Videothoracoscopic approach to primary mediastinal pathology

Study objectives: Personal results and validity of videothoracoscopic (VTS) approach to primary mediastinal diseases are analyzed. Design: Retrospective review of personal experience. Setting: Department of Surgery, San Giuseppe Hospital, University of Milano, Italy. Patients: From September 1991 to January 1999, of a personal series of 1,653 VTS procedures, 118 regarded primary mediastinal diseases. In 47 cases, diagnostic videothoracoscopy was performed to obtain large biopsy specimens or to carry out accurate staging; in 71 cases, full resection was anticipated. Interventions: The patient, intubated with a double-lumen Carlen\u2019s tube and in the lateral decubitus position, underwent videothoracoscopy. Two ports and a small anterior utility thoracotomy were completed. Thorough exploration of the mediastinum and, if possible, complete resection of the lesion were accomplished. Measurements and results: Videothoracoscopy yielded adequate diagnosis or staging in all patients operated on for diagnostic purposes. Of 71 patients operated on with resective intent, 66 had complete thoracoscopic resection (22 stage-I thymomas, 4 thymic cysts, 21 myasthenia gravis associated with thymic hyperplasia, 19 miscellaneous tumors). Conversion was required in five cases, mostly for invasion of mediastinal structures. Complications included the following: one patient developed intraoperative bleeding controlled endoscopically, two patients experienced postoperative bleeding requiring re-thoracoscopy, and one patient had postoperative pneumonia requiring assisted ventilation. One recurrence of malignant thymoma occurred 4 years postoperatively. Conclusions: Videothoracoscopy can attain a leading role in obtaining large samples in lymphatic mediastinal diseases. Dysembriomas, schwannomas, simple cysts, and similar lesions can benefit from VTS removal. Total thymectomy for myasthenia gravis associated with thymic hyperplasia can be performed thoracoscopically. Further data and more extensive experience are needed

L’ernia otturatoria : diagnosi e trattamento di un’ernia rara

Obturator hernia is a very rare condition. It is difficult to diagnose and not infrequently its first manifestation is intestinal obstruction. A case surgically repaired by positioning a polypropylene prosthesis extraperitoneally is reported. The incidence of this disease in old female patients who have recently lost weight and are affected by other chronic illnesses is underlined

Long-term survival after videothoracoscopic lobectomy for stage i lung cancer

Abstract Study objectives: The aim of this study was to evaluate our personal experience and survival curves after video-assisted thoracic surgery (VATS) lobectomies for stage I lung cancer, in comparison with the results reported in existing literature. Design: Retrospective analysis of our experience and an overview of literature. Setting: Department of Surgery, San Giuseppe Hospital, University of Milan. Patients: From October 1991 to December 2001, of 257 patients with clinical stage I lung cancer, 193 patients underwent VATS lobectomy, 7 patients were declared inoperable at thoracoscopic exploration, and 57 patients were converted (18 patients for oncologic reasons and 39 patients for technical reasons). Results: We observed no intraoperative mortality and no recurrence. Survival data were analyzed with the Kaplan-Meier method along with a log-rank test for statistical significance. The global survival rates at 3 years and 5 years were 77.7% and 63.64%, respectively. T1N0 patients had a better survival curve at 3 years and 5 years (83.50% and 70.21%, respectively) compared to T2N0 patients (71.13% and 56.12%). Patients 70 years of age (57.49% and 37.09%). This difference was statistically significant (p < 0.01). Conclusions: Our results after the VATS approach match the \u201cbest\u201d results reported in literature following conventional surgery. Minimally invasive surgery seems to imply reduced tissue damage and decreased impairment of immunologic function. VATS lobectomy permits radical oncology as accurately as lobectomy by thoracotomy, provided that long-established standards are respected. In spite of technical difficulties, it could therefore become a valid alternative in treating stage I lung cancer

Video-assisted thoracoscopic major pulmonary resections: technical aspects, personal series of 259 patients, and review of the literature, Part 2

Background Although more than 10 years have passed since the first video-assisted thoracoscopic lobectomies, these procedures have not gained widespread acceptance. We discuss the technical aspects and major problems associated with these operations, focusing on their present status and future perspectives. The results of our clinical series are presented and the relevant literature is reviewed. Methods From October 1991 to June 2003, 344 patients were submitted to surgery for an intended video major pulmonary resection. Results Of the 344 patients, seven (2.0%) were deemed inoperable at video exploration; 78 (23.1%) required conversion, either for technical reasons (n = 3), anatomical problems (n = 49), oncological conditions (n = 20), or intraoperative complications (n = 6). We carried out 253 video-assisted lobectomies and six pneumonectomies (209 for primary lung tumor, 43 for benign disease, and seven for metastases). There were no intraoperative deaths. Two patients died postoperatively. Complications occurred in 20 patients (7.7%). Global survival at 3 and 5 years was 83.24% (\ub16.9) and 68.87% (\ub19.7), respectively. Patients with T1 N0 cancer had a better survival rate at 3 and 5 years (87.13 \ub1 8.3% and 75.12 \ub1 12.2%) than those with T2 N0 cancer (78.49 \ub1 11.2% and 61.2 \ub1 15%). Conclusions Based on our experience and a review of the literature, we conclude that video-assisted thoracoscopic lobectomies offer less postoperative pain, a more rapid recovery, and better cosmetic results than their conventional counterpart. The results at 3- and 5-year follow-up for cancer are attractive. However, because no randomized study has yet proved these benefits definitively, further studies are still needed

Videothoracoscopic staging and treatment of lung cancer

Accurate staging of thoracic malingnancies is crucial not only to determine the prognosis but also to plan the treatment

Present status of thoracoscopic surgery

The last decade of the past century will surely be remember in the history of surgery for the introduction of minimally invasive techniques

Can routine laparoscopy help to reduce the rate of explorative laparotomies for gastric cancer? Laparoscopy in gastric cancer

1. Background We developed this surgical protocol about performing intraoperative laparoscopy for staging in every patient affected by stomach cancer. Sensitivity and specificity of intraoperative laparoscopy are compared with conventional preoperative staging techniques.2. Methods From January 1994 to June 1999, 83 patients affected by stomach cancer were accepted in our department: 12 patients (14.5%) were excluded from our study after the preoperative staging; in 71 patients (85.5%) an explorative laparoscopy as the first step of the operation was performed.3. Results Laparoscopy confirmed preoperative staging in 53 cases (74.6%), in 12 patients demonstrated an overstaging. Laparoscopy demonstrated in 6 patients unsuspected causes of unresectability.4. Conclusions When performed in patients affected by malignant neoplasm and declared resectable, intraoperative laparoscopy can demonstrate conditions not detectable by traditional preoperative investigations, consequently reducing to zero explorative laparotomies