No abstract available.
Cautery* ; Pneumothorax* ; Thoracoscopes*

The long QT syndromes have been classified into acquired or inheritary forms, both of which are associated with a characteristic type of life-threatening polymorphic ventricular tachycardia called torsade de points. Beta-adrenergic blocker is the first cholic treatment, but in those whom cardiac events are not prevented by beta - blockade, left thoracic sympathetic ganglionectomy may be useful in selected cases. A 50-year-old woman had an recurrent syncopal attack in which she was unconscious for 1-2 min and 1-2 times a month for 10 years. The EKG revealed that QT & QTc intervals were 744 and 632 msec respectively. Treatment with Beta-adrenergic blocker and calcium channel blocker was ineffective in preventing recurrence of syncopal spell. Therefore, she underwent left thoracic sympathetic ganglionectomy with thoracoscope. During the 9 months after operation, she was free of syncopal episodes and is doing well.
Calcium Channels ; Electrocardiography ; Female ; Ganglionectomy* ; Humans ; Long QT Syndrome* ; Middle Aged ; Recurrence ; Syncope ; Tachycardia, Ventricular ; Thoracoscopes*

Pain of intraabdominal organ is transduced through splanchnic and sympathetic nerve. Mallet- Guy et al introduced the method of splanchnicectomy and lumbar sympathectomy for control of pain of pancreatitis and pancreatic cancer. It has been considered as an out-dated procedure because of the long surgical incisions and the development of celiac plexus block with long needles. However, as VATS was recently applied to many thoracic surgical fields, splanchnicotomy assisted by a thoracoscope is considered as a good method for intractable abdominal pain.
Abdominal Pain* ; Celiac Plexus ; Needles ; Pancreatic Neoplasms ; Pancreatitis ; Splanchnic Nerves ; Sympathectomy ; Thoracic Surgery, Video-Assisted ; Thoracoscopes

Essential palmar hyperhidrosis is a disease characterized by excessive perspiration on the palms and hands due to the hyperaction of sympathetic nervous discharge. In severe cases, excessive sweating is seen on the face, axilla, trunk, and soles. Several therapeutic modalities were applied but surgical resection of the sympathetic ganglion is the only curative method. Numerous open surgeries of the thoracic sympathetic ganglia for the treatment of palmar hyperhidrosis have been advocated, but they have also produced several complications. A new therapeutic technique for this disorder has been introduced by combining a thoracoscope and video system. Nowadays, thoracoscopic transthoracic sympathectomy is accepted as the treatment of choice for essential palmar hyperhidrosis. This technique is safe and easy. It also reduces the operating time and admission period. It has also very few complications. Compensatory hyperhidrosis on the trunk, back, and thigh, etc. is commonly an unwanted and unsolved complication after thoracic sympathectomy. Through my experience of thoracic sympathectomy, I thought that the incidence of compensatory hyperhidrosis was closely related to the extent of thoracic sympathectomy. So I restricted the extent of thoracic sympathectomy as a T2 sympathetic ganglion from September 1995. From Mar., 1989 To Aug., 1995, T2, T3 sympathetic ganglionectomies were performed for palmar hyperhidrosis patients and from Sept. 1995 T2 sympathetic ganglionectomies were performed. Using questionnaires, I compared these 2 groups. The results of this study are summarized as follows; 1) Using thoracoscopic transthoracic sympathectomy, operating time, admission period and complications could be reduced. 2) The risk of bleeding during the operation(especially bleeding from the hemiazygous vein) could be reduced in the T2 sympathectomy group. 3) The treatment effect of T2 sympathectomy is no different from T2, T3 sympathectomy for essential palmar hyperhidrosis. 4) The incidence of compensatory hyperhidrosis is less in the T2 sympathectomy group than in the T2, T3 sympathectomy group. From the above results, I concluded thoracoscopic transthoracic sympathectomy is the treatment of choice for essential palmar hyperhidrosis and the adequate extent for sympathectomy is T2 sympathetic ganglion.
Axilla ; Ganglia, Sympathetic ; Ganglionectomy ; Hand ; Hemorrhage ; Humans ; Hyperhidrosis* ; Incidence ; Surveys and Questionnaires ; Sweat ; Sweating ; Sympathectomy* ; Thigh ; Thoracoscopes

