Practical Thoracoscopy

ISBN-13: 9783642755606 / Angielski / Miękka / 2011 / 107 str.

Christian Boutin; Jean R. Viallat; Yossef Aelony

Opis

This practical book has two main goals. The first is to show that thoracoscopic techniques are simple, require only short-term hospitalization, use only basic equipment, and are within the capability of not only surgeons, but other specialists as well. The second is to emphasizethe exciting aspects of this endoscopic procedure with its wide variety of findings in the pleura, the diaphragm, the lung, and the mediastinum. Under direct vision a general diagnosis is made within seconds and confirmed by microscopy within hours. Forty endoscopic pictures show the main pattern of pleural diseases; one hundred drawings, schemes, and X-rays demonstrate all the technical aspects. In addition, indications and outcome of pleural effusions, pleurodesis in chronic effusions, spontaneous pneumothorax, thoracoscopic lung biopsy, empyema, andlaser coagulation in the pleural cavity are described. This new approach demonstrates that thoracoscopy is less invasive and safer than thoracotomy. Physicians who have carefully studied this practical guide to help them master the technique should be able to perform thoacoscopy withoutdifficulties or complications.

Spis treści

1: History and Evolution of the Technique.- 2: Equipment.- 2.1 The Thoracoscope.- 2.1.1 Trocars.- 2.1.2 Telescopes.- 2.1.3 Forceps.- 2.2 Auxiliary Instruments and Accessories.- 2.3 Endoscopic Photography.- 2.4 The Endoscopy Room.- 2.5 Aseptic Conditions.- 3: Thoracoscopy Technique.- 3.1 Induced Pneumothorax.- 3.1.1 The Pleural Trocar.- 3.1.2 On the Endoscopy Table.- 3.1.3 The Day Before the Examination.- 3.2 Selecting the Point of Entry.- 3.2.1 The Standard Point of Entry.- 3.2.2 Point of Entry for Specific, Localized Lesions.- 3.3 Anesthesia.- 3.3.1 Premedication.- 3.3.2 Local Anesthesia.- 3.3.3 “Neuroleptanalgesics”.- 3.3.4 General Anesthesia.- 3.3.5 Conclusion.- 3.4 Position of the Patient.- 3.4.1 Lateral Decubitus.- 3.4.2 Dorsal Decubitus.- 3.4.3 Ventral Decubitus.- 3.5 Thoracoscopy Using a Single Point of Entry.- 3.5.1 Insertion of the 7-mm Trocar.- 3.5.2 The Thoracoscopy.- 3.6 Endoscopic Anatomy.- 3.6.1 The Pleura.- 3.6.2 The Lung.- 3.6.3 The Mediastinum and Great Vessels.- 3.7 Pleural Biopsy Technique.- 3.8 Number of Biopsies.- 3.9 The Second Point of Entry.- 3.10 Dividing Adhesions (Pneumonolysis).- 3.11 The Pulmonary Biopsy Technique.- 3.12 The Rest of the Examination.- 3.13 Positioning the Chest Tube for Pleural Drainage.- 3.14 The YAG Laser Option.- 3.14.1 Materials.- 3.14.2 Indications.- 3.15 Conclusion.- 4: Thoracoscopic Sequelae: Side Effects, Complications, Prevention.- 4.1 Morbidity.- 4.2 Practical Preventive Measures.- 4.2.1 Criteria for Patient Selection.- 4.2.2 Patient Monitoring During the Examination.- 4.2.3 Local Preventive Radiotherapy.- 4.3 Pleural Drainage Technique.- 4.3.1 Chest Tube Drainage of Short Duration.- 4.3.2 Chest Tube Drainage of Medium Duration.- 4.3.3 Long-Term Drainage (> 7 days).- 4.4 Temperature Curve After Thoracoscopy.- 5: Diagnostic Thoracoscopy for Pleural Effusions.- 5.1 Indications.- 5.2 Metastatic Pleural Malignancies.- 5.2.1 Topography of Pleural Malignancies.- 5.2.2 Histopathological Results.- 5.2.3 Cancer of the Lung.- 5.2.4 Breast Cancer and Other Hormone-Dependent Cancers.- 5.3 Diffuse Malignant Mesothelioma.- 5.3.1 Indications for Thoracoscopy.- 5.3.2 Macroscopic Examination.- 5.3.3 Histopathological Aspects of Mesothelioma.- 5.3.4 Prognostic Aspects of Mesothelioma.- 5.4 Tuberculous Pleural Effusions.- 5.5 Miscellaneous Causes of Chronic Pleurisy.- 6: Pleurodesis for Chronic Pleural Effusion.- 6.1 Which Types of Pleurisy Require Pleurodesis?.- 6.2 Is Drainage of the Effusion a Necessity?.- 6.3 Deloculation of the Pleural Fluid is Often Useful.- 6.4 Sclerosing Agents.- 6.5 Newer Agents for Pleurodesis, Including Bioadhesives.- 6.6 Conclusion.- 7: Thoracoscopy in the Diagnosis and Treatment of Spontaneous Pneumothorax.- 7.1 Indications for Thoracoscopy.- 7.2 Thoracoscopic Findings in Spontaneous Pneumothorax.- 7.3 Results of Induced Pleurodesis in Spontaneous Pneumothorax.- 7.4 Conclusion.- 8: Other Indications for Thoracoscopy.- 8.1 Pulmonary Biopsy.- 8.1.1 Indications.- 8.1.2 Contraindications.- 8.1.3 Associated Morbidity.- 8.1.4 Results.- 8.2 Empyema.- 8.3 Diverse Indications.- References.