Television thoracoscopic surgery is suitable for the treatment of about 70% of extrathoracic diseases, using three to four small holes of 1 to 2 cm instead of an incision of about 30 cm in length, allowing patients to avoid the trauma of open-heart surgery. The indications for TV thoracoscopic surgery are briefly described as follows.
1 Diagnostic television thoracoscopic surgery indications Yang Yulun, Department of Thoracic Surgery, Zhengzhou People’s Hospital
1.1 Pleural diseases
The scope and nature of pleural lesions are directly observed using thoracoscopy, resulting in a diagnostic rate of 93%-96% for pleural effusion.
1.2 Lung diseases
When lung surface lesions and diffuse lung lesions cannot be diagnosed by bronchoscopy or ultrasound or CT puncture, the diagnosis can be confirmed by thoracoscopy.
1.3 Staging of lung cancer and esophageal cancer
Thoracoscopic mediastinal lymph node biopsy is performed to determine the possibility of resection of lung cancer and esophageal cancer and to avoid the surgical trauma of open-heart exploration.
1.4 Mediastinal tumor
Preoperative thoracoscopic examination is performed to determine whether the tumor can be resected; for suspected mediastinal lymphoma, thoracoscopic biopsy can be performed to obtain cytological diagnosis and typing to determine the treatment plan.
1.5 Pericardial disease
Restricted pericardial effusion, which is not clearly diagnosed by repeated punctures, can be diagnosed by thoracoscopic biopsy.
1.6 Trauma to the chest
When active bleeding, tracheobronchial rupture or esophageal rupture is suspected, thoracoscopic examination is performed to clarify the site and degree of injury and decide whether to open the chest to avoid blind open-chest trauma or loss of surgical timing by conservative treatment.
2 Indications for therapeutic thoracoscopic surgery
1.1 Pleural disease
①Malignant pleural fluid Pleural fixation is performed. ② abscess chest and encapsulated pleural effusion ③ pleural tumor pleural mesothelioma, metastatic pleural tumor and intercostal neurofibroma.
1.2 Lung disease
①Spontaneous pneumothorax, pulmonary alveoli
②Peripheral lung tumors including benign tumors such as tuberculoma, malignant tumor, inflammatory pseudotumor, pulmonary metastases, palliative resection of peripheral lung cancer with small lesions.
③Bronchopulmonary cysts, pulmonary cavity-type tuberculosis and bronchiectasis Lobectomy can be performed under thoracoscopy.
④Early primary lung cancer Thoracoscopic lobectomy and lymph node dissection.
⑤ End-stage emphysema Thoracoscopic lung volume reduction.
1.3 Mediastinal diseases: ① mediastinal neurogenic tumors ② thymoma ③ benign mediastinal tumors: teratoma, etc.
1.4 Heart disease: ① pericardial effusion drainage ② pericardial resection ③ arteriovenous catheterization ④ atrial and ventricular septal defect
1.5 Esophageal diseases: ① Esophageal smooth muscle tumor ② Cardia failure ③ Early esophageal cancer
1.6 Thoracic spine diseases: ① thoracic paravertebral abscess incision and drainage ② thoracic vertebral body excision and decompression ③ thoracic discectomy
1.7 Thoracic trauma: ① intra-thoracic hemostasis and clot removal ② lung lobe suturing ③ foreign body in the chest
Others, such as thoracic sympathectomy for hand sweating, thoracic duct ligation for celiac disease, etc.
(Note: VATS, Video-assisted Thoracoscopic Surgery)