BACKGROUND: Recent development of endoscopic devices and surgical techniques enabled the video-assisted thoracoscopic sympathetic surgery to be reliable, safe and minimally invasive for the treatment of hyperhidrosis. People with axillary hyperhidrosis, however, were not as satisfied as those with palmar or craniofacial hyperhidrosis due to more frequent and severe compensatory sweating and lack of effect on concomitant osmidrosis. MATERIAL AND METHOD: From March 1997 through April 1999, 45 cases of axillary hyperhidrosis underwent T3,4 sympathectomy(21 patients), T2,4 sympathicotomy(20 patients) or T4 sympathectomy(4 patients). We evaluated and analyzed the early effect of symptomatic relief, compensatory hyperhidrosis and the level of long term satisfaction. The sex ratio was 28 males: 17 females with an average age of 28 years, ranging from 13 to 46 years. Two patients had concomitant osmidrosis and one patient who underwent T3,4 sympathectomy experienced profuse compensatory sweating on face and scalp for which he underwent a reoperation of T2 sympathicotomy 93 days later. All the procedures were performed under general anesthesia in semifowler's position with 30 elevation of the upper body. A 2mm needle thoracoscope was used except in 2 cases with moderate to severe pleural adhesions where a 5mm thoracoscope was used. RESULT: Average operation time was 46.2+/-11 minutes for T3,4 sympathectomy; 32.5+/-23 minutes for T2,4 sympathicotomy; and 53.8+/-18 minutes for T4 sympathectomy. Every patient who underwent T3,4 sympathectomy and T2,4 sympathicotomy showed satisfaction 17 cases(81%) and 12 cases(60%) had absolutely no sweating after T3,4 sympathectomy and T2,4 sympathicotomy, respectively and the remaining 4 cases(19%) and 8 cases(40%) experienced 'decreased amount of sweating with slightly moist armpits'. Compensatory hyperhidrosis was present in 67% and 60% of the cases after T3,4 sympathectomy and T2,4 sympathicotomy, but only 10% and 5 %, were severe enough to be embarrassing or disabling. The level of satisfaction was high in both groups, with 86% after T3,4 sympathectomy and 89% after T2,4 sympathicotomy. CONCLUSION: Both T3,4 sympathectomy and T2,4 sympathicotomy were effective means of treating axillary hyperhidrosis. T3,4 sympathectomy had superior symptomatic relief although T2,4 sympathicotomy was favored because of shorter operation time, easier surgical technique and milder compensatory sweating. Long term satisfaction level, however, was similar in both groups.
Anesthesia, General ; Female ; Humans ; Hyperhidrosis* ; Male ; Needles ; Reoperation ; Scalp ; Sex Ratio ; Sweat ; Sweating ; Sympathectomy ; Thoracoscopes

Patent ductus arteriosus(PDA) is a common congenital heart disease encountered in premature neonates infants and children. Patent ductus arteriosus was the first surgically managed congenital heart disease,. Classic surgical interruption of patent ducturs arteriosus was partially replaced by a transcatheter endovascular closure, After a 5-7 mm video-assisted thoracoscopic interruption of the patent ductus arteriosus first applied in 1991, this minimally invasive technique came to be used in many centers, Video-assisted thoracoscopic interruption of the patent ductus arteriosus is feasible in low-weight infants whereas transcatheter endovascular closure of the ductus is usually not possible. We experienced successful outcome for the treatment of patent ductus arteriosus with 2 mm video-assisted thoracoscopic titanium clipping, We believed that this technique is a simple safe and rapid method for closure of the patent arteriosus.
Child ; Ductus Arteriosus, Patent ; Heart Defects, Congenital ; Humans ; Infant ; Infant, Newborn ; Thoracoscopes* ; Thoracoscopy ; Titanium

Anterior reconstruction with instrumentation of the thoracolumbar junction (TLJ) offers: 1) the biomechanical advantage of immediate restoration of the load-bearing anterior column and 2) the ideal biological milieu for an optimal arthrodesis. The authors describe the mini-transthoracic supradiaphragmatic (MTTS) approach to the TLJ. Its technical feasibility is compared with that of the traditional transdiaphragmatic and thoracoscopic supradiaphragmatic approaches to this area of the spine. This technique was performed in 21 patients from 2004 to 2006. There were no surgical mortalities. The MTTS approach without the use of a thoracoscope was successfully employed in this study to treat patients with various lesions located at the TLJ. The diaphragmatic opening, even at its smallest diameter, provides excellent views of the operative field and avoids the significant morbidities associated with the traditional transdiaphragmatic approach.
Arthrodesis ; Diaphragm ; Humans ; Imidazoles ; Nitro Compounds ; Spine ; Stearates ; Thoracoscopes ; Weight-Bearing

