scholarly journals Retrospective review of two-port thoracoscopic (VATS) wedge bullectomy and lung wedge biopsy

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Jimmy Bejjani ◽  
Guillaume Couture ◽  
Juan-Francisco Asenjo ◽  
Marco Sirois ◽  
Chantal Sirois ◽  
...  
Keyword(s):  
Lung Biopsy ◽  
Thoracoscopic Surgery ◽  
Wedge Resection ◽  
Young Patients ◽  
Unknown Origin ◽  
Main Diagnosis ◽  
Pulmonary Infiltrates ◽  
Post Operative Pain ◽  
Tube Removal ◽  
Wedge Biopsy

Background: Video-assisted thoracoscopic surgery (VATS) involving wedge resection of bulla and lung biopsy can be done by two or three-port incisions. Controversy exists as to which approach is superior. We communicate our experience with two-port VATS for these procedures. Methods: We retrospectively analyzed the charts of all patients who underwent a VATS procedure by two-port incisions from July 2001 to July 2007 by two thoracic surgeons (S.C., S.C.) We included in the study all patients who underwent wedge resections for primary or secondary spontaneous pneumothorax and biopsies for pulmonary infiltrates and small nodules. Results: A total of 319 patients’ charts were examined, and 217 of whom had undergone two-port incisions fitted in the inclusion criteria. There were 136 (65.7%) males and 81 (37.3%) females with a mean age of 47 years. Pneumothorax was the main diagnosis for 98 (45%) patients, followed by pulmonary infiltrates for 69 (32%) patients and lung nodules for 50 (23%) patients. The mean operative time and the number of post-op days for chest tube removal and to discharge home in each group have also been recorded. There were few post-operative complications, such as 11 (5%) cases of persistent air leak, 11 (5%) cases of transient fever of unknown origin, 3 (1.4%) cases of pneumonia, 3 (1.4%) cases of bleeding within, one reoperated, and 1 (0.46%) case of C. difficile colitis. The 30-day mortality was 0%. Conclusion: The thoracoscopic (VATS) wedge biopsy via two-port incisions is a safe operation for patients presenting with pneumothorax or requiring a lung biopsy. A two-port approach seems to be a reasonable alternative to three-port incision procedures for these types of diagnosis, regarding post-operative pain and cosmetic benefits particularly for young patients.

scholarly journals Robotic video-assisted thoracoscopic surgery using conventional thoracoscopic access

2020 ◽  
Vol 28 ◽  
pp. 93-100
Author(s):  
Vu Huu Vinh ◽  
Dang Dinh Minh Thanh ◽  
Nguyen Viet Dang Quang ◽  
Truong Cao Nguyen
Keyword(s):  
Thoracic Surgery ◽  
Thoracoscopic Surgery ◽  
Wedge Resection ◽  
Operation Time ◽  
Tumour Resection ◽  
Video Assisted Thoracic Surgery ◽  
Video Assisted ◽  
Tube Removal ◽  
Conventional Open Surgery ◽  
Video Assisted Thoracoscopic Surgery

Video assisted thoracic surgery (VATS) has been widely used and confirmed to be effective and less invasive compared with conventional open surgery. Robotic video-assisted thoracic surgery (R-VATS) is VATSusing a surgeon-controlled robotic system. R-VATS has been increasingly performed worldwide but not in Vietnam. Wehave started implementing r-VATS since July 2018, using conventional thoracoscopic accesses (trocars) and reported our initial results after 18 months of implementation with 116 cases. 57 cases of lobectomy, 9 cases of wedge resection,19 cases of thymectomy, 28 cases of mediastinal tumour resection, 1 case of esophagectomy, 1 case of oesophageal leiomyoma resection, and 1 case of diaphragm plication. 110 cases had good outcomes with no complications, 5 cases suffered from haemothorax that lasted for more than 5 days. Onepatient died after 35 days due to pneumonia. The operation time was comparable to that ofc- VATS. Average time to chest tube removal was 2 days. Time from surgery to discharge was comparable to that ofc-VATS.

scholarly journals Robot - assisted thoracic surgery using conventional thoracoscopic surgery access

