Development and application of the near-infrared and white-light thoracoscope system for minimally invasive lung cancer surgery.

In minimally invasive surgery, the white-light thoracoscope as a standard imaging tool is facing challenges of the low contrast between important anatomical or pathological regions and surrounding tissues. Recently, the near-infrared (NIR) fluorescence imaging shows superior advantages over the conventional white-light observation, which inspires researchers to develop imaging systems to improve overall outcomes of endoscopic imaging. We developed an NIR and white-light dual-channel thoracoscope system, which achieved high-fluorescent signal acquisition efficiency and the simultaneously optimal visualization of the NIR and color dual-channel signals. The system was designed to have fast and accurate image registration and high signal-to-background ratio by optimizing both software algorithms and optical hardware components for better performance in the NIR spectrum band. The system evaluation demonstrated that the minimally detectable concentration of indocyanine green (ICG) was 0.01 ?? ? M , and the spatial resolution was 35 ?? ? m . The in vivo feasibility of our system was verified by the preclinical experiments using six porcine models with the intravenous injection of ICG. Furthermore, the system was successfully applied for guiding the minimally invasive segmentectomy in three lung cancer patients, which revealed that our system held great promise for the clinical translation in lung cancer surgeries.

A comparison of the diagnostic yield of rigid and semirigid thoracoscopes.

Medical thoracoscopy has an important place in the diagnosis and management of pleural disease. However, the application of this procedure is limited in the United Kingdom. This may be partly because respiratory physicians remain unfamiliar with standard rigid thoracoscopy instruments. However, the semirigid variant, popular in Europe and Japan, is similar in design to the commonly used flexible bronchoscope. The larger biopsy size obtained with the conventional rigid thoracoscope has been quoted as a reason for its superiority. To compare the histologic yield of the 2 instruments, the current authors studied a series of 66 patients with unilateral exudative pleural effusions. Twenty-seven rigid and 39 semirigid thoracoscopy procedures were included. Thoracoscopic pleural biopsy achieved a positive diagnosis in 26 of 27 patients in the rigid thoracoscopy group (96.3%) and 36 of 39 patients in the semirigid group (92.3%). Statistically, this difference was not significant (95% confidence intervals, -0.11 to 0.17). Our study demonstrates that the semirigid thoracoscope achieves a diagnostic yield similar to that of the conventional rigid instrument despite the smaller biopsy size. Both instruments remain valuable in the evaluation and management of pleural disease.

Ergonomics in thoracoscopic surgery: results of a survey among thoracic surgeons.

OBJECTIVES: The frequent and prolonged use of thoracoscopic equipment raises ergonomic risks which may cause physical distress. We aimed to determine the relationship between ergonomic problems encountered in thoracoscopic surgery and physical distress among thoracic surgeons. METHODS: An online questionnaire which investigated personal factors, product factors, interaction factors and physical discomfort was sent to all members of the European Society of Thoracic Surgeons (ESTS). RESULTS: Of the respondents, 2.4% indicated that a one arm's length should be the optimal distance between the surgeon and the monitor. Only 2.4% indicated that the monitor should be positioned below the eye level of the surgeon. Most of the respondents agreed, partially to fully, that they experienced neck discomfort because of inappropriate monitor height, bad monitor position and bad table height. Most respondents experienced numb fingers and shoulder discomfort due to instrument manipulation. Most of the respondents (77.1%) experienced muscle fatigue to some extent due to a static posture during thoracoscopic surgery. The majority of respondents (81.9, 76.3 and 83.2% respectively) indicated that they had varying degrees of discomfort mainly in the neck, shoulder and back. Some 94.4% of respondents were unaware of any guidelines concerning table height, monitor and instrument placement for endoscopic surgery. CONCLUSIONS: Most thoracic surgeons in Europe are unaware of ergonomic guidelines and do not practise them, hence they suffer varying degrees of physical discomfort arising from ergonomic issues.

American Pediatric Surgical Association New Technology Committee review on video-assisted thoracoscopic surgery for childhood cancer.

BACKGROUND/PURPOSE: Although the use of minimally invasive surgical (MIS) techniques for children with cancer is being practiced by some, its role remains unclearly defined. The purpose of this review was to describe the current literature on MIS for thoracic and mediastinal lesions in children. METHODS: We performed a literature search for English studies that evaluated MIS techniques for biopsy or resection in children with suspected or established cancer. Only studies with greater than 20 patients were included in the review. RESULTS: Ten studies were included for review. Each represented institutional retrospective reviews of experience. Seven were single-institution studies, and 3 were multi-institutional. There were no prospective nor randomized identified. CONCLUSIONS: Based on primarily retrospective and observational data, the use of MIS for children with cancer who have pulmonary and mediastinal lesions seems to be effective and safe. Ideally, prospective studies are needed to evaluate this further.

State of the art: pleuroscopy.

The terms pleuroscopy, thoracoscopy, medical thoracoscopy, and video-assisted thoracic surgery are often used interchangeably to describe a minimally invasive procedure that provides access to the pleural space, parietal pleura, lung, and other structures within the thoracic cavity. Pleuroscopy is a more exact term for describing visualization of the pleura and contents of the pleural cavity using an endoscope. This procedure provides physicians a window into the pleural space, to perform biopsy of the parietal pleura under direct visual guidance, particularly for biopsies in cases of exudative effusions with unclear origin, chest tube placement, and pleurodesis to prevent recurrent pleural effusion or pneumothorax in selected patients. In this state-of-the-art review, we discuss the indications, contraindications, and complications of pleuroscopy, and its role in thoracic oncology.

Single-trocar-access thoracoscopy for fully optical controlled routine chest drainage: a technical report and feasibility study.

Complications of tube thoracostomy, e.g., organ lesions and malpositioned tubes, are not uncommon. To date, techniques for tube placement have been nonvisualized. The authors believe that a fully visualized penetration of the thoracic wall layers should help to avoid not only perforations and organ lesions but also functionally malpositioned tubes. This article describes a modified endoscopic device, allowing fully visualized and optically controlled access to the pleural cavity for routine chest tube placement. The results of the technical feasibility study for 28 human cadavers showed that it was possible to place the tube as desired. No organ lesions were present. The results suggest that this device and the technique could reduce the risk of complications. The handling of the device is easy and safe. The technique is minimally invasive. The authors' next goal is to prove the results in a clinical study.

Minimally invasive lung and pleural biopsies using 2-mm and standard thoracoscopic equipment.

Videoendoscopic surgery is commonly used to obtain a definitive diagnosis in a patient with pleural lesions or pulmonary infiltration of unknown etiology. We have performed minimally invasive pleural and lung biopsies, using 2-mm mini-videoscopic instruments supported by standard thoracoscopy via one 11.5-mm port, in 10 patients. These involved 8 patients with diffuse pulmonary infiltration, and two with diffuse pleural thickening. They underwent thoracoscopic pulmonary wedge resection and pleural biopsy using one 11.5-mm port and two or three 2-mm mini-ports. The mean operating time was 37 minutes. This procedure was successful in establishing a definitive diagnosis in each patient. Complications included subacute acceleration in pulmonary infiltration in one patient. No patient complained of pain or discomfort at the 2 mm-thoraco port sites. Healing of this port site resulted in excellent cosmesis. Mini-videoscopic surgery supported by standard thoracoscopic equipment can be used to perform lung or pleural biopsy less invasively than standard thoracoscopic approach.