Chest surgery clinics of North America
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Chest Surg. Clin. N. Am. · Nov 1998
ReviewEffect of minimally invasive thoracic surgical approaches on acute and chronic postoperative pain.
Acute postthoracotomy pain and chronic postthoracotomy pain are significant problems leading to increased length of hospital stay and medical costs, reduction in patient quality of life and patient productivity, and potential immunologic derangement that may compromise oncologic surgical results. Minimally invasive surgical approaches can potentially benefit the patient by reducing postoperative pain-related morbidity. Objective data supporting our inclination that these VATS approaches are superior to open thoracic surgical techniques is accumulating. Further study of the relative costs, risks, and benefits of standard postoperative analgesic management (e.g., epidural analgesia) combined with limited thoracotomy compared to VATS techniques is warranted as we try to define the most effective perioperative management of the patient requiring pulmonary resection.
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Chest Surg. Clin. N. Am. · Nov 1998
ReviewVideo-assisted thoracic surgery pericardial resection for effusive disease.
In patients who can tolerate single-lung ventilation and who have a long life expectancy, VATS offers definitive and durable treatment without the morbidity of an open thoracotomy. The patients who may benefit most from this technique include those with benign effusive disease, patients with malignant pericardial effusions with a good prognosis, and patients with concurrent pulmonary pathology.
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Thoracoscopy has been a valuable modality for the diagnosis and treatment of pleural-based disease for almost 100 years. With the development of video technology and improved instrumentation, video-assisted thoracoscopy is the procedure of choice for effusions of unknown origin, pleural mass biopsy, and free-flowing empyema drainage when conventional techniques fail. Reported success rates have been very good for diagnosis and treatment of both benign and malignant disease, and the morbidity is low.