2019 ◽  
Vol 9 (3) ◽  
Author(s):  
Hữu Vinh Vũ ◽  
Keyword(s):  
Thoracic Surgery ◽  
Chest Tube ◽  
Thoracoscopic Surgery ◽  
Wedge Resection ◽  
Tumor Resection ◽  
Transition Process ◽  
Lateral Position ◽  
Subxiphoid Approach ◽  
Trocar Placement ◽  
Tube Removal

Abstract Introduction: Video-assisted thoracic surgery (VATS) has been widely used and confirmed to be effective and less invasive compared to traditional open surgery. Robotic-assisted thoracic surgery (RATS ) is actually a VATS using a robot controlled by human surgeon. RATS has been applied worldwide, however still less in Vietnam. We have been starting RATS since July 2018, using conventional thoracoscopic access (trocars). Aim of our paper is to report our initial results after 18 months implementing. Material and Methods: Retrospectively review 116 cases of RATS from July 2018 to January 2020. Trocar were placed according to type of operations: for lobectomy and pathologies of posterior and middle at lateral position with 4 ports, for thymectomy without tumor or with small tumor at lateral position at a 45 degree angle with 4 ports at one chest side or bilateral at subxiphoid approach with 4 ports. Trocars placed follow the endoscopic triangle principle similar to those for VATS Results: Among of 116 cases were : 57 cases of lobectomy, 9 cases of wedge resection, thymectomy - 19 cases, mediastinal tumor resection - 28 cases, esophagectomy - 1 case, esophageal leiomyoma resection - 1 case, and diaphragmatic plication - 1 case. Good outcomes are 110 cases, no complications, 5 cases with prolong air leak requiring chest tube for over 5 days. One death after 35 days due to pneumonia. The surgery time is similar to VATS. Average chest tube removal was 2 days. Post-operative length stay was equivalent to VATS. Conclusion: RATS is safe with good results in our series. The transition process from VATS to RATS is safe in the medical facilities with surgeons who have good background in VATS. The conventional trocar placement is suitable for RATSs application. Keywords: VATS, RATS

scholarly journals Primary Hepatic Neuroendocrine Tumor with Unusual Thyroid Follicular-Like Morphologic Characteristics

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Mohd Elmugtaba Ibrahim ◽  
Kerolos Abadeer ◽  
Qihui (Jim) Zhai ◽  
Aziza Nassar
Keyword(s):  
Liver Transplant ◽  
Neuroendocrine Tumor ◽  
Wedge Resection ◽  
Unknown Origin ◽  
Thyroid Tumor ◽  
Intermediate Grade ◽  
Morphologic Characteristics ◽  
Ischemic Cholangiopathy ◽  
Metastatic Neuroendocrine Tumor ◽  
Primary Hepatic Neuroendocrine Tumor

We describe a primary hepatic neuroendocrine tumor of a 57-year-old Thai woman who presented in 2004 with a suspicious mass in the left hepatic lobe. She underwent left hepatectomy for the 10.5-cm mass, calledintermediate grade neuroendocrine carcinoma of unknown origin,likely metastatic. The tumor recurred in 2007, then calledrecurrent primary hepatic neuroendocrine tumor(PHNET), and the patient underwent liver transplant. Because of similarity between the neuroendocrine tumor and a thyroid tumor—specifically, follicular-like characteristics—immunohistochemical stains for thyroglobulin, TTF1, and calcitonin were performed. However, all were negative. All imaging studies revealed no evidence of a primary lesion other than the liver mass. In 2008, the patient’s liver transplant failed because of ischemic cholangiopathy, and she underwent a second liver transplant. Seven years later, in 2015, she presented with metastatic neuroendocrine tumor of intermediate grade to the lung, consistent with metastatic PHNET. She underwent left upper-lobe wedge resection to remove the tumor. The patient is alive with no evidence of disease at 13 years after initial diagnosis. This rare variant of PHNET had thyroid-like morphologic characteristics but there is no evidence of primary thyroid tumor or thyroid markers in the primary and recurrent hepatic tumors and lung metastasis.

