By Dr. Rolf Inderbitzi (auth.)
After a pragmatic description of the endoscopic anatomy, the 1st a part of the publication bargains with such themes as getting ready and positioning the sufferer, anaesthesia, operation theatre structure and working group, inducing pneumothorax, common operative steps, after-care within the medical institution, prevention of thrombosis, prophylactic antibiotics, risks and dangers of the strategy, and using documentation. basic operative steps resembling thoracoscopic exploration and palpation intervention haemostasis andparenchymal leaks are defined in a separate part. a distinct half isdevoted to the diagnostic chances and present symptoms for thoroscopy together with: spontaneous pneumothorax, haemothorax, chylothorax; pleural empyema, bronchopleural fistula, extrathoracic and intrapulmonary cysts and tumours, pericardial fenestration, remedy of malignant effusions, and thoracal sympathectomy.
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Example text
With a non-ventilated lung and double-lumen intubation, on the other hand, the intrapleural pressure with the lung collapsed and the trocar sleeves open was, as might be expected, ambient pressure. The study was performed using a unit which records the intrapleural pressure in cm H 20 by means of an electronic transducer. The first incision, standardly made at the highest point anterior to the latissimus dorsi muscle (cf. Fig. 16), is used to introduce the Verres needle if a free thoracic cavity is expected.
6). Care and maintenance of the instruments, some of which are particularly delicate, and suitable storage of the instrument sets, making them readily available at all times, demands highly motivated staff. For the operation to run smoothly, 20 Operative Technique staff must be thoroughly familiar with the instrument set, the electronic units and the wide variety of accessories. The instrumentation team will take a greater interest in minimally invasive surgery if they are fully informed about the purpose of the operation and are directly involved in the events taking place.
The CO2 insufflation, which is continued under vision after the initial 500 ml, allows controlled, but fast deflation of the lung without reducing the safety provided by the endo-insufflator functions listed above. As an alternative, a pneumothorax unit can be used, as found commonly in pneumology [21, 26]. In a small study of the intrapleural pressures when using the endo insufflator involving ten patients, we discovered that during insufflation of CO2 at a preselected rate of 111m and with the maximum pressure limited to 15 mmHg, the intrapleural pressure in the initial phase of the pneumothorax varied between - 2 and + 1 cm H 20.