By Dr. Rolf Inderbitzi (auth.)
After a realistic description of the endoscopic anatomy, the 1st a part of the e-book offers with such subject matters as getting ready and positioning the sufferer, anaesthesia, operation theatre format and working crew, inducing pneumothorax, normal operative steps, after-care within the health facility, prevention of thrombosis, prophylactic antibiotics, risks and dangers of the strategy, and using documentation. normal operative steps akin to thoracoscopic exploration and palpation intervention haemostasis andparenchymal leaks are defined in a separate part. a different half isdevoted to the diagnostic probabilities and present symptoms for thoroscopy together with: spontaneous pneumothorax, haemothorax, chylothorax; pleural empyema, bronchopleural fistula, extrathoracic and intrapulmonary cysts and tumours, pericardial fenestration, remedy of malignant effusions, and thoracal sympathectomy.
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Extra resources for Surgical Thoracoscopy
Sample text
A,b Dorsoapical haemothorax extending into the transverse fissure following thoracoscopic pleurectomy. a Posteroanterior view. b Lateral view under local anaesthesia and is caused by fits of coughing triggered by the vagus nerve forcing air or gas into thoracic incisions. This is not uncommon, but nevertheless harmless. The only generalized air emphysema in our series developed postoperatively. The massive expansion involving the mediastinum could only be relieved by a transcervical mediastinotomy and multiple subcutaneous drainage.
3). The tubes used should always have a large diameter. Figure 13 shows the types of drain used in our department . The choice of type, number and length of the intrathoracic section depend on the intervention performed and the anatomical pathological situation. The exit sites of the tubes should not be in the area of the patient's back nor in the axilla to achieve optimum drainage and to reduce patient discomfort . We usually use two of the three entry sites as exits for the drains. Effectiveness takes priority over cosmesis and comfort.
Within the framework of conventional thoracoscopy, the following side effects and complications have been reported: haemothorax [21, 125, 142, 172], mediastinal emphysema, subcutaneous tension emphysema and generalized air emphysema [21, 166], air embolism [49, 172], pleural empyema [21, 33, 38], re-expansion pulmonary oedema [21 ], injuries to the lung [21] and tumorous contamination of the incision site [21, 33, 113, 114]. In addition to these, cardiac dysrhythmia [48, 125], hypotonia [38, 70], vasovagal reactions [172] and hypoxaemia [21, 125, 172] have all been described.
