| What are things to be aware of in thoracic sympathectomy? | - Horner’s syndrome (ptosis, myosis, enophtalmy, and palpebral anhydrosis),
- Reactive hyperhydrosis of the lower body,
- Dry skin of the upper body |
| What are important anatomic landmarks and surgical techniques for thoracoscopic surgery? | Intercostal arteries come from descending aorta.
• Classical thoracotomy techniques (5th intercostal space incision), big and multiple retractors used:
- invasive,
- trauma to chest wall muscles,
- trauma to intercostal nerves with longterm consequences (chest wall paresthesia) due to retractors and closure stitches,
- chronic pleuritic pain (weather changes).
• Minimally invasive video-assisted techniques (VATS) avoid most of these side effects. |
| What are advantages of VATS? | • Less invasive.
• Less traumatic to chest wall muscles and intercostal nerves.
• Less pleuritic pain.
• Less pulmonary post-operative complications.
• Less cardiac post-operative complications.
• Faster recovery.
• Less hospital stay |
| What are thoracoscopic surgery general principles? | • General anesthesia.
• Oro-tracheal selective intubation: double-lumen tube (Carlens, Malinckrodt®)
Instruments: Trocars
Patient Positioning (triportal trocar positioning) |
| What are indications of VATS? | • Diagnostic pleuroscopy.
• Pleural biopsies.
• Lung biopsies.
• Mediastinal biopsies.
• Resection of pleural adhesions: (empyema, hemothorax, chronic effusion)
• Pleurectomy (recurrent pneumothorax.)
• Pleurodesis: (pleural carcinosis, recurrent benign pleural effusion)
• Pericardial effusion (pericardial biopsy, pericardiocenthesis (posterior loculations), creation of a pleuro-pericardial window (drainage of benign pericardial effusion into the pleura).
• Bullae resection: (emphysema (obstructive disease), bullous disease of the pulmonary apex (blebs))
• Pulmonary resections: nodule, wedge, lobectomy, pneumonectomy) |
| What is indication for VATS thoracic sympathectomy? | - Hyperhidrosis of the hands,
- Erythrophobia (increased reactivness of the face: excessive redness),
- Raynaud’s disease (isolated),
- Ischemic disease of digits. |
| Table of indications of VATS dX? | . |
| Table of indication of VATS tx? | . |
| Table of CI of VATS? | . |
| What are indications of VATS in sponteneous pneumothorax bleb rupture? | - Persistent air leak after adequate drainage,
- Recurrent pneumothorax (1st episode),
- Bilateral pneumothorax,
- First episode of pneumothorax, for socioprofessional obligations (divers, pilots, etc…).
use apical bullectomy, mechanical pleurodesis, pleurectomy |
| What is important indicator in pleural effusion? | pleural protein/ serum protein (if >0.5: exudative effusion)
LDH pleural/ LDH serum (if >0.6 : exudative effusion) |
| How is mediastinal lymph node biopsies using VATS? | Anterior mediastinum reach periaortic lymph nodes through 2nd intercostal space, mediastinal lymph nodes reach by midaxillary incision |
| What are indications of Lobectomy VATS? | • Clinical stage I lung cancer.
• Tumor size < 5 cm.
• Benign disease (e.g., giant bulla, bronchiectasis).
• Physiologic operability |
| What are CI for VATS lobectomy? | • Chest wall or mediastinal invasion (T3 or T4 tumor).
• Endobronchial tumor seen at bronchoscopy.
• Positive mediastinoscopy.
• Neoadjuvant chemotherapy.
• Neoadjuvant radiation therapy. |
| What are things to be aware of in thoracic sympathectomy? | - Horner’s syndrome (ptosis, myosis, enophtalmy, and palpebral anhydrosis),
- Reactive hyperhydrosis of the lower body,
- Dry skin of the upper body |
| What are main mediastinal considerations in mediastinoscopy? | Ant; lymphoma and gioter, middle lymphoma |
| What are indications for mediastinoscopy? | • Staging of lung cancer:
- suspicion of N3 (contra-indication to resection),
- search for N2 (induction chemotherapy before resection),
- suspicion of small cell lung carcinoma(contra-indication for surgery).
• Typing of tumors:
- lung cancer: if bronchoscopy is non contributive,
- mediastinal tumors: histological typing (lymphoma, thyroid goiter or neoplasm, etc).
• Diagnosis of inflammatory diseases: sarcoidosis (biopsy of mediastinal lymph nodes) |
| What are complications of mediastinoscopy? | • Hemorrhage (innominate vein or aorta).
• Tracheal or bronchial lacerations.
• Esophageal lacerations.
• Recurrent nerve lesion (sectioned or electrocoagulated).
• Pneumothorax.
• Skin infection |
