Resultados de la Neumonectomía en el Cáncer de Pulmón no Microcítico: Estudio Unicéntrico de Morbi-Mortalidad / Results of Pneumonectomy in Non-Small Cell Lung Cancer: Single Center Study of Morbi-Mortality

Resumen abreviado: Estudio de la morbi-mortalidad de la neumonectomía por Cáncer de pulmón en nuestro centro durante 2012-2017. La morbilidad <90días y mortalidad <90días global fue 38,4% y 17%. La morbilidad y mortalidad son mayores en lado derecho. Durante último trienio disminuyó la morbi-mortalidad y el número de neumonectomías por año (5,3%).Introducción: Presentamos este trabajo para analizar la morbi-mortalidad de la neumonectomía en nuestro centro, así como los factores que influyen en la misma, mostrando nuestros resultados en el tiempo en dos períodos: 2012-2014 y 2015-2017.Material y métodos: Se trata de un estudio analítico y observacional retrospectivo de todas las neumonectomías por Cáncer de pulmón no células pequeñas (CPNCP) intervenidas durante 2012-2017. Se ha analizado la morbi-mortalidad de toda la muestra según lateralidad, FEV1, estadio, edad y sistema de sutura. También se ha estudiado la morbi-mortalidad durante: 2012-2014 y 2015-2017. El análisis estadístico se realizó con el software SPSS versión 26.Resultados: Se realizaron 65 neumonectomías (izquierdas: 39 y derechas: 26) en pacientes con el diagnóstico de CPNCP. La morbilidad <90días fue del 38,4% (25/65). El porcentaje de complicaciones en el lado derecho y en los pacientes con FEV1 <80% fue 46%, en estadio avanzado 50%, pacientes >75años 77% y neumonectomías con sistema de sutura TA-roticulator 50%. La mortalidad <90días global fue un 17% (11/65). La mortalidad de las neumonectomías en los pacientes con FEV1 <80% fue 18%, el lado derecho 30,7%, en estadio avanzado 22,2%, pacientes >75años 22% y neumonectomías con sistema de sutura TA-roticulator 28%. El análisis por períodos reveló una morbilidad (27,5%) y mortalidad (6,8%) más baja en último trienio y menor número de neumonectomías por año (5,3%). (AU)

Resumen abreviado: Study of the morbidity and mortality of pneumonectomy for lung cancer in our center during 2012-2017. Overall morbidity <90 days and mortality <90 days were 38.4% and 17%. Morbidity and mortality are higher on the right side. During the last triennium, morbidity and mortality and the number of pneumonectomies per year decreased (5.3%).Introduction: We present this work to analyze the morbidity and mortality of pneumonectomy in our center, as well as the factors that influence it, showing our results over time in two periods: 2012-2014 and 2015-2017.Material and methods: This is a retrospective analytical and observational study of all pneumonectomies for non-small cell lung cancer (NSCLC) operated during 2012-2017. The morbi-mortality of the entire sample was analyzed according to laterality, FEV1, stage, age and suture system. Morbi-mortality has also been studied during: 2012-2014 and 2015-2017. Statistical analysis was performed with SPSS version 26 software.Results: 65 pneumonectomies were performed (left: 39 and right: 26) in patients diagnosed with NSCLC. Morbidity <90 days was 38.4% (25/65). The percentage of complications on the right side and in patients with FEV1 <80% was 46%, in advanced stage 50%, patients >75 years old 77% and pneumonectomies with TA-roticulator suture system 50%. Overall <90-day mortality was 17% (11/65). Mortality of pneumonectomies in patients with FEV1 <80% was 18%, right side 30.7%, advanced stage 22.2%, patients >75 years old 22%, and pneumonectomies with TA-roticulator suture system 28%. The analysis by periods revealed a lower morbidity (27.5%) and mortality (6.8%) in the last triennium and a lower number of pneumonectomies per year (5.3%). (AU)

Herida traqueal por arma blanca con orificio de entrada y salida / Tracheal stab wound with entrance and exit orífices

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Diagnóstico y tratamiento de la hemoptisis / Diagnosis and Treatment of Hemoptysis

