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1.
Medicine (Baltimore) ; 99(5): e18959, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000421

RESUMO

The outcomes of minimally invasive thoracoscopic pulmonary segmentectomy for non-small cell lung cancer (NSCLC) still need to be defined. This study aimed to investigate the feasibility and effectiveness of thoracoscopic pulmonary segmentectomy in patients with early peripheral NSCLC.This was a retrospective study of patients with early peripheral NSCLC admitted between January 2013 and January 2017. Patients were divided into the segmentectomy and lobectomy groups (40/group), according to the surgery they underwent. Blood loss, operation time, removal of drainage tube time, inflammatory response after operation, postoperative complications, postoperative lung function, local recurrence, and survival were compared.Blood loss and removal of drainage tube time were not significantly different between the 2 groups (all P > .05). Operation time in the segmentectomy group was longer than in the lobectomy group (P < .001). The postoperative interleukin-6, procalcitonin, and C-reactive protein changes in the segmentectomy group were significantly lower than in the lobectomy group (all P < .001). The pulmonary function at 2 weeks was significantly reduced in the 2 groups (all P < .001), but it was better in the segmentectomy group than in the lobectomy group (all P < .05). The 1- and 3-year local recurrence disease-free, and overall survival rates were not significantly different between the 2 groups (P > .05). The multivariable analysis could not identify any factor associated with local recurrence or survival (all P > .05).Thoracoscopic pulmonary segmentectomy and lobectomy are both acceptable for the treatment of early peripheral NSCLC, but segmentectomy was associated with lower postoperative inflammation and better postoperative pulmonary function than lobectomy.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Toracoscopia , Adulto , Idoso , Biomarcadores Tumorais/sangue , Perda Sanguínea Cirúrgica , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Drenagem , Estudos de Viabilidade , Feminino , Humanos , Neoplasias Pulmonares/mortalidade , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Duração da Cirurgia , Complicações Pós-Operatórias , Testes de Função Respiratória , Estudos Retrospectivos , Taxa de Sobrevida
2.
Cir. pediátr ; 33(1): 11-15, ene. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-186131

RESUMO

Introducción: Publicaciones recientes reportaron el alta temprana y bajos requerimientos de opioides para el control del dolor postope-ratorio en la reparación mínimamente invasiva del pectus excavatumtras crioablación bilateral de nervios intercostales. Nuestro objetivo es describir nuestra experiencia inicial con esta técnica. Material y métodos: Análisis retrospectivo de historias clínicas de pacientes sometidos a crioanalgesia toracoscópica bilateral durante la reparación mínimamente invasiva del pectus excavatum en nuestra institución desde septiembre de 2018 a marzo de 2019. Técnica: Se aplicó una criosonda a -70°C bajo visión toracoscópica durante 2 minutos del 3º al 7º espacio intercostal, de manera bilateral. El dolor postoperatorio fue evaluado con una Escala Visual Analógica. Resultados: Se incluyeron 21 pacientes, de los cuales el 90% era de sexo masculino con una edad media de 15,2 ± 4,29 años y un peso de 53,6 ± 15,33 kg. El índice de Haller promedio fue de 5,1 ± 2,97 y el índice de corrección de 37,6 ± 13,77%. El número promedio de implantes fue de 2,55 ± 0,74. La duración media de la crioanalgesia fue de 39,9 ± 21,1 minutos. Ninguno recibió anestesia peridural. El tiempo de internación postquirúrgico fue de 1,64 ± 0,73. La necesidad de rescate con opiáceos fue menor a 1 dosis en el 71,3%. La puntuación de dolor en los días postoperatorios 1, 3, 7 y 21 fue, en promedio, de 2,55; 2,01; 0,5 y 0,06, respectivamente. Conclusiones: El empleo de la crioanalgesia toracoscópica bilateral permitió el alta hospitalaria temprana y buen control del dolor postoperatorio en todos los casos, convirtiéndose en el método analgésico de elección en nuestra práctica clínica


