Video Assisted Thoracoscopic Surgery in Exudative Pleural Effusion and its Complication Management: An Experience in a Community Hospital

Background: Exudative pleural effusions are common presentation of pleural disease. Long standing pleural effusion might complicate with loculations and cortex formation. Video assisted thoracoscopic surgery can be a useful tool for the diagnosis and the management of the complications. The aim of the study is to determine the cause and treat the complications related to the exudative pleural effusions. Materials and Methods: It is a retrospective analysis of prospectively collected data of all patients with exudative pleural effusions subjected to surgical management. Data were collected over a period of four years in a community hospital in Kathmandu. Results: Of 38 patients who underwent Video assisted thoracoscopic surgery only 33 were eligible for analysis. Male to female ratio was 2.3:1 with male (23) dominance. Twenty six (78.8%) had lymphocyte predominance and 23 (69.7%) had Adenosine deaminase level of more than 40 International unit in pleural fluid analysis. In histopathological examination most common finding was granulomatous inflammation 13 (39.4%), 9 (27.3%) were malignancy and 9 (27.3%) were nonspecific chronic inflammation. Of malignancies adenocarcinoma 3 (9.09%) was the most common finding, mesothelioma 2(6.06%) and 4 (12.12%) other. Conclusion: Video assisted thoracoscopic surgery has a role to play in diagnosis of exudative pleural effusions, particularly when there is dilemma in diagnosis. Video assisted thoracoscopic surgery definitely has a role in diagnosis and treatment of the complications related to pleural effusions.

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Uniportal Video-Assisted Thoracoscopic Surgery for the Management of Pleural Effusions, Empyema and Pleural Biopsy

Atlas of Uniportal Video Assisted Thoracic Surgery ◽

10.1007/978-981-13-2604-2_7 ◽

2019 ◽

pp. 47-49

Author(s):

Marco Scarci ◽

Fabrizio Minervini ◽

Gaetano Rocco

Keyword(s):

Thoracoscopic Surgery ◽

Pleural Effusions ◽

Pleural Biopsy ◽

Video Assisted ◽

Video Assisted Thoracoscopic Surgery

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Efficacy and Cost of Awake Thoracoscopy and Video-Assisted Thoracoscopic Surgery in the Undiagnosed Pleural Effusion

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2018.02.044 ◽

2018 ◽

Vol 106 (2) ◽

pp. 361-367 ◽

Cited By ~ 12

Author(s):

Christine M. McDonald ◽

Camille Pierre ◽

Marc de Perrot ◽

Gail Darling ◽

Marcelo Cypel ◽

...

Keyword(s):

Pleural Effusion ◽

Thoracoscopic Surgery ◽

Video Assisted ◽

Video Assisted Thoracoscopic Surgery

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Hyperthermic intrapleural chemotherapy combined with endostar by video-assisted thoracoscopic surgery for lung adenocarcinoma with pleural dissemination.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e17542 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e17542-e17542

Author(s):

Lei Yu

Keyword(s):

Pleural Effusion ◽

Lung Adenocarcinoma ◽

Thoracoscopic Surgery ◽

Pleural Effusions ◽

Term Survival ◽

Pleural Dissemination ◽

Malignant Pleural Effusions ◽

Video Assisted ◽

Intrapleural Chemotherapy

e17542 Background: Patients with lung adenocarcinoma and malignant pleural effusions have limited life expectancy. The treatment of lung adenocarcinoma with malignant pleural effusions remains controversial. The purpose of our study is to evaluate the use of video-assisted thoracoscopy to perform hyperthermic intrapleural chemotherapy combined with Endostar (recombinant human endostatin) for disseminated pleural adenocarcinoma. Methods: From 2007 to 2010, there were 46 patients with lung adenocarcinoma and pleural dissemination undergoing thoracoscopic surgery and intrathoracic hyperthermic perfusion with chemotherapy in combination of Endostar. After thoracoscopic surgery, the hyperthermic perfusion system was set up for hyperthermic intrapleural chemotherapy. The thoracic cavity was perfused at a speed of approximately 1.8-2.3 L/min with 0.9% normal saline (4-5L), containing cisplatinum (100 mg). The intrathoracic temperature remained between 42°C to 43°C. This process of perfusion lasted for 1 hours. Following this, 2L of 0.45% saline with Endostar (30 mg) at a temperature of 30 °C was put into the pleural cavity and kept for 30 min. Results: There were no peri-operative deaths. During the hyperthermic perfusion, patient's core temperature varied from 36.3ºC and 39.3ºC and pulse from 59 beats/m and 126 beats/m. Intraoperative sinus tachycardia occurred in 2 elderly cases. No hematologic toxicity and nephrotoxicity was observed within one week after surgery. Postoperative pneumonia occurred in 1 elderly case. The median survival time was 21 months. During the follow-up period, only one patient suffered from continuing pleural effusion due to atelectasis, one elderly patient died of heart failure one year after surgery and the remaining patients were completely free from pleural effusion during the last follow-up. Conclusions: Hyperthermic intrapleural chemotherapy combined with Endostar by thoracoscopic surgery offers a safe and effective treatment for lung adenocarcinoma with pleural dissemination. It may be time-consuming, but beneficial and may have an encouraging impact on its long-term survival.