La hemoptisis es la expectoración de sangre proveniente del árbol traqueobronquial. Las enfermedades que más frecuentemente la originan son las bronquiectasias, la bronquitis crónica y el carcinoma broncogénico. Las arterias bronquiales son el origen de la mayoría de las hemoptisis. Ante un paciente con sospecha de hemoptisis se debe confirmar su existencia, establecer su gravedad, localizar el origen y determinar su causa. La radiografía de tórax posteroanterior y lateral es la primera prueba de imagen que debe realizarse, aunque la existencia de una radiografía de tórax normal no excluye la posibilidad de malignidad u otra patología de base. Debe realizarse TC multidetector (TCMD) de tórax en todos los pacientes con hemoptisis franca, en los que presentan esputo hemoptoico y sospecha de bronquiectasias o factores de riesgo de carcinoma broncogénico, y en los que tienen radiografía de tórax patológica. La angio-TCMD ha sustituido a la arteriografía como método diagnóstico de las arterias que son fuente de sangrado en las hemoptisis. La angio-TCMD es una técnica de imagen no invasiva que identifica correctamente la presencia, el origen, el número y el trayecto de las arterias sistémicas torácicas, bronquiales y no bronquiales, y de las arterias pulmonares que pueden ser fuente del sangrado. El tratamiento más seguro y eficaz para detener el sangrado en la mayoría de los casos de hemoptisis masiva o recurrente es la embolización endovascular. La embolización está indicada en todos los pacientes con hemoptisis amenazante o recurrente en los que se detectan arterias patológicas en la angio-TCMD. La broncoscopia flexible juega un papel primordial en el diagnóstico de la hemoptisis, tanto de la expectoración hemoptoica como de la hemoptisis franca. Puede ser realizada rápidamente en la cama del paciente (UCI) y, además de su utilidad en el control inmediato de la hemorragia, tiene una alta rentabilidad en la localización del sangrado. La broncoscopia flexible es el procedimiento inicial de elección en pacientes con hemoptisis amenazante e inestabilidad hemodinámica, donde el control de la hemorragia es vital. La cirugía en estos casos tiene una tasa de mortalidad muy alta, por lo que la indicación actual de cirugía en la hemoptisis amenazante está reservada para aquellas situaciones en las que la causa de la misma sea tributaria de tratamiento quirúrgico y haya una localización concreta y fiable del origen de la hemorragia

Hemoptysis is the expectoration of blood from the tracheobronchial tree. It is commonly caused by bronchiectasis, chronic bronchitis, and lung cancer. The expectorated blood usually originates from the bronchial arteries. When hemoptysis is suspected, it must be confirmed and classified according to severity, and the origin and cause of the bleeding determined. Lateral and AP chest X-ray is the first study, although a normal chest X-ray does not rule out the possibility of malignancy or other underlying pathology. Multidetector computed tomography (MDCT) must be performed in all patients with frank hemoptysis, hemoptoic sputum, suspicion of bronchiectasis or risk factors for lung cancer, and in those with signs of pathology on chest X-ray. MDCT angiography has replaced arteriography in identifying the arteries that are the source of bleeding. MDCT angiography is a non-invasive imaging technique that can pinpoint the presence, origin, number and course of the systemic thoracic (bronchial and non-bronchial) and pulmonary arterial sources of bleeding. Endovascular embolization is the safest and most effective method of managing bleeding in massive or recurrent hemoptysis. Embolization is indicated in all patients with life-threatening or recurrent hemoptysis in whom MDCT angiography shows artery disease. Flexible bronchoscopy plays a pivotal role in the diagnosis of hemoptysis in patients with hemoptoic sputum or frank hemoptysis. The procedure can be performed rapidly at the bedside (intensive care unit); it can be used for immediate control of bleeding, and is also effective in locating the source of the hemorrhage. Flexible bronchoscopy is the first-line procedure of choice in hemodynamically unstable patients with life-threatening hemoptysis, in whom control of bleeding is of vital importance. In these cases, surgery is associated with an extremely high mortality rate, and is currently only indicated when bleeding is secondary to surgery and its source can be accurately and reliably located

Diagnosis and Treatment of Hemoptysis. / Diagnóstico y tratamiento de la hemoptisis.