scholarly journals Suspected Pulmonary Metastasis of Actinic Cutaneous Squamous Cell Carcinoma

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Monet E. Meter ◽  
David J. Nye ◽  
Christian R. Galvez
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Actinic Keratosis ◽  
Uv Light ◽  
Light Exposure ◽  
Thoracoscopic Surgery ◽  
Wedge Resection ◽  
Lung Lesion ◽  
The Right

Introduction. It is rare for actinic or squamous cell carcinoma (SCC) in situ to metastasize. Case Presentation. A 67-year-old male had a significant medical history including severe psoriatic arthritis treated with UVB, methotrexate, and rapamycin. He had twenty-five different skin excisions of actinic keratosis four of which were invasive SCC. Our patient developed shortness of breath necessitating a visit to the emergency department. A CT scan of his chest revealed a mass in the right lower lung. A subsequent biopsy of the mass revealed well-differentiated SCC. He underwent thoracoscopic surgery with wedge resection of the lung lesion. Discussion. Actinic keratosis (AK) is considered precancerous and associated with UV exposure. It exists as a continuum of progression with low potential for malignancy. The majority of invasive SCCs are associated with malignant progression of AK, but only 5–10% of AKs will progress to malignant potential. Conclusion. In this case, a new finding of lung SCC in the setting of multiple invasive actinic cutaneous SCC associated with a history of extensive UV light exposure and immunosuppression supports a metastatic explanation for lung cancer.

scholarly journals Adrenocortical carcinoma masquerading as pheochromocytoma: a histopathologic dilemma

2020 ◽  
Vol 2020 ◽  
Author(s):  
Impana Shetty ◽  
Sarah Fuller ◽  
Margarita Raygada ◽  
Maria J Merino ◽  
B J Thomas ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Differential Diagnosis ◽  
Lynch Syndrome ◽  
Adrenocortical Carcinoma ◽  
Renal Carcinoma ◽  
Thoracoscopic Surgery ◽  
Adrenal Adenoma ◽  
Wedge Resection ◽  
Genetic Profile ◽  
List Type

Summary Adrenocortical carcinoma (ACC) is an aggressive cancer that originates in the cortex of the adrenal gland and generally has a poor prognosis. ACC is rare but can be more commonly seen in those with cancer predisposition syndromes (e.g. Li-Fraumeni and Lynch Syndrome). The diagnosis of ACC is sometimes uncertain and it requires the use of precise molecular pathology; the differential diagnosis includes pheochromocytoma, adrenal adenoma, renal carcinoma, or hepatocellular carcinoma. We describe a case of a 57-year-old woman with Lynch Syndrome and metastatic ACC who was initially diagnosed as having pheochromocytoma. The tumor was first identified at 51 years of age by ultrasound followed by a CT scan. She underwent a left adrenalectomy, and the histopathology identified pheochromocytoma. Two years later, she had tumor recurrence with imaging studies showing multiple lung nodules. Following a wedge resection by video-assisted thoracoscopic surgery (VATS), histopathology was read as metastatic pheochromocytoma at one institution and metastatic ACC at another institution. She later presented to the National Institutes of Health (NIH) where the diagnosis of ACC was confirmed. Following her ACC diagnosis, she was treated with mitotane and pembrolizumab which were stopped due to side effects and progression of disease. She is currently receiving etoposide, doxorubicin, and cisplatin (EDP). This case highlights the importance of using a multi-disciplinary approach in patient care. Thorough evaluation of the tumor’s pathology and analysis of the patient’s genetic profile are necessary to obtain the correct diagnosis for the patient and can significantly influence the course of treatment. Learning points: Making the diagnosis of ACC can be difficult as the differential diagnosis includes pheochromocytoma, adrenal adenoma, renal carcinoma, or hepatocellular carcinoma. Patients with Lynch Syndrome should undergo surveillance for ACC as there is evidence of an association between Lynch Syndrome and ACC. Conducting a complete tumor immunoprofile and obtaining a second opinion is very important in cases of suspected ACC in order to confirm the proper diagnosis. A multi-disciplinary approach including genetic testing and a thorough evaluation of the tumor’s pathology is imperative to ensuring that the patient receives an accurate diagnosis and the appropriate treatment.