Objective: Recent publications report early discharge and low opioid requirements after minimally invasive pectus excavatum repair treated with bilateral intercostal nerve cryoablation. Our aim is to report our initial experience with this technique. Materials and methods: Retrospective analysis of medical records of patients undergoing bilateral thoracoscopic cryoanalgesia during minimally invasive pectus excavatum repair within our institution from September 2018 to March 2019. Technique: A cryoprobe was applied at -70 ºC for 2 minutes each from the 3rd to the 7th intercostal nerves bilaterally under thoracoscopic control. Postoperative pain was assessed using a visual analogue scale (VAS). Results: Twenty-one patients were included. Ninety percent were male, the mean age being 15.2 ± 4.29 years, and the mean weight being 53.6 ± 15.33 kg. The average Haller index was 5.1 ± 2.97, and the mean repair index was 37.6 ± 13.77%. The mean number of implants intro-duced was 2.55 ± 0.74. The mean duration of cryoanalgesia was 39.9 ± 21.1. No patients received epidural anesthesia. Mean postoperative stay was 1.64 ± 0.73 days. Seventy-one percent of the patients required 1 dose of opioids at the most for postoperative pain control. According to the VAS, the average pain score on postoperative days 1, 3, 7, and 21 was 2.55, 2.01, 0.5, and 0.06, respectively. Conclusions: Bilateral thoracoscopic cryoanalgesia during minimally invasive pectus excavatum repair leads to early discharge and good postoperative pain control in all cases. Cryoanalgesia has become our treatment of choice for pain control in the thoracoscopic repair of pectus excavatum


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Dor Pós-Operatória/terapia , Toracoscopia/métodos , Crioanestesia/métodos , Nervos Intercostais , Crioanestesia/instrumentação , Crioanestesia/tendências , Manejo da Dor , Cirurgia Torácica/métodos , Estudos Retrospectivos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos
4.
Kyobu Geka ; 73(1): 49-56, 2020 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-31956250

RESUMO

Esophagectomy with mediastinal lymphadenectomy is a standard surgical procedure for esophageal cancer treatment, however, it is highly invasive operation and has possibility of reduction the patients' quality of life( QOL). Thoracoscopic esophagectomy was introduced to reduce the surgical invasiveness since the 1990s and it has been widely performed now. Surgical procedure has been changed from left lateral decubitous position to prone position, and robot surgery or mediastinoscopic surgery has been applied currently. Many reports indicated good short term results compared to open surgery, especially reduction of the postoperative pulmonary complication. On the other hand, there is no scientific evidence of long term survival benefit, therefore, further researches are required including an ongoing phase Ⅲ randomized controlled trial( RCT)[ Japan Clinical Oncology Group( JCOG) 1409].


Assuntos
Neoplasias Esofágicas , Qualidade de Vida , Neoplasias Esofágicas/cirurgia , Esofagectomia , Humanos , Japão , Excisão de Linfonodo , Procedimentos Cirúrgicos Minimamente Invasivos , Toracoscopia , Resultado do Tratamento
5.
Rev Soc Bras Med Trop ; 53: e20180046, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31994653

RESUMO

Hepatopulmonary hydatidosis in young children is a rare and atypical presentation of Echinococcus granulosus infection. We report the first case of cystic echinococcosis caused by a microvariant of E. granulosus sensu stricto. Chemotherapy and systemic corticoids were administered before curative surgery was performed. Recurrence was not observed for more than 24 months of follow-up.


Assuntos
Albendazol/administração & dosagem , Equinococose Hepática/diagnóstico por imagem , Equinococose Pulmonar/diagnóstico por imagem , Echinococcus granulosus/isolamento & purificação , Animais , Pré-Escolar , Equinococose Hepática/terapia , Equinococose Pulmonar/terapia , Feminino , Seguimentos , Humanos , Toracoscopia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
6.
Braz J Med Biol Res ; 53(1): e8645, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31859910

RESUMO

Data about the feasibility and safety of thoracoscopic surgery under non-intubated anesthesia and regional block are limited. In this prospective study, 57 consecutive patients scheduled for thoracoscopic surgery were enrolled. Patients were sedated with dexmedetomidine and anesthetized with propofol and remifentanil. Ropivacaine was used for intercostal nerve and paravertebral block. Lidocaine was used for vagal block. The primary outcomes were mean arterial pressure (MAP), heart rate (HR), oxygen saturation, and end-tidal carbon dioxide partial pressure (ETCO2) at T0 (pre-anesthesia), T1 (immediately after laryngeal mask/nasopharyngeal airway placement), T2 (immediately after skin incision), T3 (10 min after opening the chest), T4 (end of surgery), and T5 (immediately after laryngeal mask/nasopharyngeal airway removal). One patient required conversion to intubation, 15 developed intraoperative hypotension, and two had hypoxemia. MAP at T0 and T5 was higher than at T1-T4; MAP at T3 was lower (P<0.05 vs other time points). HR at T0 and T5 was higher (P<0.05 vs other time points). ETCO2 at T2 and T3 was higher (P<0.05 vs other time points). Arterial pH, PCO2, and lactic acid at T1 differed from values at T0 and T2 (P<0.05). The Quality of Recovery-15 (QoR-15) score at 24 h was lower (P<0.05). One patient experienced dysphoria during recovery. Thoracoscopic surgery with regional block under direct thoracoscopic vision is a feasible and safe alternative to conventional surgery under general anesthesia, intubation, and one-lung ventilation.