Hemoptysis is the expectoration of blood from the tracheobronchial tree. It is commonly caused by bronchiectasis, chronic bronchitis, and lung cancer. The expectorated blood usually originates from the bronchial arteries. When hemoptysis is suspected, it must be confirmed and classified according to severity, and the origin and cause of the bleeding determined. Lateral and AP chest X-ray is the first study, although a normal chest X-ray does not rule out the possibility of malignancy or other underlying pathology. Multidetector computed tomography (MDCT) must be performed in all patients with frank hemoptysis, hemoptoic sputum, suspicion of bronchiectasis or risk factors for lung cancer, and in those with signs of pathology on chest X-ray. MDCT angiography has replaced arteriography in identifying the arteries that are the source of bleeding. MDCT angiography is a non-invasive imaging technique that can pinpoint the presence, origin, number and course of the systemic thoracic (bronchial and non-bronchial) and pulmonary arterial sources of bleeding. Endovascular embolization is the safest and most effective method of managing bleeding in massive or recurrent hemoptysis. Embolization is indicated in all patients with life-threatening or recurrent hemoptysis in whom MDCT angiography shows artery disease. Flexible bronchoscopy plays a pivotal role in the diagnosis of hemoptysis in patients with hemoptoic sputum or frank hemoptysis. The procedure can be performed rapidly at the bedside (intensive care unit); it can be used for immediate control of bleeding, and is also effective in locating the source of the hemorrhage. Flexible bronchoscopy is the first-line procedure of choice in hemodynamically unstable patients with life-threatening hemoptysis, in whom control of bleeding is of vital importance. In these cases, surgery is associated with an extremely high mortality rate, and is currently only indicated when bleeding is secondary to surgery and its source can be accurately and reliably located.

Análisis comparativo del abordaje para el tratamiento del timoma estadio I-II: VATS versus abordaje convencional / Comparative analysis of video-assisted thoracic surgery versus open resection for early-stage thymoma

INTRODUCCIÓN: La cirugía torácica video-asistida (VATS) es una técnica que ha evolucionado en las últimas décadas. A pesar de sus ventajas, este abordaje continúa siendo discutido para el tratamiento de los timomas. El objetivo de este estudio fue evaluar los resultados obtenidos por el abordaje convencional y la VATS para el tratamiento de timomas en estadio i-ii. MÉTODOS: Estudio comparativo en 59 pacientes a los que se les realizó una timectomía por timoma en estadio i-ii (VATS: 44 y cirugía convencional: 15) entre los años 1993 y 2011. Se analizaron las siguientes variables: características de los pacientes en ambos grupos, morbilidad, mortalidad, estancia hospitalaria, la relación miastenia gravis-timoma, recidiva y supervivencia a los 5 años. RESULTADOS: Los timomas se clasificaron según la clasificación de Masaoka: 38 en la etapa I (grupo VATS: 29 y grupo convencional: 9) y 21 en la etapa II (grupo VATS: 15 y grupo convencional: 6). El tamaño medio del tumor en el grupo convencional fue de 7,6 cm (13-4 cm) y en el grupo VATS 6,9 cm (12-2,5 cm). La duración media de la estancia hospitalaria fue más corta en el grupo VATS que en el grupo de cirugía convencional (p < 0,001). No se encontraron diferencias significativas entre los 2 grupos, en las recidivas ni en la supervivencia a los 5 años (96% vs. 100%). CONCLUSIÓN: La timectomía mediante VATS es una técnica factible y segura en el tratamiento de timomas estadio I-II. Se asocia a una menor estancia hospitalaria y a unos resultados oncológicos a los 5 años similares a los de la cirugía convencional. Los resultados oncológicos con un seguimiento de 5 años fueron similares a los obtenidos por la cirugía convencional

BACKGROUND: Video-assisted thoracic surgery (VATS) has significantly developed over the last decade. However, a VATS approach for thymoma remains controversial. The aim of this study was to evaluate the feasibility of VATS thymectomy for the treatment of early-stage thymoma and to compare the outcomes with open resection. METHODS: A comparative study of 59 patients who underwent surgical resection for early stage thymoma (VATS: 44 and open resection: 15) between 1993 and 2011 was performed. Data of patient characteristics, morbidity, mortality, length of hospital stay, the relationship between miasthenia gravis-thymoma, recurrence, and survival were collected for statistical analysis. RESULTS: Thymomas were classified according to Masaoka staging system: 38 in stage I (VATS group: 29 and open group: 9) and 21 in stage II (VATS group: 15 and open group: 6). The mean tumor size in the open group was 7.6 cm (13-4 cm) and in the VATS group 6.9 cm (12-2.5 cm). The average length of stay was shorter in the VATS group than in the open group (P<.001). No significant differences were found in the estimated recurrence-free and overall 5-year survival rates (96% vs. 100%) between the 2 groups. CONCLUSIONS: VATS thymectomy for early-stage thymoma is technically feasible and is associated with a shorter hospital stay. The 5-year oncologic outcomes were similar in the open and VATS groups

[Comparative analysis of video-assisted thoracic surgery versus open resection for early-stage thymoma]. / Análisis comparativo del abordaje para el tratamiento del timoma estadio i-ii: VATS versus abordaje convencional.

