Video-Assisted Thoracoscopic Spinal Surgery: Technical Considerations and Preliminary Clinical Outcomes

1998 ◽  
Vol 02 (01) ◽  
pp. 15-25
Author(s):  
Tsung-Jen Huang ◽  
Robert Wen-Wei Hsu ◽  
Hui-Ping Liu ◽  
Yi-Shyan Liao ◽  
Yeung-Jen Chen ◽  
...  
Keyword(s):  
Spinal Surgery ◽  
Thoracoscopic Surgery ◽  
Total Duration ◽  
Lung Ventilation ◽  
One Lung Ventilation ◽  
Total Blood ◽  
Video Assisted ◽  
Duration Of Surgery ◽  
Great Vessels ◽  
Endoscopic Spinal Surgery

Video-assisted thoracoscopic surgery (VATS) has only recently been applied in a variety of spinal procedures. Between November 1, 1995 and May 31, 1996, we used a new approach, the so-called "extended manipulating channel method", to treat 23 patients with anterior spinal abnormalities. The size of the thoracoscopic portals was made larger than usual, and placed more posteriorly so as to allow thoracoscopy and conventional spinal instruments to enter the chest cavity freely and to be manipulated similarly to techniques used in standard open surgical procedures. The total blood loss ranged from 100 to 3000 ml (average 1050 ml) and the total duration of surgery was 1 to 7.2 hours (average 3.7 hours). There was no injury to the internal organs, great vessels or the spinal cord intraoperatively. On the basis of these results, we believe that a combination of the use of thoracoscopy and conventional spinal instruments, as presented in this report, can be an ideal method for performing VATS spinal procedures. This type of approach makes endoscopic spinal surgery simpler to perform. Most complications in our patients were minor. This procedure is contraindicated for patients with severe pleurodesis or intolerance to intraoperative one-lung ventilation.

scholarly journals May awake video-assisted thoracoscopic surgery with thoracic epidural anesthesia use routinely for minimaly invasive thoracic surgery procedures in the future?

2018 ◽  
Vol 5 (5) ◽  
pp. 1602
Author(s):  
Gonul Sagiroglu ◽  
Fazli Yanik ◽  
Yekta A. Karamusfaoglu ◽  
Elif Copuroglu
Keyword(s):  
Thoracic Surgery ◽  
General Anesthesia ◽  
Epidural Anesthesia ◽  
Thoracoscopic Surgery ◽  
Lung Ventilation ◽  
Thoracic Epidural Anesthesia ◽  
One Lung Ventilation ◽  
Thoracic Epidural ◽  
Video Assisted ◽  
Video Assisted Thoracoscopic Surgery

Background: In the last years thoracic surgery developed in greater extent with equipments and techniques in one lung ventilation. Still general anesthesia in one lung ventilation approved as gold standard. In thoracic surgery most performed surgeries are plerural decortication and lung biopsy. Avoidance of intubation in Video Assisted Thoracoscopic Surgery (VATS) procedures gains us some advantages in postoperative period; a better respiratory parameters, survival and morbidity mortality rates, reduced hospitalization time and costs, reduced early stress hormone and immune response.  Methods: In this study, we reported our experience of 24 consecutive patients undergoing VATS with Thoracic Epidural Anesthesia (TEA) between December 2015 through July 2016 to evaluate the feasibility, safety and indication of this innovative technique whether it will be a gold standart in thoracic surgeries or not in the future.Results: Operation procedures included wedge resection in 11 (46%) patients (eight of them for pneumothorax, three of them for diagnosis), in 10 (42%) patients pleural biopsy (eight of them used talc pleurodesis), in two (8%) patients air leak control with fibrin glue and in one (4%) patient bilateral thoracal sympathectomy for hyperhidrosis.  We used T4-5 TEA space for 17 (72%) of patients, while we used T4-6 TEA space for 7 (28%) of patients. TEA block reached the desired level after the mean 26.4±4.3 minutes (range 21-34 min). There was no occurrence of hypotension and bradycardia during and after TEA. One (4%) patient required conversion to general anesthesia and tracheal intubation because of significant diaphragmatic contractions and hyperpne. Conversion to thoracotomy was not needed in any patient.Conclusions: We conclude that nVATS procedure with aid of TEA is feasibile and safety with minimal adverse events. The procedure can have such advantages as early mobilization, opening of early oral intake, early discharge, patient satisfaction, low pain level. Nevertheless, there is a need for randomized controlled trials involving wider case series on the subject.