Assuntos
Anestesia Geral/métodos , Máscaras Laríngeas , Bloqueio Nervoso/métodos , Toracoscopia/métodos , Adolescente , Adulto , Pressão Sanguínea/efeitos dos fármacos , Pressão Sanguínea/fisiologia , Dexmedetomidina/administração & dosagem , Estudos de Viabilidade , Feminino , Frequência Cardíaca/efeitos dos fármacos , Frequência Cardíaca/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Propofol/administração & dosagem , Estudos Prospectivos , Remifentanil/administração & dosagem , Adulto Jovem
7.
Zhonghua Wai Ke Za Zhi ; 57(12): 908-911, 2019 Dec 01.
Artigo em Chinês | MEDLINE | ID: mdl-31826594

RESUMO

Objective: To examine minimally invasive tricuspid valve operations applied in tricuspid valve insufficiency patients with previous left-sided valve surgery. Methods: Between September 2017 and June 2019, thirty-six consecutive patients received minimally invasive totally thoracoscopic tricuspid surgery through right thoracotomy at Department of Cardiovascular Surgery, Fisrt Medical Center, People's Liberation Army General Hospital. There were 13 males and 23 females, aging (56±11) years (range: 43 to 79 years). All the patients had isolated significant tricuspid regurgitation after previous left-sided cardiac surgeries. A right anterolateral thoracotomy incision about 4 cm was made from the fourth intercostal space as main operating port. The arterial cannula was placed in femoral artery. The venous cannula was placed in femoral vein using Seldingger technique. Tricuspid valve operation was performed on beating heart by assist of vena vacuum. Results: Tricuspid valve repair was performed in 7 patients. Tricuspid valve replacement with bioprosthesis was performed in 29 patients. The operation time was (2.9±0.3) hours (range:2.5 to 3.6 hours). There was no conversion to sternotomy during operation. There was no severe complications during operation period. There were no complications related to this cannulation technique. The time of cardiopulmonary bypass establishment was (22±5) minutes (range: 12 to 24 minutes) and pump time was (82±16) minutes (range: 62 to 93 minutes). The length of hospital stay was (9±3) days after operation (range: 5 to 13 days). There was no early death in hospital. All patients were followed up for 3 to 22 months. No patient died. Conclusions: One single port-based minimally invasive approach seems to be safe, feasible, and reproducible in case of redo tricuspid valve operations. Only cannulation of inferior vena cava significantly simplified the complexity of isolated redo tricuspid surgery.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Doenças das Valvas Cardíacas/cirurgia , Toracoscopia/métodos , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/cirurgia , Adulto , Idoso , Procedimentos Cirúrgicos Cardíacos/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Toracoscopia/instrumentação , Toracotomia , Resultado do Tratamento , Insuficiência da Valva Tricúspide/etiologia
8.
Angiol Sosud Khir ; 25(4): 146-157, 2019.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-31855212

RESUMO

Presented in the article is a detailed description of a modified technique of minimally invasive surgical treatment of patients with atrial fibrillation - thoracoscopic radiofrequency fragmentation of the left atrium. This modification differs from the prototype GALAXY procedure by a significant increase of the 'quantitative' rather than 'qualitative' parameter of surgical aggression in relation to the left atrium. This technique results in creation of multiple transmural continuous closed lines of lesion to the left atrium and, consequently, a reduced risk of inadequate surgical treatment for atrial fibrillation. Besides the radiofrequency action on the wall of the left atrium, the protocol of the operation included destruction of the ligament of Marshall and resection of the left atrial appendage. An indication for performing this operation is the presence of various forms of atrial fibrillation.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Átrios do Coração/cirurgia , Ablação por Cateter/instrumentação , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Toracoscopia , Resultado do Tratamento
9.
Medicine (Baltimore) ; 98(52): e18528, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876749

