Video - assisted thorascopic surgery , novel technical devices and tracheal problems

printing supported by Chiesi Farmaceutici SpA. Visit Chiesi Farmaceutici SpA. at Stand G.90 MONDAY, SEPTEMBER 20TH 2010 P2758 Value of video-assisted thoracoscopic surgery (VATS) in the diagnosis and treatment of in mediastinal and pleura-pulmonary diseases Hamdy Mahmoud, Ayman Abdelghaffar, Essam Hashem. Chest Diseases and Tuberculosis, Sohag Faculty of Medicine, Egypt Cardiothoracic Surgery, Sohag Faculty of Medicine, Egypt Cardiothoracic Surgery, Sohag Faculty of Medicine, Egypt Objective: Thoracoscopy offers great advantages when compared to open surgery in terms of postoperative pain and pulmonary complications. Thoracoscopy is safe and feasible with minimal morbidity. The purpose of this study is to evaluate the indications, surgical procedures, complications, and failure rates of VATS in the diagnosis and treatment of intrathoracic diseases. Material and method: One hundreds seventy patients 112 men and 58 women, with age ranging from 17 to 75 years (mean 45.7 years) underwent one hundreds seventy VATS procedures. Indications included pneumothorax (50), empyema (20), solitary pulmonary nodules (23), diffuse lung disease (12),undiagnosed pleural effusions (40), mediastinal masses or cysts (20),bronchiectasis with hemoptysis (5). Results: Of the 170 VATS procedures, 157 (92.4%) procedures were successfully performed. Thirteen patients required conversion to thoracotomy. There were 19 postoperative complications: prolonged air leak for more than 5 days was seen in 8 patients & Wound infection occurred in 3 patients.The success rate of the diagnostic, therapeutic, D&T procedures were (91%, 93.3% & 92.2%) respectively. Only small doses of analgesics were needed. There was no intraoperative mortality. The mean operative time, duration of chest tube drainage and postoperative hospital stay were (71 minutes, 2.5 days & 5.1 days)respectively. Conclusion: VATS is a safe and effective method for diagnosis and treatment of intrathoracic diseases. Patients had benefit in reduced postoperative pain, short hospitalization, short recovery times and good cosmetic result. P2759 The role of video-assisted cervical mediastinoscopy in mediastinal nodal assessment Oleg Stupachenko1, Denys Stupachenko1, Arkadiy Visotskiy1, Nadiya Monogarova2, Olena Semendyayeva2. 1Thoracic Surgery Department, Donetsk Regional Clinical Territorial Medical Association, Donetsk, Ukraine; 2Department of Internal Medicine after Prof. A.Y Gubergriz, Donetsk National Medical University Named after M. Gorky, Donetsk, Ukraine Cervical mediastinoscopy is a common procedure for the diagnostics of mediastinal lymphadenopathy and staging of lung cancer. Methods: From 2005 to 2009 a total of 127 video-assisted cervical mediastinoscopies were performed in our clinic. Indications for the procedure were the following: lung cancer with enlarged mediastinal lymph nodes -74 cases, mediastinal lymphadenopathy of unknown etiology – 53 cases. Results: In first group metastatic changes in lymph nodes were stated in 23 (31,1%) patients, the rest of the patients (51; 68,9%) underwent subsequent thoracothomy. In second group the diagnosis of sarcoidosis were obtained in 32 cases, lymphoma – in 18, anthracosilicosis – in 2, nonspecific reactive lymphadenitis – in 1 case. There were one intraoperative complication (hemorrhage from pulmonary artery which was stopped by tight tamponade). No postoperative complication and mortality occurred. Conclusion: Video-assisted cervical mediasttinoscopy is safe and effective procedure in nodal assessment of the mediastinum. P2760 Secondary spontaneous pneumothorax – Is VATS better than thoracotomy? Andrey Akopov, Alexei Agishev, Vladimir Varlamov. Lung Surgery, Research Institute of Pulmonology, Pavlov’Medical University, Saint-Petersburg, Russian Federation Background: That is not clearly whether pleurectomy using open or VATS procedures resulted in better outcomes for pneumothorax in patients with interstitial lung diseases. Methods: We prospectively reviewed 23 patients with interstitial lung diseases who underwent thoracotomy (12) and video-assisted thoracic surgery (11) pleurectomy for spontaneous pneumothorax. The median follow-up period was 38 months postoperatively. Results: The median operating time was significantly shorter in VATS than thoracotomy cases (62 vs. 82 min; p=0,01). Postoperative chest tube drainage was shorter in VATS group. There were no differences in chest tube duration (2,1 vs. 2,2 days; p=0,34) and postoperative hospital stay (6,1 vs. 6,8 days; p=0,12). Short-term complications were: prolonged air leak (18%) and haemothorax (9%) in VATS group and non in open group. Postoperative pneumothorax recurrences were significantly more frequent in VATS group (27% vs. 0; p=0,00). Conclusions: Pleurectomy by thoracotomy resulted in better outcomes than VATS pleurectomy for spontaneous pneumothorax in interstitial lung diseases. P2761 Medical thoracoscopy at patients with pleural effusion: Diagnostics and treatment, what’s more? Sergey Pushkin, Armen Benyan, Alexander Reshetov. Thoracic Surgery, Samara Regional Clinical Hospital, Russian Federation Combination of diagnostic and medical components of medical thoracoscopy helps to manage the course of disease. Application of medical thoracoscopy on the first phase of disease is the perspective approach in the treatment of pleurisy. In the department of thoracic surgery there are 273 medical thoracoscopy have been performed in period from 1999 to 2008 years. The tactics for definition of indications for thoracoscopy depends on duration of pleurisy, its sizes, characteristics of anamnesis, presence of multiple encapsulations. At thoracoscopy were diagnosed: tuberculosis – at 78 patients, mesothelioma – at 58 patients, metastatic pleurisy – 7 patients, non-specific pleurisy – 112 patients. Big number of patients with non-specific pleurisy is the consequence of the fact that pleura becomes inflamed at many diseases. Exclusion of specific cause of pleurisy at these patients directs to adequate therapy. Also, application of thoracoscopy reveals such rare pathology as sarcoidosis of pleura – at 16 patients, ascariasis of pleura – at 1, yellow nail syndrome – at 1 patient. After diagnostics we perform the dissection of encapsulations, elimination of fibrin, lung decortication. So the value of diagnostic and medical components of medical thoracoscopy is equivalent. Small trauma of operation and possibility of local anesthesia are positive sides of this method. Early application of thoracoscopy furthers to quick start of etiotropic therapy, prevents multiple encapsulations, development of empyema. P2763 Our autoflorescence VATS experience: 6 cases Serife Liman1, Salih Topcu1, Aykut Eliçora1, Korkmaz Burc1, Salih Mehmetoglu1, Serkan Ozbay1, Tulay Hosten2, Ahmet Ilgazli3 . 1Thoracic Surgery, 2Anesthesiology, 3Chest Diseases, Kocaeli University Medical Faculty, Turkey VATS is performed for diagnosis and treatment of pleural pathologies. It is seen that white light is insufficient in some lesions especially for premalignant lesions in endoscopic procedures like bronchoscopy and autoflorescence systems is used. It has been used in thoracoscopy also. We would like to discuss our 6 cases here, even it is a small serie, because as far as we know autoflorescence VATS is first used in our clinic in Turkey and they are the first experiences. Autoflorescence VATS was used in 6 cases, 1 female, 5 male with age range between 22 and 58 in our clinic. The diagnosis was not achieved from previously performed examinations to explain the etiology of pleural fluid.