A hemothorax usually occur, due to injuries to the intercostal and great vessels, pulmonary damage, and sometimes fractured ribs. We report a case in which the hemothorax that occurred, neither intrathoracic injury nor injury to internal thoracic vessels and organs, via lacerated diaphragmatic and liver laceration due to a right upper part of anterior chest stab injury caused by a sharp object. The patient's general conditions gradually worsened, so chest and abdominal computed tomogram were taken. The abdominal computed tomogram revealed diaphragmatic injuries and bleeding from the lacerated liver. We performed an exploratory laparotomy to control the bleeding from the lacerated liver with simple primary sutures. In addition exploration was performed in the right pleural space through the lacerated diaphragm with a thoracoscopic instrument. There were no bleeding foci in the right pleural space, the vessels, or the lung on the thoracoscopic video. Closure of the lacerated diaphragm was achieved with simple, primary sutures. The postoperative course of the patient was uneventful, and the patient was discharged.
Diaphragm ; Hemorrhage ; Hemothorax ; Humans ; Lacerations ; Laparotomy ; Liver ; Lung ; Pleural Cavity ; Ribs ; Sutures ; Thoracoscopes ; Thorax ; Wounds, Stab

Numerous open operations on the thoracic sympathetic ganglia for the treatment of palmar hyperhidrosis have been advocated, but have also produced several complications. A new therapeutic technique for this disorder has been introduced by combining a thoracoscope and video system. We performed thoracoscopic transthoracic sympathecomy safely and effectively in thirtyfour cases with palmar hyperhidrosis. Althought the follow up period was short, all hands of patients were dry immediately after the operation & there was no recurrence of palmar sweating. Based on our experience, this method is considered a relatively minor and safe procedure without producing significant postoperative complication, causing minimal discomfort and almost invisible scar.
Cicatrix ; Follow-Up Studies ; Ganglia, Sympathetic ; Hand ; Humans ; Hyperhidrosis* ; Postoperative Complications ; Recurrence ; Sweat ; Sweating ; Sympathectomy* ; Thoracoscopes

OBJECTIVETo create a standard mini-swine model of chronic ischemic myocardium by endoscopy for the research of gene transfer and stem cell.

METHODSTwenty-three male China experimental minipigs were used, aged from 8 to 11 months with a mean of (9.3 +/- 1.8) months and weighed from 20 to 30 kg with a mean of (29.3 +/- 4.3) kg. The myocardial ischemia was established by gradual occlusion of the left circumflex coronary artery (LCX) with an Ameroid constrictor. The Ameroid constrictor was implanted around LCX by endoscopy. Selective coronary angiography, electrocardiogram and Echo-Doppler study were performed perioperatively to evaluate the degree of stenosis.

RESULTSChronic ischemic myocardial models were successfully generated in 20 of 23 swine by full-endoscopy. Ameroid constrictors were placed at the LCX accurately. Three swine died of anesthetic accident, cardiac arrhythmia at secondary coronary angiography, and pulmonary infection within 6 weeks after operation respectively. Operation time was 25 to 65 min with a mean of (46 +/- 9) min. The blood loss was 30 to 60 ml with a mean of (55 +/- 12) ml. Six weeks later, coronary angiography revealed the total occlusion and partial stenosis (> 85%) of the LCX occurred in 7 and 13 swine respectively. Cardiac systolic and diastolic dysfunction were found in all swine. The ejection fraction value was (65.0 +/- 6.3)% before operation and (41.0 +/- 9.3)% after operation (P = 0.008). The fractional shortening value was (36.2 +/- 4.3)% before operation and (34.2 +/- 2.3)% after operation (P = 0.027).

CONCLUSIONThe endoscopic surgery is a less invasive way to create a standard mini-swine model of chronic ischemic myocardium with effective results.