Videothoracoscopic First Rib Resection for Neurogenic Thoracic Outlet Syndrome: Results of 13 Patients.

PURPOSE: To present the clinical experience in video-assisted thoracic surgery (VATS) of first rib resection for patients with neurogenic thoracic outlet syndrome (NTOS). METHODS: The files of 13 patients (10 males, 3 females) having unilateral NTOS undergoing first rib resection via VATS were retrospectively investigated. The symptoms, operative times, durations of chest tube and hospital stay, complications, and postoperative courses were analyzed. All patients underwent VATS using a camera port and 3-5 cm utility incision. RESULTS: There was no morbidity. The average operation time was 81 ± 11 min (range 65-100 min). Chest tubes were removed in the first or second postoperative day (mean 1.23 ± 0.43 days). The mean postoperative length of hospital stay was 2.1 ± 0.9 days (range 1-3 days). The average duration of follow-up was 19 ± 13 months (range 2-38 months). Ten patients completed a follow-up during 6 months. One patient (10%) had minor residual symptoms, and the remaining patients (90%) were fully asymptomatic. CONCLUSION: The VATS approach in the resection of the first rib for thoracic outlet syndrome is a safe method. It should be performed with acceptable risks under experienced hands. The magnified view and optimal visualization from the scope are beneficial. Avoiding neurovascular bundle retraction may seem to decrease the postoperative pain.

Ultrasound-guided thoracal paravertebral block for awake thoracoscopic lobectomy in a high-risk patient: The first reported case.

One-lung ventilation provided by double-lumen tube intubation under general anaesthesia has conventionally been considered necessary for thoracoscopic major pulmonary resections. Recently, regional anaesthesia techniques have been used to avoid complications of tracheal intubation and general anaesthesia. Although paravertebral block (PVB) comes to the fore as a safe and useful regional anaesthesia technique for intra-operative and post-operative analgesia for a wide variety of surgeries involving the thoracic and lumbar regions, it is sometimes used for anaesthesia. Here, we aimed to demonstrate that biportal video-assisted thoracoscopic surgery can be performed in a right upper lobectomy while maintaining spontaneous ventilation in a 55-year-old, awake patient who was not intubated under ultrasound-guided PVB.

Mini-open lateral approach for anterior lumbar corpectomy combined with posterior screw-rod system augmentation for correction of kyphosis.

INTRODUCTION: Traumatic burst fractures most commonly occur in thoracolumbar junction. Maintenance of spinal stability and decompression of spinal canal are the main goals of management in these cases. Either anterior, posterior or combined approaches may be selected. For anterior corpectomy, mini-open lateral incision may be used. CASE: 29 years old male patient, in whom posterior segmental instrumentation had been performed previously, readmitted 4 months later with a complaint of low back pain and urinary and gait incontinence. Radiological scans revealed iatrogenic kyphosis and loosening of uppermost transpedicular screws. Patient was managed via revision of posterior instrumentation and L1 corpectomy with cage and rod insertion. RESULT: In patients with thoracolumbar burst fracture, loosening of screws and consequent iatrogenic kyphosis may be seen as a late complication. Combined anterior and posterior approach may regenerate spinal stability in these patients. Moreover; mini-open lateral incision with muscle sparing thoracotomy for anterior approach may cause less postoperative complications.

Nuss procedure without videothoracoscopy.

Minimally invasive repair of pectus excavatum (Nuss) operation is the current choice of surgical treatment for pectus excavatum deformities. Technical pitfalls arise in patients with previous thoracic and/or cardiac surgical interventions, due to severe intrathoracic fibrous adhesions. Herein, we describe an original modification technique in a patient with bilateral apical wedge resection and total pleurectomy due to recurrent spontaneous pneumothorax episodes within the past two years. Correction was performed by opening the pleura bilaterally and retrosternal release with digital palpation via a subxiphoid incision, to help to guide the introducer and the pectus bar, without a videothoracoscopic visualization.

Rare Lung Tumors: Alveolar Adenoma-Four Case Reports.

Alveolar adenoma is one of the rarely seen benign tumors of the lung, to date, one or two series have been reported. In this study, four rare alveolar adenoma cases were presented, thereby contributing to the existing scarce data.

Thoracoscopic Diagnosis of Follicular Lymphoma Relapsing after 13 Years.

Relapse in lymphoproliferative malignancies is not an exceptional entity and generally occurs within the first 2 or 3 years following the primary treatment. Lymph node biopsy is essential for the diagnosis of relapse and treatment. A 64-years-old woman was referred to our clinic for back pain and dyspnea. Chest X-ray and computed tomography (CT) showed pleural thickening in the right hemithorax and pleural effusion. Hereby, we report a patient with a history of follicular lymphoma treatment 13 years ago, presenting with unilateral pleural effusion and being diagnosed, unpredictably, with relapsing lymphoma by video-assisted thoracoscopic surgery pleural biopsy.