Thoracic Surgical Procedure

Abstract:这第二版包含18个部分75 chapters written by 79 contributors. Of these, 26 chapters are new, reflecting advances in thoracic surgery during the past ten years. Diaphragmatic pacing, lung transplantation, and laser endoscopic procedures are examples of this expanding field. The text is arranged in a logical sequence of anatomy, physiology, diagnostic procedures, and preoperative evaluation. Following is more specific consideration of the surgical treatment of trauma and diseases of the chest wall, diaphragm, lungs, esophagus, and mediastinum. The section on anesthetic treatment of patients undergoing thoracic surgery includes discussion of postoperative care and ventilatory support. Considerable attention is devoted to the continuing study of the function and motor disturbances of the esophagus in the sections on physiology and the esophagus. Chapters dealing with radiation therapy, chemotherapy, and immunology discuss the optional or adjuvant therapies currently available. Technical aspects are well presented in the section on

Abstract:研究设计。1的前瞻性多中心研究00 consecutive surgical procedures. Objectives. A prospective multicenter study was performed to evaluate the early perioperative complications in 100 endoscopic spinal procedures-78 video-assisted thoracic surgical procedures and 22 laparoscopic lumbar instrumentation and fusion procedures. Summary of Background Data. Endoscopic procedures have been widely applied in general surgery for appendectomy, cholecystectomy, liver resection, Nissen fundoplication, colon resection, and hernia repairs. Video-assisted thoracic surgery is widely used for pleural biopsy, lung resection, and sympathectomy. This is the first large series to date investigating the safety and potential complications using endoscopic surgery for anterior decompression or fusion of the thoracolumbar spine. Methods. Video-assisted thoracic surgical procedures included multilevel anterior thoracic releases for deformity, 27 patients; anterior thoracic discectomies with spinal canal decompression, 41 patients; pyogenic vertebral osteomyelitis decompression, 2 patients; and vertebral corpectomy for neurologic decompression, 8 patients. Mean operative time was 2 hours, 34 minutes (range, 45 minutes to 6 hours), and mean length of stay was 4.97 days (range, 2-21 days). Anterior laparoscopic interbody stabilization and fusion at L4-5 or L5-S1 was performed in 22 patients. The mean operative time was 4 hours, 17 minutes (range, 2 hours, 40 minutes to 9 hours), and the mean length of stay was 5.6 days (range, 1-23 days). Results. The most common video-assisted thoracic surgical complications were transient intercostal neuralgia (six patients) and atelectasis (five patients). The most common laparoscopic complication was bone graft donor site infection (two patients). There were two endoscopic cases that were converted to open procedures, one for extensive pleural adhesions and one for a common iliac vein laceration. Conclusions. The endoscopic spinal approaches proved to be safe operative procedures in 100 consecutive cases. There were no permanent iatrogenic neurologic injuries and no deep spinal infections

Abstract:Video-assisted thoracic surgery is emerging as a viable approach to a number of intrathoracic disorders. Technical difficulties related to improper instrument selection and suboptimal intercostal operative access can reduce the utility of, and the enthusiasm for, the video-assisted thoracic surgical approach. This report describes the intercostal access strategy and the instrument positioning that we now prescribe for many video-assisted thoracic surgical procedures. These approaches have become refined during the course of our experience with 467 patients undergoing video-assisted thoracic operations over the last 18 months.

Abstract:THE pain that accompanies thoracic surgery is notable for its intensity and duration. Acutely, moderate to severe levels of pain may not decrease substantially over the course of hospitalization and the first postoperative month. Chronically, pain can last for months to years, and even low levels of pain can decrease function. Other than pain syndromes associated with limb amputation, pain after thoracic surgery may be the most recognized pain syndrome associated with a specific surgery. Although used with increasing frequency, thoracoscopic approaches have not had the favorable impact on pain that many had anticipated. Given that the adverse effects of thoracic surgery on pulmonary function can be mitigated by effective perioperative analgesia, it is not surprising that thoracic surgeons have joined anesthesiologists in becoming strong advocates of analgesic interventions known to limit the pain accompanying thoracic surgery. Here, we review evidence-based strategies for preventing and treating this type of pain.

Abstract:Objective: Recently, robots have been introduced into surgical procedures in an attempt to facilitate surgical performance. The purpose of this study was to develop a technique to perform thoracoscopic lung resection using a telemanipulation system. Methods: We have used a robotic system to perform thoracoscopic surgery in 12 cases: five lobectomies, three tumor enucleations, three excisions and one bulla stitching completed with fibrin glue for spontaneous pneumothorax. The operations were performed using the Intuitive Microsurgical system (Da Vinci System) through three ports and, a fourth space ‘service entrance’ incision, in the major lung resection. Results: Three procedures begun with the robotic technique were completed by a minimal thoracotomy. No technical operative mishaps were associated with the manoeuvres of robotic arms. In all manoeuvres (up, down, insertion, extraction, etc.), the robotic arms moved appropriately in the favorable operative fields. All patients tolerated the procedure well and the post-operative course was satisfactory, requiring few analgesics. Conclusions: Although further studies on robotically assisted procedures are needed to clarify the clinical feasibility of this procedure, the results in our cases are encouraging. We believe that thoracoscopic procedures using a robotic manipulation system may be technically feasible in selected cases and in the hands of experienced thoracic surgeons. q 2002 Elsevier Science B.V. All rights reserved.