Chest
Volume 124, Issue 5, November 2003, Pages 1975-1977
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Minimally Invasive Techniques
Minithoracoscopy*: A Less Invasive Approach to Thoracoscopy

https://doi.org/10.1378/chest.124.5.1975Get rights and content

Study objectives

To evaluate minithoracoscopy using 3-mm instrumentation for diagnosis of pleural effusions. In the initial phase of the study, minithoracoscopy was used only for small loculated effusions not accessible with standard-sized endoscopes. Indication was later extended to larger nonloculated effusions that could have been examined using conventional thoracoscopy.

Patients

A total of 30 patients were studied, including 12 patients with nonloculated effusions of undetermined etiology, 17 patients with loculated effusions, and 1 patient with bilateral effusion.

Technique

The double-entry site technique was used with placement of two trocars, ie, one for the telescope and one for the biopsy forceps or accessory instruments. All procedures were performed under local anesthesia with mild sedation (midazolam).

Results

Minithorascopy provided high diagnostic yield (93.4%). Visualization using minithoracoscopy instrumentation was equal to that obtained using conventional thoracoscopy instrumentation. Tolerance and cosmetic results were good.

Conclusions

Minithoracoscopy is safe and effective for routine diagnostic applications.

Section snippets

Instrumentation

The basic components for minithoracoscopy are two 3.8-mm trocars, one 3.3-mm telescope, and one 3.0-mm biopsy forceps. The key instrument is the telescope (Karl Storz Endoskope; Karl Storz; Tuttlingen, Germany), which is 25 mm in length and has viewing angles of 0° and 45°. Connection of the telescope to a videocamera with a zoom lens allows image enlargement. All components are reusable after autoclave sterilization at 121°C for 15 min.

Technique

The minithoracoscopy technique is basically the same as

Results

Visualization using minithoracoscopic instrumentation was excellent allowing thorough inspection of the pleural space. Figure 2 shows the same lesions observed using minithoracoscopy and conventional thoracoscopy. There were no complications in this series. Suture was never required for closure, and scarring was minimal. Based on evaluation using a patient questionnaire, tolerance was considered as good in 24 patients and fair in 6 patients. No patients reported poor tolerance.

The main

Discussion

Table 1 summarizes the pros and cons of minithoracoscopy according to our experience. The main advantage of minithoracoscopy in comparison with conventional medical thoracoscopy is pain reduction. Unlike conventional 7-mm trocars, minithoracoscopy 3.3-mm trocars do not cause pressure pain against chest wall. This advantage is especially notable in patients with small chests or narrow intercostal spaces. As a result, patient tolerance is better and local anesthesia is safer. Minithoracoscopy

Conclusion

Our experience indicates that, like minilaparoscopy,7 minithoracoscopy can be used for routine diagnostic applications. Minithoracoscopy is most useful for assessment of small effusions not accessible to conventional medical thoracoscopy; however, it can also be considered as a complement or even an alternative to conventional thoracoscopy. In many cases, minithoracoscopy would probably be adequate with conversion to conventional thoracoscopy only if necessary.

References (7)

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