BACKGROUND: Video-assisted thoracic surgery (VATS) has significantly developed over the last decade. However, a VATS approach for thymoma remains controversial. The aim of this study was to evaluate the feasibility of VATS thymectomy for the treatment of early-stage thymoma and to compare the outcomes with open resection. METHODS: A comparative study of 59 patients who underwent surgical resection for early stage thymoma (VATS: 44 and open resection: 15) between 1993 and 2011 was performed. Data of patient characteristics, morbidity, mortality, length of hospital stay, the relationship between miasthenia gravis-thymoma, recurrence, and survival were collected for statistical analysis. RESULTS: Thymomas were classified according to Masaoka staging system: 38 in stage I (VATS group: 29 and open group: 9) and 21 in stage II (VATS group: 15 and open group: 6). The mean tumor size in the open group was 7.6cm (13-4cm) and in the VATS group 6.9cm (12-2.5cm). The average length of stay was shorter in the VATS group than in the open group (P<.001). No significant differences were found in the estimated recurrence-free and overall 5-year survival rates (96% vs. 100%) between the 2 groups. CONCLUSIONS: VATS thymectomy for early-stage thymoma is technically feasible and is associated with a shorter hospital stay. The 5-year oncologic outcomes were similar in the open and VATS groups.

Experiencia y desarrollo de la técnica de lobectomía por cirugía torácica videoasistida: estudio comparativo con cirugía convencional en estadio i de cáncer de pulmón no microcítico / Experience and Development of the Video-Assisted Thoracic Surgery Lobectomy Technique: Comparative Study With Conventional Surgery in Stage I Non-Small Cell Lung Cancer

Objetivo: Analizar nuestra experiencia con la cirugía torácica videoasistida (VATS) y comparar sus resultados a corto y a largo plazo con la lobectomía por cirugía convencional, en el tratamiento quirúrgico del cáncer de pulmón no microcítico (CPNM) en estadio i . Material y métodos: Se realizó un estudio retrospectivo y analítico de los pacientes intervenidos de cáncer de pulmón no microcítico en estadio i durante el periodo de enero de 1993 a diciembre de 2005. Las variables analizadas fueron: supervivencia global, recidiva, metástasis a distancia, morbimortalidad y estancia hospitalaria. Durante este periodo se realizaron 256 resecciones pulmonares anatómicas: 141 por VATS y 115 por cirugía convencional. Resultados: Se encontraron diferencias estadísticamente significativa en: a) estancia media postoperatoria en pacientes que no tuvieron complicaciones (grupo VATS: 4,3 días; grupo de cirugía convencional: 8,7 días; p = 0,0001); b) estancia media postoperatoria en pacientes que tuvieron complicaciones (VATS: 7,2 días; cirugía convencional: 13,7 días; p = 0,0001), y c) morbilidad (VATS: 15,6%; cirugía abierta: 36,52%; p = 0,0001). No se encontraron diferencias estadísticamente significativas en: a) mortalidad (VATS: 2,17%; cirugía convencional: 1,7%; p = 0,88); b) supervivencia global a 5 años (VATS: 68,1%; cirugía convencional: 63,8%); c) recidiva local y metástasis a distancia (p = 0,82). Conclusiones: La lobectomía VATS es una técnica segura y eficaz, con una menor estancia hospitalaria y morbilidad que la cirugía convencional, sin que se observen diferencias estadísticamente significativas en la supervivencia en pacientes intervenidos por cáncer de pulmón no microcítico en estadio I

