Surgical Thoracoscopy by Dr. Rolf Inderbitzi (auth.)

By Dr. Rolf Inderbitzi (auth.)

After a pragmatic description of the endoscopic anatomy, the 1st a part of the publication offers with such themes as getting ready and positioning the sufferer, anaesthesia, operation theatre structure and working group, inducing pneumothorax, basic operative steps, after-care within the sanatorium, prevention of thrombosis, prophylactic antibiotics, risks and dangers of the strategy, and using documentation. basic operative steps equivalent to thoracoscopic exploration and palpation intervention haemostasis andparenchymal leaks are defined in a separate part. a distinct half isdevoted to the diagnostic percentages and present symptoms for thoroscopy together with: spontaneous pneumothorax, haemothorax, chylothorax; pleural empyema, bronchopleural fistula, extrathoracic and intrapulmonary cysts and tumours, pericardial fenestration, therapy of malignant effusions, and thoracal sympathectomy.

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Example text

The routine postoperative monitoring during the first few hours is carried out according to the parameters shown in Table 5. Thorax drains should not be clamped, otherwise they serve no purpose and create a false sense of security. If symptoms are unclear and a drain is in place, the differential diagnosis is unlikely to be the development of a tension pneumothorax or haemothorax (see Sect. 7 for drainage methods and removal of drains). Once the anaesthesia has worn off, the majority of patients have pain during the first few hours in the side of the thorax in which the endoscopy was performed.

To date, we have not yet had to abandon thoracoscopy due to patient anxiety. 7 Drainage Following thoracic surgery, including thoracoscopic interventions, special postoperative measures are necessary owing to the negative physiological pressure in the pleural space (cf. Sect. 6). There is a potential risk of pleural callosities or a residual dead space forming if air fistula or postoperative collections of fluid are inadequately drained. To avoid this, large-lumen thorax drains must be placed correctly.

This can be prevented firstly by blunt penetration of the thoracic wall, secondly by applying an anti-misting agent to the window, thirdly by rinsing the trocar ·sleeve with Ringer's solution or cleaning it through a Fig. 17. a Endoscopic image: elastic sail-like adhesions. In the lower part of the figure lung parenchyma can be seen, and at the top the thorax wall. These adhesions obstruct the induction of a pneumothorax. b If the Verres needle is inserted at a point with such adhesions between the lung and wall of the chest, there is a danger of the tip penetrating lung parenchyma.

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