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  1. Dydykin S, Paulsen F, Khorobykh T, Mishchenko N, Kapitonova M, Gupalo S, et al.
    Surg Radiol Anat, 2022 Jan;44(1):117-127.
    PMID: 34426859 DOI: 10.1007/s00276-021-02820-8
    PURPOSE: There is no systematic description of primary anatomical landmarks that allow a surgeon to reliably and safely navigate the superior and posterior mediastinum's fat tissue spaces near large vessels and nerves during video-assisted endothoracoscopic interventions in the prone position of a patient. Our aim was to develop an algorithm of sequential visual navigation during thoracoscopic extirpation of the esophagus and determine the most permanent topographic and anatomical landmarks allowing safe thoracoscopic dissection of the esophagus in the prone position.

    METHODS: The anatomical study of the mediastinal structural features was carried out on 30 human cadavers before and after opening the right pleural cavity.

    RESULTS: For thoracoscopic extirpation of the esophagus in the prone position, anatomical landmarks are defined, their variants are assessed, and an algorithm for their selection is developed, allowing their direct visualization before and after opening the mediastinal pleura.

    CONCLUSION: The proposed algorithm for topographic and anatomical navigation based on the key anatomical landmarks in the posterior mediastinum provides safe performance of the video-assisted thoracoscopic extirpation of the esophagus in the prone position.

    Matched MeSH terms: Thoracic Surgery, Video-Assisted*
  2. Gunasagaran J, Ab Wahab N, Khoo SS, Shamsul SA, Shivdas S, Hashim S, et al.
    J Orthop Surg (Hong Kong), 2023;31(2):10225536231180330.
    PMID: 37256763 DOI: 10.1177/10225536231180330
    BACKGROUND: In complete brachial plexus injury, phrenic nerve (PN) is frequently used in neurotization for elbow flexion restoration. The advancement in video-assisted thoracoscopic surgery (VATS) allows full-length PN dissection intrathoracically for direct coaptation to recipient without nerve graft.

    PURPOSE: We report our experience in improving the surgical technique and its outcome.

    METHODS: Seven patients underwent PN dissection via VATS and full-length transfer to musculocutaneous nerve (MCN) or motor branch of biceps (MBB) from June 2015 to June 2018. Comparisons were made with similar group of patients who underwent conventional PN transfer.

    RESULTS: Mean age of patients was 21.9 years. All were males involved in motorcycle accidents who sustained complete brachial plexus injury. We found the elbow flexion recovery were earlier in full-length PN transfer. However, there was no statistically significant difference in elbow flexion strength at 3 years post-surgery.

    CONCLUSION: We propose full-length PN transfer for restoration of elbow flexion in patients with delayed presentation.

    Matched MeSH terms: Thoracic Surgery, Video-Assisted*
  3. Lee YM, Lim YC, Liam CK, Majid A
    Med J Malaysia, 1996 Mar;51(1):109-13.
    PMID: 10967989
    Consecutive 25 patients (M/F:18/7) underwent video-assisted thoracoscopic surgery (VATS) for various chest illnesses. These included nine cases of pneumothorax, three cases of pericardial effusion, three cases of pleural effusion, four cases of lung lesion requiring either incisional or excisional biopsy, two cases of empyema, one case of traumatic haemothorax, and three cases of mediastinal lesion. The mean age was 36.2 years (range 19-78 years). A total of forty-three procedures were performed. The mean durations of intrapleural chest-tube requirement and hospitalisation following VATS alone were 4.5 days (range: 0-13 days) and 8.3 days (range: 2-25 days) respectively. No intraoperative complication and VATS procedure-related mortality reported. Apart from simple analgesics such as paracetamol or tramadolol, no opiate analgesia was given to patients undergoing only VATS. The results support that VATS is a safe and effective procedure in the management of pulmonary, mediastinal, pericardial and pleural diseases and the treatment of persistent and recurrent spontaneous pneumothorax.
    Matched MeSH terms: Thoracic Surgery, Video-Assisted*
  4. 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*
  5. 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*
  6. 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*
  7. 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*
  8. Sachithanandan A, Badmanaban B
    Interact Cardiovasc Thorac Surg, 2011 Mar;12(3):434.
    PMID: 21345828 DOI: 10.1510/icvts.2010.241950A
    Matched MeSH terms: Thoracic Surgery, Video-Assisted/adverse effects; Thoracic Surgery, Video-Assisted/standards*
  9. 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/adverse effects; Thoracic Surgery, Video-Assisted/methods
  10. Muhamad NI, Mohd Nawi SN, Yusoff BM, Ab Halim NA, Mohammad N, Wan Ghazali WS
    Respir Med Case Rep, 2020;31:101276.
    PMID: 33209576 DOI: 10.1016/j.rmcr.2020.101276
    Vanishing lung syndrome (VLS) is a rare condition characterized by giant emphysematous bullae. It is frequently misdiagnosed as pneumothorax. We describe a case of a 30-year-old male who presented with shortness of breath, reduced effort tolerance, and pleuritic chest pain for three months. He was initially diagnosed with bilateral pneumothorax based on clinical examination and chest radiograph findings. However, further imaging with a high resolution computed tomography (HRCT) of the thorax confirmed bilateral giant emphysematous bullae. Our patient subsequently underwent video-assisted thoracoscopic surgery (VATS) and bullectomy. In this report, we discuss the clinical presentations, radiological features, and the management of VLS. We also highlight the differentiating features of VLS from a pneumothorax.
    Matched MeSH terms: Thoracic Surgery, Video-Assisted
  11. 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
  12. 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*
  13. Shu Ann Hon, Jan Jan Chai, Lian Thai Lee, Qin Jian Low
    MyJurnal