Background: Surgical treatment of stage I non-small cell lung cancer (NSCLC) can be performed either by thoracotomy or by employing video-assisted thoracic surgery (VATS). The aim of this study was to compare long and short-term results of conventional surgery (CS) vs. VATS lobectomy in the treatment of stage I NSCLC. Materials and methods: We performed a retrospective, analytical study of patients undergoing surgery for stage I NSCLC during the period January 1993 to December 2005. The variables analyzed were overall survival, recurrence, distant metastasis, morbidity, mortality and hospital stay. During this period,256 anatomic lung resections were performed: 141 by CS and 115 by VATS. Results: There were statistically significant differences in: (I) mean hospital stay in patients with no complications (VATS group: 4.3 days vs. CS group: 8.7 days, P = 0.0001); (ii) mean hospital stay in patients with complications (VATS: 7.2 days vs. CS: 13.7 days, P =0.0001), and (iii) morbidity (VATS: 15.6% vs. CS: 36.52%, P = 0.0001). No statistically significant differences were found in: (I) mortality (VATS: 2.17% vs. CS:1.7%, P = .88); (II) 5-year overall survival (VATS: 68.1% vs. CS: 63.8%), and (III) local recurrence and distant metastasis (P = 0.82). Conclusions: VATS lobectomy is a safe and effective approach, with a shorter hospital stay and lower morbidity than CS; no statistically significant differences were observed in survival in patients undergoing surgery for stage I NSCLC

Experience and development of the video-assisted thoracic surgery lobectomy technique: comparative study with conventional surgery in stage I non-small cell lung cancer.

BACKGROUND: Surgical treatment of stage I non-small cell lung cancer (NSCLC) can be performed either by thoracotomy or by employing video-assisted thoracic surgery (VATS). The aim of this study was to compare long and short-term results of conventional surgery (CS) vs. VATS lobectomy in the treatment of stage I NSCLC. MATERIALS AND METHODS: We performed a retrospective, analytical study of patients undergoing surgery for stage I NSCLC during the period January 1993 to December 2005. The variables analyzed were overall survival, recurrence, distant metastasis, morbidity, mortality and hospital stay. During this period, 256 anatomic lung resections were performed: 141 by CS and 115 by VATS. RESULTS: There were statistically significant differences in: (i)mean hospital stay in patients with no complications (VATS group: 4.3 days vs. CS group: 8.7 days, P=.0001); (ii)mean hospital stay in patients with complications (VATS: 7.2 days vs. CS: 13.7 days, P=.0001), and (iii)morbidity (VATS: 15.6% vs. CS: 36.52%, P=.0001). No statistically significant differences were found in: (i)mortality (VATS: 2.17% vs. CS: 1.7%, P=.88); (ii)5-year overall survival (VATS: 68.1% vs. CS: 63.8%), and (iii) local recurrence and distant metastasis (P=.82). CONCLUSIONS: VATS lobectomy is a safe and effective approach, with a shorter hospital stay and lower morbidity than CS; no statistically significant differences were observed in survival in patients undergoing surgery for stage I NSCLC.

Comparative study of talc poudrage versus pleural abrasion for the treatment of primary spontaneous pneumothorax.

Primary spontaneous pneumothorax is a pathology mainly affecting healthy young patients. Clinical guidelines do not specify the type of pleurodesis that should be conducted, due to the lack of comparative studies on the different techniques. The aim of this study was to compare talc poudrage and pleural abrasion in the treatment of spontaneous pneumothorax. A retrospective comparative study was performed, including 787 patients with primary spontaneous pneumothorax. The 787 patients were classified into two groups: Group A (pleural abrasion) n = 399 and Group B (talc pleurodesis) n = 388. The variables studied were recurrence, surgical time, morbidity and in-hospital length of stay. Statistical analysis was done by an unpaired t-test and Fisher's exact test (SSPS 18.0). Statistically significant differences were observed in the variables: surgical time (A: 46 ± 12.3; B: 37 ± 11.8 min; P < 0.001); length of stay (A: 4.7 ± 2.5; B: 4.3 ± 1.8 days; P = 0.01); apical air camera (A: 25; B: 4; P < 0.001); pleural effusion (A: 6; B: 0; P = 0.05). Talc poudrage shows shorter surgical times and length of stay, and lower re-intervention rates. Morbidity is lower in patients with talc poudrage. Statistically significant differences were not observed in recurrence, persistent air leaks, atelectasis and haemothorax.

Posterolateral thoracotomy without muscle division: a new approach to complex procedures.

Today, there is a strong increase in video-assisted thoracic surgery; however, there are still some diseases and interventions that need a wide pleural cavity exposure (i.e. sulcus tumours and extended resections). These complex procedures are usually performed via a standard posterolateral thoracotomy, which is a good approach but has significant disadvantage due to pain and difficulty coughing. We propose a new thoracotomy that avoids a dorsal muscle division but has the same intrathoracic exposure as a posterolateral thoracotomy.

