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Diagnostic and Therapeutic Thoracoscopy (Videothoracoscopy) in Malignant Pleural Effusion - Our Experience

100%
Kacprzak G., Kołodziej J., Pawełczyk K., Marciniak M., Rzechonek A.
Polish Journal of Surgery
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2008
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vol. 80
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issue 1
35-41
EN
Diagnosis and treatment of patients with malignant pleural effusion (MPE) is a serious problem for clinicians.The aim of the study were: to evaluate the diagnostic and therapeutic value of thoracoscopy and videothoracoscopy (VTS) and to determine the efficiency of using talc for the management of MPE.Material and methods. Between January 1996 and December 2006, thoracoscopy (VTS) was performed in 95 patients. A 4 g dose of talc was used for pleurodesis. Out of the 95 diagnostic procedures, malignancy was diagnosed in 94 (98.9%) patients. Patients were divided into two subgroups: subgroup A, patients (n=4) who died within first month, and subgroup B, patients (n=91) who lived more than one month. In subgroup A, complete remission (CR) was achieved in four (100%) patients until they died. In subgroup B, CR was achieved in 90 (98.9%) patients after one month, with relapse (R) occurring in 1 (1.1%) patient. After three months, CR was achieved in 86 (94.5%), partial remission (PR) in three (3.3%), and R in two (2.2%) patients. After six and nine months, CR was achieved in 85 (93.4%), PR in three (3.3%), and R in three (3.3%) patients. Postoperative complications, side effects after applying talc, and general performance were assessed. Difficulties in lung expansion requiring redrainage occurred in four (4.2%) patients. Fever appeared in 79 (83.2%) patients, while pain appeared in 90 (94.7%) patients. After treatment, the number of patients classified as I on the WHO scale increased from 36.8% to 74.7%, while the number of patients classified as III on the WHO scale decreased from 10.5% to 2.1%.Conclusions. Thoracoscopy (VTS) significantly improves diagnostic effectiveness in cases without cytological and histological diagnosis and is a method of treatment for MPE. Very good results were achieved after intrapleural administration of talc (CR occurred in 93.4% patients). The most common side effect of administering talc was pain.
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Minimally Invasive Surgery in Newborns and Infants - Own Experience

88%
Patkowski D., Rysiakiewicz K., Rysiakiewicz J., Koziełł A., Apoznański W., Czernik J.
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EN
The aim of the study was to present own experience in utilisation of minimally invasive techniques in newborn and infant.Material and methods. It is retrospective analysis of minimally invasive procedures conducted in Department of Pediatric Surgery and Urology with focus on patients group up to age of one year.Results. In total 1791 minimally invasive procedures were conducted of which 234 (13.1%) operations were performed on 227 (7 patients underwent procedure twice) children in age group of up to one year in period from 01.04.1995 till 30.06.2008. There were 28 (11.97%) thoracoscopic and 206 (88.03%) laparoscopic procedures. No complications related to creation of pneumoperitoneum or surgical pneumothorax were observed. The commonest indications to surgery were inguinal hernia (116 children) oesophageal atresia with tracheoesophageal fistula (23 cases) and prolonged neonatal jaundice (18 patients).In total in 29 cases it was necessary to convert to open surgery, 2 cases due to intraoperative complications (bleeding, duodenal wall perforation) and in 14 cases due to poor visualisation of operating field.Conclusions. There is broad spectrum of indications to minimally invasive surgery in newborn and infant patients. Results indicate good tolerability of the procedure even in patients with low weight, safety and efficacy in typical conditions. Limited number of procedures performed in various conditions does not allow to draw uniform conclusions and requires further study.
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Minimally Invasive Repair of Acquired Benign Thoracic Tracheo-Esophageal Fistula

75%
Banerjee J. K., Saranga Bharathi R.
Polish Journal of Surgery
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2019
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vol. 91(5)
55-58
EN
Background: Repair of large, upper thoracic, cuff-induced, tracheo-esophageal fistula (TEF) is technically demanding and is conventionally performed by open surgery. Minimal access approach is, hitherto, unreported. T echnique & Case: Minimally invasive repair of TEF involving fistula isolation – by thoracoscopic oesophageal exclusion, and simultaneous establishment of alimentary continuity – by laparoscopy-assisted sub-sternal colonic transposition, is described. The technique was successfully employed in repairing a large (4.5 centimetres), cuff-induced, upper thoracic TEF, in a 25-year-old woman. The rationale behind the technique, its pros and cons are analysed and contrasted against conventional techniques of TEF repair. Conclusion: Large upper thoracic, cuff-induced TEF can be successfully repaired employing minimal access.
4
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Własne doświadczenia w leczeniu dzieci z pierwotną samoistną odmą opłucnową