RESUMO

The objective of this study was to investigate the therapeutic effects of bronchoscopy alveolar lavage (BAL) combined with thoracoscopy in the treatment of empyema in children.Retrospectively analyzed 174 cases of pediatric empyema treated with thoracoscopy combined with BAL from January 2010 to December 2016 in our hospital. All the cases, according to admission order, were randomly divided into 2 groups, the control group (group A), which contained 89 cases, was treated with thoracoscopy; and the experimental group (group B), which contained 85 cases, was treated with BAL combined with thoracoscopy. The results of BAL treatment, the inflammatory indexes including body temperature, total leukocyte count in peripheral blood and CRP, and the therapeutic effect and prognosis including the days of antibiotic use, hospital stay, the incidence of thoracotomy and lobectomy were compared between the 2 groups.There was statistical difference in all the therapeutic indexes (P < .05).Bronchoscopy alveolar lavage combined with thoracoscopy has a higher success rate in the treatment of pediatric empyema, and is more comprehensive, safe and effective in controlling inflammation.


Assuntos
Lavagem Broncoalveolar/métodos , Empiema Pleural/terapia , Toracoscopia/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos
10.
Arq Bras Cir Dig ; 32(4): e1475, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31859928

RESUMO

BACKGROUND: Esophageal cancer neoadjuvant therapy followed by surgery increases the likelihood of treatment success. AIM: To evaluate variables that can influence the number of retrieved lymph nodes, the number of retrieved metastatic lymph nodes and lymphnodal recurrence in esophagectomy after neoadjuvant chemoradiotherapy. METHODS: Patients of a single institute were evaluated after completion of trimodal therapy. Univariate and multivariate analyses were performed to evaluate variables that can influence in the number of retrieved lymph nodes and retrieved metastatic lymph nodes. RESULTS: One hundred and forty-nine patients were included. Thoracoscopy access was considered an independent factor for the number of lymph nodes retrieved, but was neither related to the number of positive lymph nodes retrieved nor to lymphnodal recurrence. Pathological complete response on the primary tumor and male were independent variables associated with the number of positive lymph node retrieved. Pathological complete response on the primary tumor site did not statistically influence the likelihood of a lower number of lymph nodes retrieved. CONCLUSION: Patients submitted to esophagectomy after neoadjuvant chemoradiotherapy, thoracoscopic access is more accurate for pathological staging, even in a complete pathological response. With a proper patient selection, transhiatal surgery may preserve the quality of lymphadenectomy of the positive lymph nodes.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Excisão de Linfonodo/métodos , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Estudos Retrospectivos , Toracoscopia , Resultado do Tratamento
11.
Kyobu Geka ; 72(13): 1110-1113, 2019 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-31879389

RESUMO

We performed an exploratory thoracoscopy for a suspected diaphragm injury caused by a blunt-force chest trauma. A male patient in his fifties involved in a traffic accident and was transported by ambulance to our hospital. Upon arrival, his vital signs were stable, however, he was diagnosed as having fractures of the right tibia and fibula, multiple rib fractures and a slight right hemothorax. The limb fracture was treated by emergency surgery and the chest trauma was managed by chest drainage. Since injury of the diaphragm by fragment of the right 10th rib was suspected with chest computed tomography(CT), an exploratory thoracoscopy was performed after orthopedic surgery, and a laceration of the diaphragm without herniation was successfully closed.


Assuntos
Diafragma/lesões , Fraturas das Costelas , Traumatismos Torácicos , Ferimentos não Penetrantes , Hemotórax , Humanos , Masculino , Toracoscopia , Ferimentos não Penetrantes/complicações
12.
J Cardiothorac Surg ; 14(1): 183, 2019 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-31684981

