Chest
Minimally Invasive TechniquesMinithoracoscopy*: A Less Invasive Approach to Thoracoscopy
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.
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