedimentos cirúrgicos ditos minimamente invasivos têm progressivamente conquistado aceitação dentro das várias especialidades médicas. Na área da cirurgia cardíaca, nenhum tema tem despertado maior interesse e gerado maior discussão do que a revascularização miocárdica minimamente invasiva (RMMI). Este trabalho apresenta uma revisão bibliográfica sobre a RMMI, com ênfase à descrição da técnica operatória e a análise crítica dos resultados preliminares, publicados recentemente na literatura

Thoracoscopy. A prospective study of safety and outcome.

OBJECTIVE: To assess a standard classification of adverse events and evaluate the safety and long-term outcome of thoracoscopy in patients with pleural disease. DESIGN: Prospective nonrandomized cohort study. SETTING: The Pulmonary Special Procedures and Nd:YAG Laser Unit of the University of California San Diego Medical Center, San Diego. PATIENTS: Fifty consecutive patients undergoing thoracoscopy for diagnosis of pleural effusion or thickening, pleurodesis, or empyema drainage. INTERVENTION: A list of major and minor adverse events that could be temporally related to thoracoscopy performed for diagnosis or treatment of pleural processes was established before beginning this prospective study. Procedures were performed using multiple point-of-entry techniques and either local or general anesthesia. Most procedures were performed in the operating room using double-lumen intubation. Patients were seen daily during hospitalization and at least 7, 30, and 90 days after thoracoscopy. Long-term follow-up data were obtained by telephone calls, clinical visits, or medical chart reviews or all of these, until 12 months after procedures. MEASUREMENTS: Occurrence of major and minor adverse events possibly related to thoracoscopy was recorded prospectively. Demographic and clinical data, as well as efficacy and outcome after thoracoscopy, were also noted. RESULTS: Fifty-two procedures were performed in 50 patients. Median age was 60 years (range, 18 to 88 years). Thoracoscopy provided a diagnosis in 93% of patients with pleural disease of unclear origin. Pleurodesis by thoracoscopic talc insufflation was successful in 95% of cases and in 91% of patients with malignant pleural effusions still available for evaluation and follow-up examination 3 months after pleurodesis. Thoracoscopic drainage of empyema was successful in six of seven patients and led to referral for open decortication in one. There were no procedure-related deaths or intraoperative accidents. Open-chest surgery intervention was never required. Only 1 major adverse event occurred: a patient with scleroderma and trapped lung had recurrent pleural effusion requiring chest tube drainage 1 week after hospital discharge. Minor adverse events, however, were noted in ten instances (19%). These included fever after talc pleurodesis, asymptomatic pneumothorax after chest tube removal, and minor would infection in a patient with empyema. CONCLUSION: Using the proposed classification of major and minor adverse events, prospective evaluation demonstrated the safety, diagnostic utility, and long-term efficacy of thoracoscopy performed for diagnosis and management of pleural processes. Potential dangers, however, of thoracoscopy are acknowledged, and limitations of the procedure are addressed.