RESUMO

BACKGROUND: The prognosis of patients who undergo unilateral pneumonectomy and subsequently develop a contralateral pulmonary tumor can be improved by tumor resection. Thus, surgery is a treatment option if the patient's pulmonary function and performance status are satisfactory. To date, there have been only few cases reporting thoracoscopic lung resection for pulmonary tumor after contralateral pneumonectomy because of the difficulty in respiratory management during surgery. Thoracoscopic surgery requires the maintenance of the operative field to allow the lung to collapse, and in partial lung resection we need to identify tumor localization. The identification of a tumor lesion just inferior to the pleura is easy; however, the identification of a tumor lesion in the deep parts is difficult. The tumor in the deep part of the lung segments can be easily located if the tumor-affected lobe is allowed to completely collapse. Therefore, ventilation technique should be modified according to the tumor localization. CASE PRESENTATION: Here, we report three cases of thoracoscopic partial lung resections for pulmonary tumors that developed after contralateral pneumonectomy. Intermittent manual ventilation using a tracheal tube was performed in two cases with a lesion just inferior of the pleura. The tumors in both patients were resected using automatic suturing devices while arresting manual ventilation. The affected lobe was allowed to collapse using a bronchial blocker in one of the cases with a lesion in the deep part. Furthermore, she had contralateral pneumothorax with bullae on the right upper and lower lobes of the lung. The tumor in the deep part of the lung segment and ruptured bullae were easily located and resected using automatic suturing devices. The hemodynamic status of the patients was stable, and the intra- and postoperative courses were uneventful. CONCLUSIONS: Our cases demonstrate that thoracoscopic lung resection after contralateral pneumonectomy can be performed if intermittent manual ventilation is utilized when the tumor is located just inferior to the pleura and if selective double ventilation using an intrabronchial blocker is utilized when the tumor is located in the deep part.


Assuntos
Carcinoma Adenoide Cístico/cirurgia , Neoplasias Pulmonares/cirurgia , Pneumonectomia , Adulto , Idoso , Carcinoma Adenoide Cístico/diagnóstico por imagem , Carcinoma Adenoide Cístico/secundário , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/secundário , Masculino , Metástase Neoplásica , Toracoscopia , Tomografia Computadorizada por Raios X
13.
J Cardiothorac Surg ; 14(1): 188, 2019 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-31694695

RESUMO

BACKGROUND: The aim of this study is to report the long-term efficacy and safety of thoracoscopic epicardial left atrial ablation (TELA) in patients with paroxysmal atrial fibrillation (AF). METHODS: This was a retrospective review of medical records. We included all patients diagnosed with paroxysmal AF who underwent TELA at our institution between 04/2011 and 06/2017. TELA included pulmonary vein isolation, LA dome lesions and LA appendage exclusion. All (n = 55) patients received an implantable loop recorder (ILR), 30 days post-operatively. Antiarrhythmic and anticoagulation therapy were discontinued at 90 and 180 days postoperatively, respectively, if patients were free of AF recurrence. Failure was defined as ≥two minutes of continuous AF, or atrial tachycardia. RESULTS: Fifty-five patients (78% males, mean age = 61.6 years) qualified for the study. The average duration in AF was 3.64 +/- 3.4 years, mean CHA2DS2-VASc Score was 2.0 +/- 1.6. The procedure was attempted in 57 patients and completed successfully in 55 (96.5%). Two patients experienced a minor pulmonary vein bleed that was managed conservatively. Post procedure, one patient experienced pulmonary edema, another experienced a pneumothorax requiring a chest tube and another experienced acute respiratory distress syndrome resulting in longer hospitalization. Otherwise, there were no major procedural complications. Success rates were 89.1% (n = 49/55), 85.5% (n = 47/55) and 76.9% (n = 40/52) at 6, 12 and 24 months, respectively. In the multivariate cox-proportional hazard model, survival at the mean of covariates was 86 and 74% at 12 and 24 months, respectively. CONCLUSION: In this single center experience, TELA was a safe and efficacious procedure for patients with paroxysmal AF.


Assuntos
Técnicas de Ablação/métodos , Fibrilação Atrial/cirurgia , Átrios do Coração/cirurgia , Toracoscopia/métodos , Adulto , Idoso , Fibrilação Atrial/diagnóstico por imagem , Feminino , Seguimentos , Átrios do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
14.
Kyobu Geka ; 72(12): 989-992, 2019 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-31701908

RESUMO

Mediastinal enteric cysts are very rare among in adults and usually asymptomatic. A 54-year-old male was referred to our hospital due to an abnormal shadow incidentally found on a chest X-ray at health check. Chest computed tomography scan revealed a cystic mass in the posterior and inferior mediastinum surrounded by diaphragm, inferior vena cava, and esophagus. Based on many reports of thoracoscopic esophagectomy in the prone position in recent years, we chose thoracoscopic resection of the mediastinal tumor in the prone position with artificial pneumothorax. The prone position with artificial pneumothorax provided much better exposure of the operating field and the surgery was performed successfully.


