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 without difficulties or complications. Read more Read less. Amazon Global Store US International products have separate terms, are sold from abroad and may differ from local products, including fit, age ratings, and language of product, labeling or instructions.
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Thoracoscopy for Pulmonologists
No customer reviews. Share your thoughts with other customers. The next chapter discusses the role of thoracoscopy in diagnosing pleu- ral effusions. My own opinion here is in general that, as long as well trained personnel are available, thoracoscopy is preferable to open pleural biopsy, because it is associated with less morbidity and mortality and can be done if necessary under local anesthesia. The following chapter is directed at using to thoracoscopy to facilitate pleurodesis for chronic pleural effusions.
With Boutin's method, talc pou- drage is performed during thoracoscopy, and certainly, if a thoracoscopy is used to establish the diagnosis of a malignant pleural effusion, it is appro- priate to attempt to induce a pleurodesis with talc at the time of the diag- nostic procedure. Product details Format Paperback pages Dimensions x x Table of contents 1: History and Evolution of the Technique.
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Goodreads is the world's largest site for readers with over 50 million reviews. We're featuring millions of their reader ratings on our book pages to help you find your new favourite book. In , we organized the First International Symposium on thoracoscopy in Marseilles 9. In Loddenkemper organized a second Symposium in Berlin Diagnostic or therapeutic exploration of the pleural cavity is performed using one or several points of entry. In addition to visual inspection of the thoracic cavity, a number of procedures can be performed.
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Biopsies can be collected from the pleura and, more rarely, the lung. Adhesions preventing exploration can be cut. Coagulation can be performed to stop bleeding or remove small blebs or superficial bullae in patients with spontaneous pneumothorax. A pleural drain is placed at the end of the examination to ensure prompt expansion of the lung against the chest wall.
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If lung biopsy or pleurodesis is performed, the mean duration of drainage is days. In simple cases involving pleurisy, the examination can be performed as an ambulatory procedure. To practice thoracoscopy, a chest physician needs specific training to learn thoracic anatomy, use of instrumentation biopsy forceps, coagulation systems, video-endoscopic equipment , and surveillance of drainage during the recovery period.
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To stay in practice pulmonologist should perform at least thoracoscopies a year. Interventional chest physicians are often also interested in rigid bronchoscopy stents and laser endoscopy as well as in brachytherapy and cryotherapy in some cases. The usual diameter of the telescope is 7 mm but surgeons often prefer larger ports 10 mm. The procedure room can be an operating room or a sterile endoscopy suite equipped with a procedure table, anesthesia equipment, Mayo stands, a roller tray for instruments, diathermo-coagulation and patient monitoring devices.
The anesthesia technique varies. Local anesthesia can be performed after premedication and sedation. Neuroleptanalgesia with an association of benzodiazepam, droperidol and alfentanyl can be used.
General anesthesia can be done using propofol or another suitable product. Medical thoracoscopy does nor normally require tracheal intubation but surgeons practice selective intubation with a double lumen tube.
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The examination is performed with the patient lying on the healthy side. The entry site is generally made on the axilla midline in the 3rd to 7th intercostal spaces. Thoracoscopy is one of the safest pneumonological examinations. In a review of cases, Viskum and Enk noted only one death.
In our own review of cases, the mortality rate was 0. In his review Viskum found that there was no mention of wound infection in any study, that empyema occurred in only 12 of cases in 3 studies, and that hemorrhage occurred in 6 of cases described in 3 other studies. Complications can best be prevented by observing the following rules: 1.
Postpone thoracoscopy for several days if the patient is coughing; 2.
Measure blood gases, monitor cardiac signs by simultaneous ECG; 3.