Sympathetic chain clipping for hyperhidrosis is not a reversible procedure.

BACKGROUND: Many techniques have been used to treat palmar hyperhidrosis. Compensatory sweating is a difficult adverse effect. Clipping has been proposed because of its supposed reversibility when clips are removed at a later date. The primary aims of this article are to investigate the neuronal lesion of the sympathetic chain caused by clipping and to study the possibility of regeneration after removal of the clips. METHODS: We performed an experimental study at the Minimally Invasive Surgery Centre Jesus Uson in Caceres (Spain). We used a swine model, performing clipping, unclipping, and extirpation of different segments of sympathetic chain with clips and after clip removal, following a chronogram of 10, 20, and 30 days. Pathologic studies of specimens and statistics were done at the University of Seville. RESULTS: Ten days after clipping, all sympathetic chains displayed evident Wallerian degeneration. Twenty days after clipping, Wallerian degeneration of myelinated fibers was more widespread and also more striking. Thirty days after clipping, a very marked macrophagic reaction was visible, with multiple signs of phagocytosis of myelin debris. By 30 days post operation and 20 days after clip removal, a few residual myelin and amyelinated fibers were visible. These findings suggest that axon regeneration is not possible. CONCLUSIONS: There are Wallerian degeneration and axon loss 10 days after clipping. The almost total absence of myelinated and amyelinated fibers following clip removal suggests that there was no nerve regeneration, and that therefore clipping cannot be considered a reversible technique.

Ventana pericárdica por videotoracoscopia / Pericardial Window by Videothorascopy

Introducción El derrame pericárdico (DP) es una entidad clínica de manejo multidisciplinar. Existen varias técnicas quirúrgicas para su diagnóstico y tratamiento. En el presente estudio aportamos nuestra experiencia en la realización de ventana pericárdica (VP) por videotoracoscopia. Material y métodos Hemos intervenido a 56 pacientes (20 mujeres y 36 hombres) con el diagnóstico de DP crónico moderado-severo. La edad media fue de 56±1,22 años. El lado elegido para el abordaje dependía de la existencia del derrame pleural o lesión pulmonar asociada, en su defecto por el lado izquierdo. Resultados La duración media de la intervención fue de 37,6±16 minutos. Los diagnósticos definitivos fueron en el 23% de los casos por procesos malignos, destacando el carcinoma broncogénico y el cáncer de mama. La mortalidad intraoperatoria fue del 0%.Conclusiones La VP videotoracoscópica es una técnica efectiva y segura para el diagnóstico y tratamiento del DP crónico, que permite en un mismo acto quirúrgico su drenaje y la biopsia pleuropulmonar y/o mediastínica (AU)

Introduction Pericardial effusion is a clinical condition requiring multidisciplinary management. There are several surgical techniques for its diagnosis and treatment. In the present study we report our experience in performing a pericardial window (PW) by videothorascopy. Material and methods We performed surgery on 56 patients (20 females and 36 males), with a mean age of 56±1.22 years, and diagnosed with moderate to severe chronic pericardial effusion. The side chosen for the approach depended on whether there was an associated pleural effusion or lung lesion, and if not the left side was chosen. Results The mean duration of the surgery was 37.6±16min. The definitive diagnoses were malignant processes in 23% of cases, including bronchogenic carcinoma and breast cancer. The intraoperative mortality was 0%.Conclusions Videothorascopic pericardial window is an effective and safe technique for the diagnosis and treatment of chronic pericardial effusion, and which enables it to be drained and perform a pleuropulmonary and/or mediastinal biopsy during the same surgical act (AU)

Incisiones y vías de abordaje quirúrgicas / Incisions and routes of surgical access

La correcta elección de la vía de abordaje al tórax es fundamental para obtener el éxito quirúrgico y un postoperatorio favorable. Debe adaptarse tanto a la patología como a la experiencia del cirujano torácico, buscando el equilibrio entre agresividad y seguridad de la técnica. En este artículo se describirán las características de las incisiones quirúrgicas al tórax desde las clásicas toracotomías, esternotomías y sus variantes hasta llegar a la videotoracoscopia y cirugía de mínima invasión. Recordaremos también las diferentes técnicas que se utilizan para abordar las áreas linfáticas del mediastino, incluyendo las más novedosas linfadenectomía mediastínica videoasistida y linfadenectomía mediastínica transcervical extendida (AU)

