Nonvideo thoracoscopy with local anesthesia in elderly patients

Main Article Content

Julio Mott Ancona Lopez Andre Miotto Cristiano Rodrigo de Alvarenga Nascimento

Abstract

Introduction

Thoracoscopy was improved after the introduction of video-surgery at the end of the 80s, enabling thorough investigation of the pleural cavity. However, the video-assisted thoracic surgery (VATS), requires general anesthesia, which limits its use in seriously ill patients and elderly patients. Closed pleural biopsy and analysis of pleural fluid by thoracocentesis have limited value in the diagnosis of pleural conditions. Thus, we studied the indications and the results of this procedure under local anesthesia in an elderly population and with borderline clinical condition.

Method

Between 2003-2010, 137 thoracoscopies with local anesthesia and sedation were performed.

Results

73 patients (53.2%) were female and 64 (46.8%) were male. The average age was 67 years. 91 patients (66.4%) had comorbidities, such as cardiac and renal failure, hypertension, diabetes and chronic obstructive pulmonary disease.

The indication of thoracoscopy was given by the following reasons: 6 patients with pleural empyema (4.3%); 7 hemothorax patients (5.1%); 49 patients (35%) with a history of malignancy and suspected secondary pleural effusion; 75 patients (54.7%) with pleural effusion of unknown cause.

In patients with neoplastic history (49 patients), the secondary pleural disease was confirmed in 71.4%. In 14 patients, pleural infiltration was not diagnosed. In 38 patients (86.3%), pleurodesis was performed due to a history of cancer and recurrence of pleural effusion. Talc was the only sclerosing agent used in all cases of pleurodesis. There was no immediate mortality related to the procedure nor need for thoracotomy due to bleeding after pleura and lung biopsies.

Conclusion

Thoracoscopy under local anesthesia is a low-cost method, technically simple and useful in the diagnosis and treatment of several pleural diseases. In critically ill, elderly and patients with several comorbidities, it should be considered as an alternative to VATS

Article Details

How to Cite
LOPEZ, Julio Mott Ancona; MIOTTO, Andre; NASCIMENTO, Cristiano Rodrigo de Alvarenga. Nonvideo thoracoscopy with local anesthesia in elderly patients. Medical Research Archives, [S.l.], v. 4, n. 7, nov. 2016. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/753>. Date accessed: 28 mar. 2024.
Keywords
Thoracic surgery, Thoracoscopy, Pleural Effusion
Section
Articles

References

1. Mishra AK, Verma SK, Kant S, Kushwaha RA, Garg R, Kumar S, Prakash V, Verma A, Sagar M. A study to compare the diagnostic efficacy of closed pleural biopsy with that of the thoracoscopic guided pleural biopsy in patients of pleural effusion. South Asian J Cancer. 2016 Jan-Mar;5(1):27-8. doi: 10.4103/2278-330X.179700.
2. Jacobeous HC. Possibility of the use of cystoscope for the investigation of serous cavities. Munch Med wochenschr. 1910; 57:2090–2092.
3. Urschel JD. Current applications of nonvideo thoracoscopy. Int Surg. 1997 Apr-Jun;82(2):131-3.
4. Fraga JC, Lima A, Schopf L, Antunes C.Thoracoscopy with mediastinoscope in pediatric complicated parapneumonic effusion J Pediatr (Rio J). 1999 Nov-Dec;75(6):470-6.
5. Dharmesh Patel Are the days of closed pleural biopsy over? Yes, Lung India. 2015 Nov-Dec; 32(6): 638–640. doi:10.4103/0970-2113.168114
6. Lee P, Mathur P. Advances in pleural diseases: what is the future for medical thoracoscopy? Curr Opin Pulm Med. 2016 Mar 17.
7. Shojaee S, Lee HJ. Thoracoscopy: medical versus surgical-in the management of pleural diseases. J Thorac Dis. 2015 Dec;7(Suppl 4): S339-51. doi: 10.3978/j.issn.2072-1439.2015.11.66.
8. Akulian J, Feller-Kopman D. The past, current and future of diagnosis and management of pleural disease. J Thorac Dis. 2015 Dec;7(Suppl 4):S329-38. doi: 10.3978/j.issn.2072-1439.2015.11.52.
9. Gonzalez-Rivas D. Uniportal thoracoscopic surgery: from medical thoracoscopy to non-intubated uniportal video-assisted major pulmonary resections. Ann Cardiothorac Surg. 2016 Mar;5(2):85-91. doi: 10.21037/acs.2016.03.07
10. Cajozzo M, Lo Iacono G, Raffaele F, Anzalone AA, Fatica F, Geraci G, Dioguardi S. Thoracoscopy in pleural effusion - two techniques: awake single-access video-assisted thoracic surgery versus 2-ports video-assisted thoracic surgery under general anesthesia. Future Oncol. 2015 Nov;11(24 Suppl):39-41. doi: 10.2217/fon.15.288.
11. Dixon G, de Fonseka D, Maskell N. Pleural controversies: image guided biopsy vs. Thoracoscopy for undiagnosed pleural effusions? J Thorac Dis. 2015 Jun;7(6):1041-51. doi: 10.3978/j.issn.2072-1439.2015.01.36.