Assuntos
Cisto Mediastínico , Pneumotórax Artificial , Esofagectomia , Humanos , Masculino , Cisto Mediastínico/cirurgia , Pessoa de Meia-Idade , Posicionamento do Paciente , Decúbito Ventral , Toracoscopia
15.
Artigo em Inglês | MEDLINE | ID: mdl-31751009

RESUMO

Minimally invasive pulmonary segmentectomy allows adequate oncologic treatment in selected cases while preserving lung parenchyma and minimizing perioperative morbidity and length of hospital stay.  Most lung segments can be resected as segmentectomies or as part of bisegmentectomies (as is the case for the lingula). However, the resection of individual basal segments can be particularly challenging. Although several variations of minimally invasive pulmonary segmentectomy have been described, I favor a fully thoracoscopic multiport approach that offers direct access to the segmental structures, and is straightforward and versatile enough to allow for adaptation in case of unexpected intraoperative findings (such as conversion to lobectomy in the case of positive margins). Key aspects of anterobasal segmentectomy include proper patient positioning, appropriate positioning of operating trocars, standardized technique to expose and dissect the segmental artery and bronchus, and accurate division of the intersegmental plane.


Assuntos
Neoplasias Colorretais/patologia , Nódulos Pulmonares Múltiplos , Neoplasias Primárias Múltiplas/patologia , Pneumonectomia/métodos , Toracoscopia/métodos , Idoso , Humanos , Masculino , Mastectomia Segmentar , Nódulos Pulmonares Múltiplos/patologia , Nódulos Pulmonares Múltiplos/cirurgia , Tratamentos com Preservação do Órgão/métodos , Posicionamento do Paciente/métodos
16.
J Cardiothorac Surg ; 14(1): 182, 2019 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-31665049

RESUMO

BACKGROUND: The authors presented a 63-year old female synchronously complicated with a thymic tumor located at the left-side of the superior mediastinum, and a paravertebral tumor located at the right-side of the lower thorax. Conventional thoracoscopic surgical procedure using rigid instruments to simultaneously resect the two tumors via the same ports might be technically challenging. To our knowledge, the use of a surgical robot allowed the surgeon to perform precise dissection from extreme angles with the characteristic of articulating surgical instruments. CASE PRESENTATION: Two lesions were successfully dissected using the da Vinci Surgical System through the same four ports on the right side of the chest and two-step docking. Firstly, the patient cart came from the dorsal side of the patient and the paravertebral neoplasm was dissected. Afterwards, the patient cart was undocked and the operation table was rotated 180 degrees counterclockwise. The robot was re-introduced and the patient cart came from the ventral side of the patient and the whole thymus was resected. CONCLUSION: This case report suggests that two-step docking via the same four ports for these two tumors located at different directions of the thorax was safe and effective, demonstrating a clear advantage of the surgical robot.


Assuntos
Cisto Broncogênico/cirurgia , Neoplasias do Mediastino/cirurgia , Neoplasias Primárias Múltiplas/cirurgia , Neurilemoma/cirurgia , Neoplasias do Timo/cirurgia , Cisto Broncogênico/diagnóstico por imagem , Cisto Broncogênico/patologia , Feminino , Humanos , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/patologia , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Primárias Múltiplas/patologia , Neurilemoma/diagnóstico por imagem , Neurilemoma/patologia , Procedimentos Cirúrgicos Robóticos/métodos , Vértebras Torácicas , Toracoscopia/métodos , Timectomia/métodos , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/patologia , Tomografia Computadorizada por Raios X
17.
Medicine (Baltimore) ; 98(38): e17270, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31568005