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Uniportal video-assisted thoracoscopy surgery in lung cancer: largest experience

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492319868651 ◽

2019 ◽

Vol 27 (7) ◽

pp. 559-564

Author(s):

Balasubramanian Venkitaraman ◽

Jiang Lei ◽

Wu Liang ◽

Cai Jianqiao

Keyword(s):

Lung Cancer ◽

Thoracoscopic Surgery ◽

Primary Lung Cancer ◽

Median Number ◽

Short Term ◽

Female Ratio ◽

Oncological Outcomes ◽

Video Assisted ◽

Video Assisted Thoracoscopic Surgery

Background Uniportal video-assisted thoracoscopic surgery is one of the latest development in minimal invasive thoracic surgery. It is being increasing applied in various parts of the world for the treatment of lung cancer. Although the technique has become popular, there is a lack of largescale literature addressing the safety and oncological outcomes. We aimed to describe our experience, highlighting the short-term outcomes and oncological efficacy. Methods From July 2013 to December 2017, 441 uniportal video-assisted thoracoscopic procedures were carried out in patients with primary lung cancer and no metastatic disease. The male-to-female ratio was 240:201. The median age of the patients was 63 years (range10 to 85 years). Results The median number of mediastinal lymph node stations dissected and median number of mediastinal nodes were 5 and 14, respectively. Ten or more nodes were dissected in 93.1% of patients. All surgeries were complete R0 resection. Minor postoperative morbidity according to the Clavien-Dindo classification was 4%. Seven patients experienced major morbidity requiring intensive care management. There was no 30-day mortality. Conclusion Uniportal video-assisted thoracoscopic anatomical resection for lung cancer appears to have similar postoperative outcomes to multiport surgery in terms of short-term morbidity and oncological efficacy. Uniportal video-assisted thoracoscopic surgery can be offered as a standard of care for lung cancer surgery in centers with adequate surgical expertise. Long-term follow-up will be needed to establish the long-term oncological outcomes.

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Paediatric empyema: video-assisted thoracoscopic surgery (vats) and its outcome study

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20171691 ◽

2017 ◽

Vol 4 (3) ◽

pp. 882

Author(s):

Manasa G. ◽

Swetha B. ◽

Yashoda H. T. ◽

Pramod S.

Keyword(s):

Chest Pain ◽

Respiratory Distress ◽

Thoracoscopic Surgery ◽

Supplemental Oxygen ◽

Empyema Thoracis ◽

Chest Tubes ◽

Female Ratio ◽

Duration Of Stay ◽

Video Assisted ◽

Video Assisted Thoracoscopic Surgery

Background: Empyema thoracis defined as purulent pleural effusion is a common condition in children with significant morbidity and mortality. The aim of therapy for empyema is to ensure rapid recovery with a normal long term pulmonary outcome. VATS (Video-assisted thoracoscopic surgery) is gaining acceptance as a primary modality of treatment in cases of early empyema. VATS is associated with decreased morbidity and reduced hospital stay of the patient. Methods: This is a retrospective observational study conducted in the department of pediatrics KIMS Hospital, Bengaluru from November 2014 to November 2016. In this study, review of the medical records of all the children aged 2 months to 18 years, who underwent VATS for empyema was done. The children included in the study were diagnosed with empyema thoracis based on chest X- ray, USG chest and CT chest and have undergone VATS by pediatric surgical team. Results: The median age of presentation was 4.1 yrs. 18 children were malnourished of which 3 had severe malnutrition. Male to female ratio was 1:1. Most common symptoms were fever (96%), cough (84%), respiratory distress (61%) and chest pain (48%). All patients had parapneumonic effusions and received antibiotics before undergoing surgery. Post-operative supplemental oxygen was required for 2.5±0.5 days. Chest tubes were removed in 4.53±0.7days and duration of stay in hospital was 8.26±1.77 days. All patients were afebrile before discharge and were discharged on oral antibiotics. Follow-up data showed that symptoms resolved in 24 children, 2 children had complications, one child had a pneumothorax and another had a broncho-pleural fistula. Results: Most common symptoms were fever (96%), cough (84%), respiratory distress (61%) and chest pain (48%). All patients had parapneumonic effusions and received antibiotics before undergoing surgery. Post-operative supplemental oxygen was required for 2.5±0.5 days. Chest tubes were removed in 4.53±0.7days and duration of stay in hospital was 8.26±1.77 days. All patients were afebrile before discharge and were discharged on oral antibiotics.Conclusions: These results suggest that primary operative therapy in the form of VATS is an effective treatment option for children with empyema. VATS is associated with a lower in-hospital mortality rate, re-intervention rate, length of stay and duration of tube thoracostomy.

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