scholarly journals Pleurodesis methods in the surgical treatment of primary spontaneous pneumothorax

2021 ◽  
pp. 77-81
Keyword(s):  
Surgical Treatment ◽  
Recurrence Rate ◽  
Spontaneous Pneumothorax ◽  
Thoracoscopic Surgery ◽  
Wedge Resection ◽  
Primary Spontaneous Pneumothorax ◽  
High Recurrence Rate ◽  
Parietal Pleura ◽  
Advantages And Disadvantages ◽  
Video Assisted Thoracoscopic Surgery

Pneumothorax is the collection of air in the pleural space. Pneumothorax can be spontaneous, traumatic or iatrogenic. Primary spontaneous pneumothorax mostly occurs in healthy individuals without an apparent cause, probably due to the rupture of subpleural emphysematous bullae located on the apex of the lung. It usually occurs in tall and healthy males younger than 40 years old. Primary spontaneous pneumothorax has a recurrence rate of 20-30% after the first attack, 50% after the second attack, and 80% after the third attack. Surgery is presented as a treatment option to reduce the high recurrence rate after the second attack. It has been reported that recurrence is between 10 and 20% in patients who undergo bullectomy or wedge resection with endoscopic steps alone. Therefore, various pleural pleurodesis methods are applied in addition to bulla resection in order to reduce the recurrence rate after surgery. In mechanical pleurodesis, adhesion between visceral and parietal pleura is achieved by mechanical abrasion of the parietal pleura or by total or partial removal of the parietal pleura. In chemical pleurodesis, the visceral pleura is adhered to the parietal pleura by creating irritation in the pleura with chemical agents. In cases where pleurodesis was added, the recurrence rate was reported to be between 1.7 and 2.8%. Whether the pleurectomy, pleural mechanical or chemical abrasion methods performed with video-assisted thoracoscopic surgery is superior for preventing recurrence is still a matter of debate. In this article, we aimed to discuss the advantages and disadvantages of pleurodesis methods in the surgical treatment of primary spontaneous pneumothorax in the light of the literature.

The Impact of Open Lung Biopsy on Diffuse Pulmonary Infiltrates in Patients with AIDS

2009 ◽  
Vol 75 (2) ◽  
pp. 157-162
Author(s):  
Chao-hsiang Lee ◽  
Jang-ming Lee ◽  
Chien-ching Hung ◽  
Pei-ming Huang ◽  
Shunn-wen Kuo ◽  
...  
Keyword(s):  
Lung Biopsy ◽  
Pulmonary Infiltrate ◽  
Therapeutic Benefit ◽  
Open Lung Biopsy ◽  
University Hospital ◽  
Severe Illness ◽  
Open Lung ◽  
Pulmonary Infiltrates ◽  
Prolonged Air Leak ◽  
The Impact

The evidence concerning open lung biopsy (OLB) for diffuse pulmonary infiltrates in patients with AIDS is limited. This study retrospectively evaluated the diagnostic and therapeutic yields of OLB compared with bronchoscopy for patients with AIDS with diffuse pulmonary infiltrate treated in the National Taiwan University Hospital from 1997 to 2004. There were 15 and 46 patients enrolled in the OLB and bronchoscopic groups in this study, respectively. As compared with the bronchoscopic group, patients from the OLB group had a higher chance of acquiring a specific diagnosis and possible change of therapy (73 vs 32.6% and 60 vs 21.7%, respectively; P < 0.05). There were two (13.3%) patients with prolonged air leak (greater than 7 days) in the OLB group, whereas four patients (8.7%) had procedure-related complications in the bronchoscopic group. There was no procedure-related mortality in the OLB group. This study demonstrated that OLB can be safely performed in select patients and provide a superior diagnostic and therapeutic benefit compared with bronchoscopy for diffuse pulmonary infiltrates in patients with AIDS. This procedure should be performed early in the clinical course to avoid irreversible clinical deterioration of the patients with severe illness.

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