[Video thoracoscopy and video-assisted thoracic surgery. An analysis of 303 consecutive cases]. / Videotoracoscopia y cirugía torácica videoasistida. Análisis de 303 casos consecutivos.

OBJECTIVES: To present our experience in video thoracoscopy and video-assisted thoracic surgery from November of 1991 until November of 1997. PATIENTS AND METHODS: 303 endoscopic thoracic surgery procedures (210 males and 93 females with a mean age of 42.2 years) with the following indications: 151 spontaneous pneumothorax, 51 pulmonary biopsies, 50 pulmonary nodules, 15 mediastinal tumors, 13 pleuroparietal tumors, 8 pericardial windows and 15 thoracic sympathectomies. RESULTS: Mean postoperative stay was of 5.5 days. The thoracotomy conversion was necessary in 32 cases (10.9%). The morbimortality has been: one parietal recidive of a tumor in the way of one of the trocars and one death of a patient to who was accomplished a pulmonary biopsy by diffuse pneumopathy. CONCLUSIONS: The video thoracoscopy and thoracic surgery are effective and sure technical options for diagnosis and treatment of various thoracic affections.

Videotoracoscopia y cirugía torácica videoasistida.Análisis de 303 casos consecutivos / Videothoracoscopy and videoassisted thoracic surgery

Objetivos: Comunicar nuestra experiencia en videotoracoscopia y cirugía torácica videoasistida desde noviembre de 1991 hasta noviembre de 1997. Pacientes y métodos: Comprende 303 procedimientos de cirugía torácica endoscópica (210 varones, 93 mujeres y edad media de 42,2 años). Las indicaciones fueron: 151 neumotórax espontáneos, 51 biopsias pulmonares, 50 nódulos pulmonares, 15 tumores mediastínicos, 13 tumores pleuroparietales, 8 ventanas pericárdicas y 15 simpatectomías torácicas. Resultados: La estancia media postoperatoria fue de 5,5 días. La conversión a toracotomía fue necesaria en 32 casos (10,9%). La morbimortalidad ha sido: recidiva parietal de tumor en el trayecto de uno de los trócares y fallecimiento por sepsis de un paciente a quien se le realizó una biopsia pulmonar por neumopatía difusa. Conclusiones: La videotoracoscopia y cirugía torácica videoasistida son opciones técnicas seguras y eficaces para el diagnóstico y tratamiento de diversas afecciones torácica (AU)

[Pulmonary biopsy in diffuse interstitial disease: videothoracoscopy versus thoracotomy]. / Biopsia pulmonar en la enfermedad intersticial difusa: videotoracoscopia frente a toracotomía.

The aim of this work was to evaluate and compare the results of lung biopsies performed by videothoracoscopy (VT) and minithoracotomy (MT) in diffuse interstitial disease between 1992 and 1994, during which period 45 lung biopsies were performed on patients (20 women) with a mean age of 56 years. Thirty-one biopsies were performed by VT (group I) and 14 by MT (group II). For all patients we recorded duration of procedure, days to discharge after surgery, total time with a pleural drain in place, and volume of tissue sample. Diagnosis was possible in all cases. Mean duration of surgery was 49.3 minutes for group I and 58.2 minutes for group II. Mean time to discharge was 6.7 days for group I and 10.1 for group II. Mean time of pleural drainage was 3.8 days for group I and 5.9 days for group II. Mean volume of tissue sample was 6.5 cm3 for group I and 5.18 cm3 for group II. One patient died in group I from causes unrelated to surgical technique. In conclusion, lung biopsy with VT is effective and useful for diagnosing diffuse interstitial lung diseases. The sample obtained is in every way comparable to that obtained by thoracotomy. Mean hospital stay and mean time of postoperative drainage decreases significantly (p < 0.05) with VT.

[Rapid surgical exploration of the mediastinum]. / Cirugía de corta estancia en la exploración quirúrgica del mediastino.

This study aimed to evaluate the morbidity-mortality of surgical exploration of the mediastinum in patients with mediastinal masses or adenopathy in the context of a rapid-surgery program that has been operating over the past 8 years (1985-1993). A total of 93 mediastinal explorations have been carried out. Sixty-five involved transcervical mediastinoscopy, 20 were anterior mediastinotomies, 4 were combined procedures and 4 were video-thoracoscopies. We found 34 cases of lymphoma, 28 of metastasis of bronchopulmonary carcinoma and 16 of mediastinal-ganglionic tuberculosis; the 15 remaining cases were classified as miscellaneous. No deaths were directly related to the surgical procedures; morbidity involved 2 wound infections. Surgical exploration of the mediastinum is a safe diagnostic procedure, provided it is carried out by an experienced team, and allows care givers to take better advantage of therapeutic options with no loss of quality.

[Contribution of transcervical mediastinoscopy and anterior mediastinostomy to the diagnosis of mediastinal lymphomas]. / Aportación de la mediastinoscopia transcervical y mediastinotomía anterior al diagnóstico de los linfomas mediastínicos.

UNLABELLED: The aim of this study has been to assess the profitability of mediastinal explorations (transcervical mediastinoscopy and anterior mediastinostomy) in the diagnosis of mediastinal lymphomas within a short-stay surgery programme. Out of 129 mediastinal explorations conducted within a period of six years, 63 were programmed as short-stay surgery, 24 of which were due to mediastinal lymphomas. Fourteen patients were discharged from the hospital within the first twelve hours and ten patients, after 24 hours. RESULTS: There were 11 cases of Hodgkin's lymphomas and 13 non-Hodgkin's lymphomas. No immediate complications were developed by the patients, with just two minor complications which did not delay hospital discharge. CONCLUSIONS: Mediastinal explorations (transcervical mediastinoscospy and anterior mediastinostomy) can be planned as short-stay surgery without any risks if they are conducted by groups with experience in these surgical techniques and provided with an adequate care infrastructure. This allows a more rationale usage of hospital resources without reducing the quality of care.