The correct choice of the incision to the chest is essential for surgical success and a favorable postoperative course. The route of access to the thorax must be adapted both to the disease and to the thoracic surgeon’s experience, striking a balance between aggressiveness and the safety of the technique. This article describes the characteristics of surgical incisions, including classical thoracotomy, sternotomy and its variants, thoracoscopy and minimally-invasive surgery. The distinct techniques used to explore mediastinal lymphatic areas, including video-assisted mediastinal lymphadenectomy and transcervical extended mediastinal lymphadenectomy, are also described (AU)

[Pericardial window by videothorascopy]. / Ventana pericárdica por videotoracoscopia.

INTRODUCTION: Pericardial effusion is a clinical condition requiring multidisciplinary management. There are several surgical techniques for its diagnosis and treatment. In the present study we report our experience in performing a pericardial window (PW) by videothorascopy. MATERIAL AND METHODS: We performed surgery on 56 patients (20 females and 36 males), with a mean age of 56±1.22 years, and diagnosed with moderate to severe chronic pericardial effusion. The side chosen for the approach depended on whether there was an associated pleural effusion or lung lesion, and if not the left side was chosen. RESULTS: The mean duration of the surgery was 37.6±16 minutes. The definitive diagnoses were malignant processes in 23% of cases, including bronchogenic carcinoma and breast cancer. The intra-operative mortality was 0%. CONCLUSIONS: Videothorascopic pericardial window is an effective and safe technique for the diagnosis and treatment of chronic pericardial effusion, and which enables it to be drained and perform a pleuro-pulmonary and/or mediastinal biopsy during the same surgical act.

Extirpación de la primera costilla por videotoracoscopia para el tratamiento del síndrome del estrecho torácico / First Rib Resection Using Videothorascopy for the Treatment of Thoracic Outlet Syndrome

Introducción: El síndrome del estrecho torácico es una patología provocada por la compresión de la arteriasubclavia, vena subclavia y/o el plexo braquial. Su tratamiento más efectivo es la sección de la musculaturaescalena y la extirpación de la primera costilla. El objetivo de este trabajo es mostrar la técnica de laextirpación de la primera costilla por videotoracoscopia.Técnica: Describimos la técnica de extirpación costal por videotoracoscopia a través de tres puertas deentrada de 12mm (si bien una se amplía 3 cm para la introducción de periostotomos y costotomos).Hemos realizado esta intervención a tres casos de síndrome del estrecho torácico con resultados muybuenos.Conclusiones: La extirpación de la primera costilla por videotoracoscopia es una técnica factible, muyestética y de escasa morbilidad. Es una opción muy buena para la mayoría de pacientes afectos de estesíndrome, especialmente en pacientes obesos o con síndrome de Paget-Schroetter(AU)

Objective: Thoracic outlet syndrom is a condition caused by compression of the subclavian artery, subclavianvein and/or the brachial plexus. Scalene muscle section and first rib removal is the most effectivetreatment. The objective of this article is to demonsrate first rib resection using videothoracoscopy.Material and method: We describe first rib removal by videothoracoscopy using three 12mm entranceports (although one is widened to 3 cm to introduce periosteotomy cutters and rib shears). We haveperformed this operation on three cases of thoracic outlet syndrome with very good results.Conclusions: Removal of the first rib by videothoracoscopy is a viable and very aesthetic technique with alow morbidity. It is a very good option for the majority of patients affected by this syndrome, particularlyin obese patients or those with Pager-Schroetter syndrome(AU)

First rib resection using videothorascopy for the treatment of thoracic outlet syndrome.

OBJECTIVE: Thoracic outlet syndrome is a condition caused by compression of the subclavian artery, subclavian vein and/or the brachial plexus. Scalene muscle section and first rib removal is the most effective treatment. The objective of this article is to demonstrate first rib resection using videothoracoscopy. TECHNIQUE: We describe first rib removal by videothoracoscopy using three 12 mm entrance ports (although one is widened to 3 cm to introduce periosteotomy cutters and rib shears). We have performed this operation on three cases of thoracic outlet syndrome with very good results. CONCLUSIONS: Removal of the first rib by videothoracoscopy is a viable and very aesthetic technique with a low morbidity. It is a very good option for the majority of patients affected by this syndrome, particularly in obese patients or those with Pager-Schroetter syndrome.