• Journal of Chest Surgery
• /
• v.36 no.10
• /
• pp.748-753
• /
• 2003

Background: The pulmonary nodules (PN), when indicated, need thoracoscopic resection, especially in cases of non-diagnostic or technically infeasible PCNA (percutaneous needle aspiration). In the difficult situations of small or deeply seated PN, several techniques facilitating thoracoscopy have been used for detecting them. Our new protocol for managing PN was developed and prospectively reviewed. Material and Method: In the procedure of PCNA, we firstly placed the tip of the needle in the center of, or just in contact with PN under CT guidance, and loaded one or two segments of platinum radiomarker inside the needle after removing the stylet. Then, we forced the radiomarker to move to the tip of the needle by pushing the stylet. Finally, if the tip of the needle was not within PN, it was reoriented to the their center to obtain the sample for PCNA. Result: Between May 1999 and May 2000, radiomarkers were successfully placed in 28 PN of 26 patients, with the exception of one. In 18 (85%) of 21 nodules needing throacoscopy, intraoperative fluoroscopy was used to detect them or guide stapling resection during thoracoscopy. Conclusion: The advantages of this technique are that there is that there is no need for further localization for thoracoscopy even in cases of unsuccessful PCNA, and it was more effective in respect to both cost and time. Therefore, this strategy for PN expecting thoracoscopy will be helpful to patients and medical staff alike.

• Journal of Chest Surgery
• /
• v.38 no.5 s.250
• /
• pp.371-376
• /
• 2005

Background: Retrospective study was carried out on patients with primary spontaneous pneumothorax with the aim of determining if conventional thoracoscopic wedge resection is superior to modified transaxillary minithoracotomy with thoracoscopy in the surgical treatment. Material and Method: 160 patients, aged 14 to 35 years with primary spontaneous pneumothorax were involved in this study. Patients were assigned to two groups by surgical technique; Conventional thoracoscopic wedge resection (group A; n=80) and modified transaxillary minithoracotomy with thoracoscopy (group B; n=80). Apical pleural abrasion & talc poudrage were performed in all cases. This study evaluated the following factors: duration of operation, days of analgesics used after operation, number of no air leak on the first postoperative day, duration of indwelling chest tube, hospital stay, postoperative complications, chronic chest pain (during follow-up) and resumption of normal activity. Relapses (ipsilateral recurrence after discharge) during follow-up periods were evaluated. Result: No significant differences were found in any of the factors studied in either group. Conclusion: Conventional thoracoscopic wedge resection and modified transaxillary minithoracotomy with thoracoscopy offer similar results in the surgical treatment of primary spontaneous pneumothorax. The rate of complication is low and the level of pain is acceptable without long-term sequele. Therefore, modified transaxillary minithoracotomy with thoracoscopy method appears as a valuable alternative surgical technique.

• Tuberculosis and Respiratory Diseases
• /
• v.40 no.5
• /
• pp.468-473
• /
• 1993

Background: Recent advance in video technology, endoscopic equipments, and surgical techniques have expanded the use of thoracoscopy from diagnosis of the pleural diseases to treatment of the various intrathoracic diseases. Video Assisted Thoracoscopic Surgery(VATS) is a pretty new and fascinating thoracic surgical modality, and so we present our early VATS resuls. Methods: Using Video Thoracoscopic techniques in 30 patients for 10 months from July 1992 to April 1993, we had performed a variety of procedures. These incuded (1) bleb resections in 18 patients (19 cases), (2) mediastinal tumor excision in 4, (3) lung biopsies for parenchymal pulmonary disease in 3, (4) pleural biopasies in 3, (5) pleural tumor excision in 1, (6) and pleuropericardial window in 1. Results: There were no mortality associated with the procedures. We had minor 8 complications; prolonged air leak in 3 patients, prolonged serous drainage in 2, recurrence of pneumothorax in 1, Honer's syndrome in 1, and hoarseness in 1 patient. None of the 30 patients had reverted to the conventional full thoracotomies. Mean postoperative hospital stay of non-complicated pneumothoraces was about 5 days, which was a little shorter than conventional thoracotomy group. Conclusion: Though we had somewhat higher postoperative complication rate due to lack of experiences in the begining, we were able to convince that VATS had benifical value for patients; lesser postoperative pain, shorter hospitalization, quicker recovery time, and cosmetically superior scar. The role of VATS can be expanded to the diagnosis and treatment of various thoracic diseases, even to the cardiovascular diseases, with satisfactory outcome and less postoperative morbidity.