63%
Jabłoński J., Polityło P., Andrzejewska E., Lewandowska M.
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EN
Background: Pneumothorax is defined as an air accumulated in the pleural cavity. Primary spontaneous pneumothorax usually is caused by rupture of a subpleural bleb or bulla. The current treatment options for pneumothorax included observation, needle aspiration, chest tube drainage, thoracotomy or thoracoscopy. There are few reports about treatment of pneumothorax in the paediatric population. Aim of the study: Presentation of authors’ experience in the treatment of primary spontaneous pneumothorax in children. Material and methods: Between 2007 and 2010 in Department of Paediatric Surgery and Oncology, Medical University of Lodz 9 patient with spontaneous pneumothorax were treated. Results: Mean follow-up lasted 5‑36 months (median 11.9). We had 7 boys and 2 girls. Patient’s age ranged from 13 to 17 years (median 15.9). Pneumothorax occured on the left side in 6 patients, on the right side in 2 patients and on both side in 1 patient. Two patients were successfully treated by conservative therapy. Among 7 children managed with chest tube drainage 3 had ipsilateral recurrence. The thoracoscopy was performed in 4 of 7 patients. The indications for thoracoscopy were failure of lung expansion after chest tube placement, persistent air leak (>7 days) and contralateral pneumothorax. Conclusions: Establishment of optimal management for children with primary spontaneous pneumothorax requires more reports about the treatment of pneumothorax in the paediatric population. High recurrence rate after treatment with chest tube drainage indicates the need of early thoracoscopy. Thoracoscopy is an effective and safe method for primary spontaneous pneumothorax in children.
PL
Wstęp: Odma opłucnowa to nagromadzenie powietrza w obrębie jamy opłucnowej. Przyczyną pierwotnej samoistnej odmy opłucnowej jest zazwyczaj rozerwanie podopłucnowego pęcherzyka lub torbielki. Metody leczenia odmy obejmują: leczenie zachowawcze, nakłucie i aspirację powietrza, drenaż jamy opłucnowej, leczenie operacyjne metodą torakotomii lub torakoskopii. Tylko nieliczne prace opisują leczenie odmy samoistnej u dzieci. Cel pracy: Przedstawienie własnych doświadczeń w leczeniu pierwotnej samoistnej odmy opłucnowej u dzieci. Materiał i metoda: W latach 2007‑2010 w Klinice Chirurgii i Onkologii Dziecięcej UM w Łodzi leczono z powodu pierwotnej samoistnej odmy opłucnowej 9 pacjentów. Wyniki: Okres obserwacji pacjentów wynosił od 5 do 36 miesięcy, średnio 11,9 miesiąca. Wśród leczonych dzieci były 2 dziewczynki i 7 chłopców. Wiek chorych wahał się od 13 do 17 lat i wynosił średnio 15,7 roku. U 6 pacjentów rozpoznano odmę opłucnową lewostronną, u 2 prawostronną, a u 1 odmę opłucnową obustronną. Dwóch pacjentów leczono z sukcesem zachowawczo. Spośród 7 dzieci leczonych drenażem u 3 wystąpił nawrót odmy po tej samej stronie. U 4 z 7 pacjentów wykonano torakoskopię. Wskazaniami do zabiegu operacyjnego były: brak rozprężenia płuca po leczeniu drenażem, utrzymujący się przeciek powietrza (>7 dni) oraz przeciwstronny nawrót odmy. Wnioski: Ustalenie optymalnego algorytmu postępowania u dzieci z pierwotną samoistną odmą opłucnową wymaga większej liczby doniesień dotyczących leczenia odmy w tej grupie wiekowej. Wysoki odsetek nawrotów u dzieci leczonych drenażem jamy opłucnowej przemawia za wcześniejszym kwalifikowaniem tych chorych do torakoskopii. Torakoskopowe wycięcie pęcherzy rozedmowych u dzieci z pierwotną samoistną odmą jest postępowaniem skutecznym i bezpiecznym.
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