CARDIO THORACIC AND VASCULAR SURGERY
DR AVINASH DAL
Thoracoscopy started many years back and has been very successful in management of patients with various thoracic diseases and who require surgery. The modality improves exposure as well as reduces the morbidity of long and painful incisions that accompany conventional thoracic surgery. With the advent of staplers and devices such as harmonic scalpel the range of thoracoscopy is increased to even lung resections.
There may be some limitations of thoracoscopy especially if there are dense pleural adhesions and if the patient is not able to sustain a single lung ventilation. In such cases or if there is some bleeding, one may have to revert to open surgery. However, this is not common.
EVENTRATION OF DIAPHRAGM : TOTALLY ENDOSCOPIC TREATMENT
Eventration of diaphragm may be treated by open thoracotomy, laparatomy or laparaoscopy. We had a case successfully treated purely by thoracoscopy [VATS] with plication followed by prolene mesh augmentation. Below are the pre- and post- operative xrays,
VATS BRONCHOGENIC CYST
Thymus gland being dissected thoracoscopically by Dr Avinash Dal
Final incisions [after removal of mass]
VATS is video assisted thoracic surgery as nowadays no one uses old scopes by looking into the eyepiece.
Besides stapler techniques, one may also suture the lung or any tissue with minimal access or thoracoscopic needle drivers and holders as shown above.
Many procedures such as pleurodesis for the recurrent spontaneous pneumothorax and formation of pleuropericardial window for recurrent pericardial collections can be performed besides routine lung and wedge resections and biopsies.
Pleurodesis especially gives excellent results as shown below. One may use abrasion with a gauze piece or even cauterisation of parietal pleura
Final effect of punctate marks on the parietal pleura
Cauterisation of the parietal pleura gives good long term results. The cauterisation must be done on the rib and not in the intercostal space or else there may be severe neuropathic pain postoperatively
VATS removal of chest wall mass
With miniimal incisions to access inside the chest, there is early recovery and less postoperative pain. Also it has been proved that thoracoscopic surgery has a beneficial effect on WBC activation when compared with routine open thoracic surgery. For the surgeon, the magnification with the scope is great and enhances accuracy
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