• Journal of Chest Surgery
• /
• v.31 no.1
• /
• pp.40-45
• /
• 1998

Recently, video-assisted thoracoscopic surgery for mediastinal lesions has been considered a new effective therapeutic method. From March, 1992 to April, 1997, 33 cases of video assisted thoracoscopic surgery for mediastinal lesions were performed. Gender distribution was 16 males and 17 females. Average age was 42 years old(ranged from 14 to 69). The locations of lesions were anterior mediastinum in 14 cases, middle mediastinum in 5 cases, posterior mediastinum in 11 cases, and superior mediastinum in 3 cases. These included 9 neurilemmomas, 5 benign cystic teratoma, 4 pericardial cysts, 2 ganglioneuroma, 2 thymus, 2 thymic cyst, 1 thymoma, 2 esophageal leiomyomas, 1 dermoid cyst, 1 lipoma, 1 malignant lymphoma, 1 bronchogenic cyst, 1 pericardial effusion, and 1 Boerhaave's disease with empyema. Working window was needed in 6 cases. We converted to open thoracotomy in 6 cases. Reasons of convertion to open thoracotomy were large sized mass(1), severe adhesion(3), and difficult location to approach(2). The average operation time was 116min($\pm$56 min). The average chest tube drainage time was 4.7days. The average hospital stay was 8.7 days. Operative complications were atelectasis(2), empyema with mediastinitis(1), recurrent laryngeal nerve palsy(1), and plenic nerve palsy(1). In conclusion, VATS for mediastinal lesions were performed with shorter operation time and hospital stay, and lesser complications and pain than those of conventional thoracotomy.

• Proceedings of the KTCVS Conference
• /
• 1993.06a
• /
• pp.60-60
• /
• 1993

• Journal of Chest Surgery
• /
• v.35 no.1
• /
• pp.43-47
• /
• 2002

Background: With the advances of video technology, thoracoscopic surgery has been applied to various areas of the thoracic surgical fields including major surgeries. Now a days,-thoracoscopic surgery is Performed as a procedure of choice for primary spontaneous pneumothorax. But the operative indication for the primary spontaneous pneumothorax has not been changed since the last few decades, although the procedure of choice was changed from open thoracotomy to thoracoscopy. Therefore, we thought new treatment strategy will be necessary for the management of primary spontaneous pneumothorax. Material and Method: Between January 1998 and December 1999, 149 primary spontaneous pneumothorax patients were admitted to the Kyungpook National University Hospital. Result: Of these patients, 177 were first attack pneumothoraces and the number of total attacks were 250. Conclusion: Analyzing the amount of pneumothorax, methods of treatment, number of recurrences, recurrence rate and hospital stay, we propose a critical pathway for establishing new treatment strategy for the management of primary spontaneous pneumothorax.

