Thoracoscopic procedures for intrathoracic diseases: the present status

Preferred surgical procedure for posterior mediastinal neurogenic tumor

AIM

  To compare the outcomes of video-assisted thoracoscopic surgery (VATS) with those of thoracotomy for the removal of posterior mediastinal neurogenic tumors.

METHODS

  Twenty-four patients were enrolled in the VATS group and 29 were enrolled in thoracotomy group between 1996 and 2010.

RESULTS

  When compared with the thoracotomy group, patients in the VATS group had a shorter operation time (90 ± 29 min vs. 136 ± 41 min, P < 0.001), less blood loss (42 ± 12 mL vs. 209 ± 162 mL, P < 0.001), shorter time to extubation and discharge (2.5 ± 0.7 days vs. 3.1 ± 1.0 days, P= 0.027; 3.6 ± 0.6 days vs. 4.1 ± 1.0 days, P= 0.045).

CONCLUSION

  VATS is a safe and effective surgical procedure for posterior mediastinal neurogenic tumors with better outcomes than thoracotomy.

Videothoracoscopic surgical approach for spontaneous pneumothorax: review of the pertinent literature

Spontaneous pneumothorax is usually caused by the rupture of subpleural blebs/bullae in the underlying lung and is one of the most common elective applications of video-assisted thoracoscopic surgery (VATS). VATS has been used as an alternative to thoracotomy in the treatment of spontaneous pneumothorax. Recurrent pneumothorax and persistent air leakage are quite often indications for spontaneous pneumothorax, and bilateral spontaneous pneumothorax is also considered to be an indication for surgical intervention. The goals of surgical intervention are to eliminate intrapleural air collection and prevent recurrence. Diverse procedures have been reported in the surgical treatment for spontaneous pneumothorax. We review the literature regarding the VATS approach for spontaneous pneumothorax.

Estimation of performance and sequential selection of diagnostic tests in patients with lung lesions suspicious for cancer

CONTEXT

Measuring variation in clinician test ordering behavior for patients with similar indications is an important focus for quality management and cost containment.

OBJECTIVE

To obtain information from physicians and nonphysicians regarding their test-ordering behavior and their knowledge of test performance characteristics for diagnostic tests used to work up patients with lung lesions suspicious for cancer.

DESIGN

A self-administered, voluntary, anonymous questionnaire was distributed to 452 multiple-specialty physicians and 500 nonphysicians in academic and private practice in Pennsylvania, Iowa, and North Carolina. Respondents indicated their estimates of test sensitivities for multiple tests used in the diagnosis of lung lesions and provided their test selection strategy for case simulations of patients with solitary lung lesions. Data were analyzed using descriptive statistics and the chi(2) test.

RESULTS

The response rate was 11.2%. Both physicians and nonphysicians tended to underestimate the sensitivities of all minimally invasive tests, with the greatest underestimations reported for sputum cytology and transthoracic fine-needle aspiration biopsy. There was marked variation in sequential test selection for all the case simulations and no association between respondent perception of test sensitivity and their selection of first diagnostic test. Overall, the most frequently chosen first diagnostic test was bronchoscopy.

CONCLUSIONS

Physicians and nonphysicians tend to underestimate the performance of diagnostic tests used to evaluate solitary lung lesions. However, their misperceptions do not appear to explain the wide variation in test-ordering behavior for patients with lung lesions suspicious for cancer.

Detection and localization of pulmonary air leaks using laser-polarized (3)He MRI

Pulmonary air leaks were created in the lungs of Yorkshire pigs. Dynamic, 3D MRI of laser-polarized (3)He gas was then performed using a gradient-echo pulse sequence. Coronal magnitude images of the helium distribution were acquired during gas inhalation with a voxel resolution of approximately 1.2 x 2.5 x 8 mm, and a time resolution of 5 sec. In each animal, the ventilation images reveal focal high-signal intensity within the pleural cavity at the site of the air leaks. In addition, a wedge-shaped region of increased parenchymal signal intensity was observed adjacent to the site of the air leak in one animal. (3)He MRI may prove helpful in the management of patients with pulmonary air leaks.