A preliminary report of a disposable electrical non-fiberoptic endoscope in thoracoscopic surgery

Application of wireless electrical non-fiberoptic endoscope: Potential benefit and limitation in endoscopic surgery

INTRODUCTION

Conventional rigid endoscope requires a bundle of optic fibers for illumination and a set of camera for viewing body cavity. The design is bulky in the hand-held part and the laterally positioned optic fibers may hinder manipulation of instruments, especially in single port surgery. We designed a simplified unit to replace conventional endoscope.

MATERIALS AND METHODS

We used an independent front image sensor along with six light emitting diode crystals. A wireless module working in 2.4 GHz and its antenna were integrated into the hand-help part. Two 800 mA batteries were used for power supply. The study was tested in two 35 kg pigs. Some simple thoracoscopic and laparoscopic operations were simulated to test the reliability and surgeon's acceptability.

RESULTS

Signal Noise ratio can be controlled well in the setting of the operative room. Signal transmission was influenced significantly when covered by damped gauze or drape. The best quality of wireless transmission is through line-of-sight. Dropping frame is less than 1 frame per second in 99% time period during the test.

CONCLUSION

Wireless modules in the design of rigid endoscope may be a plausible option with good acceptability.

Bilateral pulmonary metastectomy through a unilateral single-port thoracoscopic approach

A 58-year-old woman underwent radical proctectomy 19 months prior to admission. The initial diagnosis was rectal adenocarcinoma of pathological stage T2N0M0. She was discharged five days after the operation. She was followed by abdominal computed tomographic (CT) scan at 3, 9 and 18 months after the operation. Eighteen months after the operation, follow-up abdominal CT scan revealed tiny nodules in the bilateral lower lobes. Subsequent CT scan of the chest showed two tiny nodules in the right lower lobe and a single tiny nodule in left lower lobe. She then underwent single port thoracoscopic surgery through the right side for resection of the nodules. Using a single port wound, we excised the two tiny nodules on the right side and the one tiny nodule in the left lower lobe across the mediastinum. She was discharged four days later. The final pathology report showed those three nodules were metastases from an adenocarcinoma in the colon.

Video-guided tube thoracostomy with use of an electrical nonfiberoptic endoscope

PURPOSE

Tube thoracostomy is a common and generally safe procedure. However, potential hazards can occur during placement of the chest tube. Inasmuch as unexpected injuries may arise from tube thoracostomy, we propose a novel video-guided method.

DESCRIPTION

We used an independent complementary metal oxide semiconductor image sensor with a processing chip to obtain a front view image of the chest cavity. The device is connected to an aluminum shaft with four small light-emitting diode crystals in the tip, and a detachable small monitor with a battery inside. The apparatus is small and can be used to direct vision-guided tools in tube thoracostomy.

EVALUATION

We performed video-guided tube thoracostomy in 6 patients with pleural adhesions. All patients experienced good tolerance to the procedure and had no immediate adverse events. The thoracostomies were performed by a single surgeon with good acceptability, and each procedure was completed in less than 10 minutes.

CONCLUSIONS

In some cases of pleural adhesion, the video-guided thoracostomy may be a safer alternative to non-image guided tube thoracostomy.

A preliminary report on the feasibility of single-port thoracoscopic surgery for diaphragm plication in the treatment of diaphragm eventration

Introduction

Thoracoscopic surgery is a popular widely used surgical technique in the treatment of common chest conditions. Conventional thoracoscopic surgery utilizes multiple small wounds for carrying out the procedure. Many procedures can also be performed with a single small port wound. In this study, we performed diaphragm plication using the techniques of single-port thoracoscopic surgery.

Materials and methods

From July 1st, 2008 to December 31th, 2011, there were 21 patients admitted to our hospital due to diaphragm eventration. All of them underwent diaphragm plication. The initial 11 patients underwent two-port thoracoscopic surgery while the subsequent 10 patients underwent single-port thoracoscopic surgery.

Results

The side of diaphragm eventration was on the left in all of the cases. The mean operative time was 87.3 minutes and the mean follow-up time was 17 months. There was no procedure-related complication or mortality. The time required for surgery and the postoperative pain scores were similar in the two groups.

Conclusion

Single-port thoracoscopic surgery for diaphragm plication is a safe procedure. It can serve as an alternative to conventional thoracoscopic approaches to diaphragm surgery.

Treatment of bilateral empyema thoracis using unilateral single-port thoracoscopic approach

A variety of disease in the chest can be treated with thoracoscopic surgery. Although with limited experience, thoracoscopic surgery can be performed with single-port approach. Theoretically, single-port approach can be applied in treating bilateral pleural effusions. Here we reported a case of 28-year-old man with the diagnosis of septic embolization of the lung with complications of bilateral empyema. He was treated with single-port thoracoscopic surgery for decortication of right pleural space and deloculation of left pleural space. After prolonged course of antibiotics for 21 days, the patient was discharged. After follow-up for 3 months, the patient recovered well and had no evidence of recurrence.

The adequacy of single-incisional thoracoscopic surgery as a first-line endoscopic approach for the management of recurrent primary spontaneous pneumothorax: a retrospective study

BACKGROUND

Thoracoscopic surgery is a commonly used endoscopic surgical treatment approach in patients with primary spontaneous pneumothorax. The conventional thoracoscopic approach utilizes three or more small wounds for surgery. Currently, a single port approach is a potential alternative procedure in general thoracoscopic surgery. We investigated whether a single-port approach is suitable as a first-line endoscopic approach for all patients with primary spontaneous pneumothorax requiring surgery.

METHODS

From July 1st, 2008 to Dec 31, 2009, a total of 62 patients was included in this study. All the patients were admitted to our ward because they had surgical indications for surgery. Twenty-six patients underwent conventional three-port thoracoscopic surgery and thirty-six underwent single-port thoracoscopic surgery. All of the clinical data were analyzed retrospectively. Variables were compared and analyzed to determine the outcomes of the different surgical approaches.

RESULTS

The mean age of the 62 patients was 27.2 years. Forty-nine patients were men and thirteen patients were women. The mean time required for the operation was 61.6 minutes. There was one patient who had a recurrence in single-port group and 2 patients had a recurrence in three-port group during the period of follow-up. The average pain scores at 24 and 48 hrs after the operation were similar, but the pain scores at 72 hrs in the single-port group were better than the three-port group. There was no case that required conversion from a single-port to multiple wound approach in this study. There was no immediate postoperative recurrence. The follow-up duration was greater than 12 months.

CONCLUSION

This study showed that single-port thoracoscopic surgery is a feasible and reasonable first-line endoscopic approach in the surgical treatment of primary spontaneous pneumothorax.