    A 49-year-old gentleman presented with epigastric pain for one day associated with one episode of vomiting and dyspnoea. Respiratory examination showed reduced breath sound over his left lower zone. He was treated as left spontaneous pneumothorax and left lung empyema requiring left chest tube insertion and intravenous antibiotics. His left pleural fluid biochemistry result was exudative while its centrifuge showed empyema. In ward, we noticed food material draining from his left chest tube during feeding. An urgent contrast enhanced computed tomography (CECT) thorax showed a left oesophageal-pleural fistula with possible broncho-oesophageal fistula. During oesoph- agogastroduodenoscopy (OGDS), air bubbles were seen in his left under-water chest drainage during air-insufflation of the oesophagus. The revised diagnosis was Boerhaave syndrome. He was treated with an esophageal stent to cover the perforation and a left lung decortication via video assisted thoracoscopic surgery (VATS) for his left empyema. He improved and was discharged well.
    Matched MeSH terms: Thoracic Surgery, Video-Assisted
  14. Md Noh MSF, Abdul Rashid AM, Abdul Rahim E
    J Bronchology Interv Pulmonol, 2018 07;25(3):e30-e32.
    PMID: 29944591 DOI: 10.1097/LBR.0000000000000456
    Matched MeSH terms: Thoracic Surgery, Video-Assisted
  15. Cheng KP, Wong WJ, Hashim S, Mun KS
    J Thorac Dis, 2017 Sep;9(9):E752-E756.
    PMID: 29221336 DOI: 10.21037/jtd.2017.08.74
    Hemangiopericytomas (HPCs) are uncommon tumours. We present the case of a 41-year-old female with multiple resections at different sites over the course of 11 years. The approach considerations, as well as treatment options and prognosis are discussed. A 41-year-old female with two previous resections for intracranial meningeal HPC in 2004 and 2008, as well as adjuvant radiotherapy, presented in 2015 with left intrathoracic and left hip recurrence confirmed by positron emission tomography/computed tomography (PET/CT). She underwent left proximal femur resection/reconstruction and video-assisted thoracoscopic surgery (VATS) resection of the intrathoracic tumour was attempted. She was discharged home on her 4th post-operative day with minimal pain. There were no neurosensory or motor deficits. Any patient who has been diagnosed with HPC in the past who develops new symptoms should be worked up for recurrence, regardless of the length of disease-free interval, as our case study suggested. There has yet to be a standardized follow-up regime due to the rarity of these tumours. HPC remains a rare soft tissue sarcoma with high recurrence rate. Planned VATS evaluation and resection is possible provided complete resection with clear surgical margins can be achieved, as clear surgical margins offer the best chance of survival.
    Matched MeSH terms: Thoracic Surgery, Video-Assisted
  16. Sathiamurthy N, Balasubbiah N, Dharmaraj B
    Asian Cardiovasc Thorac Ann, 2020 Oct;28(8):495-499.
    PMID: 32787442 DOI: 10.1177/0218492320950898
    BACKGROUND: The Covid-19 pandemic has caused changes in the surgical treatment of non-Covid patients, especially in thoracic surgery because most procedures are aerosol generating. Hospital Kuala Lumpur, where thoracic procedures are performed, was badly affected. We describe our experience in performing aerosol generating procedures safely in thoracic surgery during the Covid-19 era.

    METHODS: Medical records of patients who underwent thoracic surgery from March 18, 2020 to May 17, 2020 were reviewed retrospectively. All patients undergoing thoracic surgery were tested for Covid-19 using the reverse transcriptase polymerase chain reaction method. Patients with malignancy were observed for 10 to 14 days in the ward after testing negative. The healthcare workers donned personal protective equipment for all the cases, and the number of healthcare workers in the operating room was limited to the minimum required.

    RESULTS: A total of 44 procedures were performed in 26 thoracic surgeries. All of these procedures were classified as aerosol generating, and the mean duration of the surgery was 130 ± 43 minutes. None of the healthcare workers involved in the surgery were exposed or infected by Covid-19.

    CONCLUSION: Covid-19 will be a threat for a long time and thoracic surgeons must continue to provide their services, despite having to deal with aerosol generating procedures, in the new normal. Covid-19 testing of all surgical candidates, using the reverse transcriptase polymerase chain reaction, donning full personal protective equipment for healthcare workers, and carefully planned procedures are among the measures suggested to prevent unnecessary Covid-19 exposure in thoracic surgery.

    Matched MeSH terms: Thoracic Surgery, Video-Assisted
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