• Journal of Chest Surgery
• /
• v.42 no.1
• /
• pp.72-78
• /
• 2009

Background: Mediastinal neurogenic tumors are generally benign lesions and they are ideal candidates for performing resection via video-assisted thoracoscopic surgery (VATS). However, benign neurogenic tumors at the thoracic apex present technical problems for the surgeon because of the limited exposure of the neurovascular structures, and the optimal way to surgically access these tumors is still a matter of debate. This study aims to clarify the feasibility and safety of the VATS approach for performing surgical resection of benign apical neurogenic tumors (ANT). Material and Method: From January 1996 to September 2008, 31 patients with benign ANT (15 males/16 females, mean age: 45 years, range: 8~73), were operated on by various surgical methods: 14 VATS, 10 lateral thoracotomies, 6 cervical or cervicothoracic incisions and 1 median sternotomy. 3 patients had associated von Recklinhausen's disease. The perioperative variables and complications were retrospectively reviewed according to the surgical approaches, and the surgical results of VATS were compared with those of the other invasive surgeries. Result: In the VATS group, the histologic diagnosis was schwannoma in 9 cases, neurofibroma in 4 cases and ganglioneuroma in 1 case, and the median tumor size was 4.3 cm (range: 1.2~7.0 cm). The operation time, amount of chest tube drainage and the postoperative stay in the VATS group were significantly less than that in the other invasive surgical group (p<0.05). No conversion thoracotomy was required. There were 2 cases of Hornor's syndrome and 2 brachial plexus neuropathies in the VATS group; there was 1 case of Honor's syndrome, 1 brachial plexus neuropathy, 1 vocal cord palsy and 2 non-neurologic complications in the invasive surgical group, and all the complications developed postoperatively. The operative method was an independent predictor for postoperative neuropathies in the VATS group (that is, non-enucleation of the tumor) (p=0.029). Conclusion: The VATS approach for treating benign ANT is a less invasive, safe and feasible method. Enucleation of the tumor during the VATS procedure may be an important technique to decrease the postoperative neurological complications.

• Journal of Chest Surgery
• /
• v.43 no.4
• /
• pp.399-403
• /
• 2010

Background: Video-Assisted Thoracic Surgery can be performed with the lung collapsed. During the procedure, pleural adhesion may result in lung injury, bleeding, and thoracotomy conversion. Identifying the presence of pleural adhesion before surgery can make it easy to plan trocar introduction and perform the procedure. Material and Method: Between June 2009 and November 2009, we performed ultrasound in 24 patients to detect pleural adhesion before surgery and compared the results with the operative findings. We primarily examined the lateral chest, where the trocar would be inserted, and, occasionally, the anterior or posterior chest. Result: Patient diseases were: 6 hyperhidroses, 8 interstitial lung diseases, 5 lung cancers, 2 mediastinal tumors, 1 peripheral pulmonary embolism, 1 metastatic lung cancer, and 1 sarcoidosis. Of the 22 patients who did not have pleural adhesions on ultrasound, four revealed mild adhesions not related to the trocar insertion sites. However, ultrasound showed pleural adhesions in two patients, consistent with the operative findings. There was no air leak or thoracotomy conversion related with trocar insertion. Conclusion: Ultrasound requires only a few minutes to detect the presence of the pleural adhesion and was very useful in identifying the pleural adhesion before VATS.

• Journal of Chest Surgery
• /
• v.39 no.1 s.258
• /
• pp.80-84
• /
• 2006

A combined anterolateral and posterior approach with thoracotomy has been recommended as the traditional surgical approach for the tumors of the thoracic spine. Recently, because of the morbidity associated with open thoracotomy, the thoracoscopically assisted surgical technique was introduced successfully in thoracic spinal surgery. Herein, we report a combined surgical technique for giant cell tumor of the thoracic spine (T10) consisting of bilateral thoracoscopic anterior release of the spine followed by a posterior on bloc spondylectomy and reconstruction by orthopedic surgeons. The thoracoscopic spinal surgery is safe and effective alternative for other open thoracotomic procedures in the approach to the anterior thoracic spine, avoiding the disadvantage inherent to thoracotomy.

• Journal of Chest Surgery
• /
• v.31 no.3
• /
• pp.336-338
• /
• 1998

Facial hyperhidrosis has a symptom of excessive sweating on the face with or without underlying disease. It can be surgically treated by video-assisted thoracic surgery(VATS). We encountered three cases of facial hyperhidrosis which we treated by VATS, which was performed by resection of the lower third of stellate ganglion and T2-T3 sympathetic ganglia with chains. Postoperative symptom was improved in all cases. There were no postoperative complications such as Horner's syndrome or postsympathectomy neuralgia.