scholarly journals Two-Lung Ventilation: A Safer and More Efficient Method Than One-Lung Ventilation in Bilateral Video-Assisted Thoracoscopic Extended Thymectomy in Myasthenia Gravis

2021 ◽  
Author(s):  
Mijung Yun ◽  
Gunn Hee Kim ◽  
Sung-chul Ko ◽  
Wooshik Kim
Keyword(s):  
Myasthenia Gravis ◽  
Lung Ventilation ◽  
One Lung Ventilation ◽  
Extended Thymectomy ◽  
Time Points ◽  
Video Assisted ◽  
Hemodynamic Variables ◽  
Duration Of Surgery ◽  
Anesthesia Time ◽  
Group D

Abstract Background Myasthenia gravis (MG) is an autoimmune disease and early thymectomy has been recommended. After the introduction of VATS, the safety and effectiveness of carbon dioxide (CO2) insufflation in thoracic cavity (capnothorax) has been continuously controversial. This study aimed to compare the safety and effectiveness of ventilation methods in bilateral video-assisted thoracoscopic extended thymectomy (BVET) with capnothorax.Methods We retrospectively investigated the medical records of MG patients who underwent BVET between August 2016 and January 2018.Patients were divided into two groups: group D (n=26) for one-lung ventilation and group S (n=28) for two lung-ventilation. We set nine anesthesia time points (T0–T8) and collected respiratory and hemodynamic variables including arterial O2 index (PaO2/FiO2).Results The EtCO2 at T0, T1–T4, and T7 were insignificantly higher in group D than those in group S. The SpO2 at T1–T3 and T8 were significantly lower in group D than those in group S. The FiO2 in group S was lower than that in group D at all-time points. The number of PaO2/FiO2 ≤ 300 and PaO2/FiO2 ≤ 200 were significantly higher in group D than those in group S. Hemodynamic variables were not insignificantly different between the two groups at all-time points. The duration of surgery and anesthesia was shorter in group S than that in group D. Conclusions This retrospective study suggests that anesthesia using two-lung ventilation during BVET with capnothorax was a safe and effective method to improve lung oxygenation and reduce the operation and anesthesia time.

Cadaveric evaluation of fluoroscopy‐assisted placement of one‐lung ventilation devices for video‐assisted thoracoscopic surgery in dogs

2019 ◽  
Vol 49 (S1) ◽  
Author(s):  
Philipp D. Mayhew ◽  
Amandeep Chohan ◽  
Brian T. Hardy ◽  
Ameet Singh ◽  
J. Brad Case ◽  
...  
Keyword(s):  
Thoracoscopic Surgery ◽  
Lung Ventilation ◽  
One Lung Ventilation ◽  
Video Assisted ◽  
Video Assisted Thoracoscopic Surgery

Left uniportal VATS for lung decortication after chemical pleurodesis under spontaneous breathing in patient with lymphangiomyomatosis

2021 ◽  
Keyword(s):  
Spontaneous Breathing ◽  
Thoracoscopic Surgery ◽  
Lung Ventilation ◽  
Lung Parenchyma ◽  
One Lung Ventilation ◽  
Chemical Pleurodesis ◽  
Video Assisted ◽  
Lung Expansion ◽  
Talc Poudrage ◽  
Video Assisted Thoracoscopic Surgery

Pneumothorax can be the first symptom of lymphangioleiomyomatosis. Patients with lymphangioleiomyomatosis have a higher risk of recurrence of pneumothorax. Chemical pleurodesis is a viable option to treat the recurrence, but in rare cases, it is not the solution. We present the case of a patient with lymphangioleiomyomatosis undergoing a talc poudrage via video-assisted thoracoscopic surgery for pneumothorax that failed to reexpand the lung. We proposed to the patient a surgical approach to debride the lung parenchyma with the patient under deep sedation with spontaneous breathing. The patient was discharged on the 5th postoperative day. The chest computed tomography scan showed complete lung reexpansion. We advocate that video-assisted thoracoscopic surgery in patients who are awake is a feasible surgical option that permits the restoration of physiological lung expansion in selected patients who underwent chemical pleurodesis and minimizes the risk of one-lung ventilation.

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