RESUMO

BACKGROUND: Atrial septal defect (ASD) is one of the most common congenital heart diseases, with an average of 1.64 per 1000 newborns with the ASD. Empirical studies suggest that surgery should be performed early in the presence of right atrium and or right ventricular enlargement, even for asymptomatic patients. Many surgical procedures can be used to treat ASD. But which method is the best choice remains unclear. This study aims to compare the efficacy and safety of standard median sternotomy, right minithoracotomy, totally thoracoscopic surgery, percutaneous closure, transcutaneous by echocardiography, and transcutaneous by radiotherapy for ASDs in children using Bayesian network meta-analysis (NMA). METHODS: We will perform a comprehensive literature search using PubMed, EMBASE.com, the Cochrane Library, Web of Science, and Chinese Biomedical Literature Database to identify relevant studies from inception to April 2019. Randomized controlled trials, prospective or retrospective cohort studies that reported the efficacy and safety of surgical procedures for the treatment of atrial septal defects will be included. Risk of bias of the included randomized controlled trials and prospective or retrospective cohort studies will be evaluated according to the Cochrane Handbook 5.1.0 and the risk of bias in non-randomized studies of interventions, respectively. A Bayesian NMA will be performed using R 3.4.1. RESULTS: The results of this NMA will be submitted to a peer-reviewed journal for publication. CONCLUSION: This NMA will summarize the direct and indirect evidence to assess the efficacy and safety of different surgical procedures for the treatment of ASDs. ETHICS AND DISSEMINATION: Ethics approval and patient consent are not required as this study is a network meta-analysis based on published trials. PROSPERO REGISTRATION NUMBER: CRD42019130902.


Assuntos
Comunicação Interatrial/cirurgia , Esternotomia , Toracoscopia , Toracotomia , Técnicas de Fechamento de Ferimentos , Criança , Humanos
18.
Kyobu Geka ; 72(10): 805-809, 2019 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-31582700

RESUMO

Lung disease requiring surgical treatment has shifted from pulmonary tuberculosis that was prevalent in the 1940s during wartime to lung cancer in the last half century. The surgical approach for pulmonary tuberculosis was open chest surgery. Likewise for lung cancer, a thoracotomy approach had initially been used for a while. Thoracoscopic minimally invasive surgery became more widely used around 1990 and was shown to improve the patient's quality of life (QOL). Currently, thoracoscopic surgery and robotic surgery are the mainstream procedures for patients with lung cancer, and thoracotomy procedures have fallen out of favor. However, in some cases of unexpected bleeding from the pulmonary artery or tumor infiltration into the pulmonary artery, appropriate thoracotomy must be performed. In this volume, 4 representative methods of performing thoracotomy are described with some tips in Japanese.


Assuntos
Neoplasias Pulmonares , Toracotomia , Humanos , Neoplasias Pulmonares/cirurgia , Qualidade de Vida , Toracoscopia , Tórax
19.
Kyobu Geka ; 72(10): 859-863, 2019 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-31582710

RESUMO

Extended thymectomy reported by Masaoka in 1981 is a standard surgical treatment in patients with myasthenia gravis. Thoracoscopic thymectomy, which could be less invasive, has been widely accepted for an anterior mediastinal lesion in addition to the conventional median sternotomy approach. In thoracoscopic thymectomy, artificial pneumothorax using carbon deoxide(CO2) insufflation or chest wall lifting using rib hook can contribute to make better surgical view with enough working space. Recently, thoracoscopic thymectomy with subxiphoid approach has been reported with its usefulness. Since MGTX trial revealed the significant efficacy of thymectomy in myasthenia gravis patients aged up to 65, the number of patients having operative indication may increase. Therefore, thoracic surgeons should acquire the safe and effective technical skill of thymectomy.


Assuntos
Parede Torácica , Timectomia , Humanos , Mediastino , Miastenia Gravis , Cirurgia Torácica Vídeoassistida , Toracoscopia
20.
Kyobu Geka ; 72(10): 864-868, 2019 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-31582711

RESUMO

Recently, thoracoscopic esophagectomy has been widely accepted as a minimally invasive surgery and a possible standard procedure for esophageal cancer patients. Furthermore, it has an advantage for meticulous lymph node dissection by providing a magnification view and less blood loss. Mediastinal lymphadenectomy, especially upper mediastinal lymph node dissection, is a key point for esophageal cancer surgery because of its high frequency of metastasis and dissection efficacy. To avoid complications such as recurrent laryngeal nerve palsy, pneumoniae, chylothorax and unexpected injury in mediastinal lymph node dissection, detailed anatomical knowledge and careful procedures are required for surgeon. An appropriate operative procedure or technique will lead to good short- and long-term outcomes for the patients with esophageal cancer.


Assuntos
Neoplasias Esofágicas , Esofagectomia , Humanos , Excisão de Linfonodo , Mediastino , Decúbito Ventral , Estudos Retrospectivos , Toracoscopia
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