MyMedR

Uniportal video assisted thoracoscopic surgery right upper sleeve lobectomy- The first experience in Hospital Kuala Lumpur

Diong NC, Dharmaraj B, Sathiamurthy N

Med J Malaysia, 2020 07;75(4):445-446.

PMID: 32724014

Sleeve lobectomy is a lung sparing surgery and is the preferred alternative to pneumonectomy for centrally located tumours, which has less postoperative morbidity and mortality. Surgical approach for the technically demanding sleeve lobectomy evolved over the decades from conventional thoracotomy to video assisted thoracoscopic surgery (VATS) to uniportal VATS (uVATS) which allows for quicker recovery and less pain postoperatively. We report our very first successful uVATS sleeve right upper lobectomy performed in the Hospital Kuala Lumpur, Malaysia.

Matched MeSH terms: Thoracic Surgery, Video-Assisted/methods*

Fulltext Single stage minimally invasive bilateral video assisted thoracoscopic surgery for simultaneous bilateral primary spontaneous pneumothorax

Sachithanandan A, Nur Ezrin I, Badmanaban B

Med J Malaysia, 2012 Apr;67(2):226-7.

PMID: 22822653 MyJurnal

Simultaneous bilateral spontaneous pneumothorax (SBSP) is a very rare life-threatening condition that requires rapid diagnosis and treatment. Most cases are secondary to various underlying lung pathology but a primary SBSP may occur due to rupture of subpleural blebs or bullae. Surgery via an open or minimally invasive approach provides definitive treatment and can be undertaken as a staged or simultaneous procedure. We report our experience with two such rare cases utilizing a single stage minimally invasive bilateral video assisted thoracoscopic (VATS) approach. The pathogenesis of this rare condition and intra-operative technical considerations for a successful outcome are discussed.

Matched MeSH terms: Thoracic Surgery, Video-Assisted/methods*

Primary spontaneous pneumothorax in children: factors predicting recurrence and contralateral occurrence

Ng GYH, Nah SA, Teoh OH, Ong LY

Pediatr Surg Int, 2020 Mar;36(3):383-389.

PMID: 31993738 DOI: 10.1007/s00383-020-04619-x

BACKGROUND: The risk factors for recurrence in primary spontaneous pneumothorax (PSP) in children are not well known. We aimed to identify possible risk factors, and to evaluate the utility of computerised tomography (CT) scans in predicting future episodes.

METHODS: We reviewed children aged

Matched MeSH terms: Thoracic Surgery, Video-Assisted/methods*

Mediastinal liposarcoma: a rare visceral mediastinal tumour

Krishnasamy S, Krishna Nair A, Hashim SA, Raja Mokhtar RA

Interact Cardiovasc Thorac Surg, 2019 12 01;29(6):976-977.

PMID: 31363757 DOI: 10.1093/icvts/ivz191

Liposarcoma is the second most common type of soft tissue malignancy in adults. They are malignant tumours with a mesenchymal origin. Mediastinal liposarcoma accounts for <1% of mediastinal tumours and 2% of liposarcoma. We report a patient with mediastinal liposarcoma who presented with cardiac tamponade, 25 years after the initial liposarcoma in the popliteal fossa.

Matched MeSH terms: Thoracic Surgery, Video-Assisted/methods*

Fulltext Sandstorm appearance of pulmonary alveolar microlithiasis incidentally detected in a young, asymptomatic male

Ch'ng LS, Bux SI, Liam CK, Rahman NA, Ho CY

Korean J Radiol, 2013 Sep-Oct;14(5):859-62.

PMID: 24043987 DOI: 10.3348/kjr.2013.14.5.859

Pulmonary alveolar microlithiasis (PAM) is a rare chronic disease with paucity of symptoms in contrast to the imaging findings. We present a case of a 24-year-old Malay man having an incidental abnormal pre-employment chest radiograph of dense micronodular opacities giving the classical "sandstorm" appearance. High-resolution computed tomography of the lungs showed microcalcifications with subpleural cystic changes. Open lung biopsy showed calcospherites within the alveolar spaces. The radiological and histopathological findings were characteristic of PAM.

Matched MeSH terms: Thoracic Surgery, Video-Assisted/methods

Anesthetic management of thoracoscopic resection of lung lesions in small children

Mohtar S, Hui TWC, Irwin MG

Paediatr Anaesth, 2018 11;28(11):1035-1042.

PMID: 30281181 DOI: 10.1111/pan.13502

BACKGROUND: Video-assisted thoracoscopic surgery has dramatically increased over the last decade because of both medical and cosmetic benefits. Anesthesia for video-assisted thoracoscopic surgery in small children is more challenging compared to adults due to the considerable problems posed by small airway dimensions and ventilation. The optimal technique for one-lung ventilation has yet to be established and the use of remifentanil infusion in this setting is not well described.

AIMS: This study investigated the use of extraluminal bronchial blocker placement for one-lung ventilation and the effect of infusion of remifentanil in infants and small children undergoing video-assisted thoracoscopic surgery.

METHODS: We retrospectively reviewed the technique of one-lung ventilation and the hemodynamic effects of remifentanil infusion in 31 small children during elective video-assisted thoracoscopic surgery for congenital lung lesions under anesthesia with sevoflurane or isoflurane, oxygen, and air. Patients' heart rate, blood pressure, and endtidal carbon dioxide at baseline (after induction of anesthesia), immediately after one-lung ventilation, during carbon dioxide insufflation, and at the end of one-lung ventilation were extracted from the database and analyzed. The use of vasopressors or dexmedetomidine was also recorded and analyzed.

RESULTS: Extraluminal placement of a bronchial blocker alongside the tracheal tube was successfully performed in 90.3% of cases (28 patients) without any serious complications or arterial oxygen desaturation. There was no significant rise in blood pressure or heart rate even with the rise of endtidal carbon dioxide concentration during video-assisted thoracoscopic surgery. In 58% of patients (18 patients), phenylephrine was administered to maintain the blood pressure within 20% of the baseline value. There was no significant change in the heart rate of all patients at each time point.

CONCLUSION: One-lung ventilation with an extraluminal parallel blocker was used effectively in this series of young children undergoing thoracoscopic excision of congenital pulmonary lesions. Remifentanil infusion attenuated surgical stress effectively in infants and small children undergoing video-assisted thoracoscopic surgery.

Matched MeSH terms: Thoracic Surgery, Video-Assisted/methods*

Fulltext Silicone Y-stent insertion under extracorporeal membrane oxygenation (ECMO) in a patient with tracheal tear

Mohd Esa NY, Faisal M, Vengadesa Pilla S, Abdul Rahaman JA

BMJ Case Rep, 2020 Dec 22;13(12).

PMID: 33370965 DOI: 10.1136/bcr-2020-236414

Tracheal tear after endotracheal intubation is extremely rare. The role of silicone Y-stent in the management of tracheal injury has been documented in the previous studies. However, none of the studies have mentioned the deployment of silicone Y-stent via rigid bronchoscope with the patient solely supported by extracorporeal membrane oxygenation (ECMO) without general anaesthesia delivered via the side port of the rigid bronchoscope. We report a patient who had a tracheal tear due to endotracheal tube migration following a routine video-assisted thoracoscopic surgery sympathectomy, which was successfully managed with silicone Y-stent insertion. Procedure was done while she was undergoing ECMO; hence, no ventilator connection to the side port of the rigid scope was required. This was our first experience in performing Y-stent insertion fully under ECMO, and the patient had a successful recovery.

Matched MeSH terms: Thoracic Surgery, Video-Assisted/methods

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