Tips and Tricks in Thoracic Surgery (eBook)

Pala Babu Rajesh, MBBS, MAMS, FRCS Ed, FRCS, (C/th) FETCS, FRCS( Eng) FIACS (Hon) Consultant Thoracic Surgeon, Regional Department of Thoracic Surgery, Birmingham Heartlands Hospital, UK Dakshesh H. Parikh, MD; FRCS (Paed) Consultant Paediatric Surgeon, The Birmingham Children’s Hospital NHS Trust, UK.

Foreword 6
Preface 7
Contents 8
Part I: Lung 11
1: Congenital Lung Malformations 12
1.1 Introduction 13
1.2 Lung Agenesis/Aplasia 13
1.3 Cystic Lung Lesion 14
1.4 Congenital Pulmonary Airway Malformation CPAM 15
1.5 Congenital Lobar Emphysema 17
1.6 Lung Sequestration 17
1.7 Bronchogenic Cyst 20
1.8 Technical Tips and Tricks for Thoracic Surgery in Congenital Lung Malformation 21
1.8.1 Thoracoscopic Resection 21
1.9 Muscle-Sparing Thoracotomy 23
References 24
2: Lung Volume Reduction Surgery for Severe Emphysema 26
2.1 Introduction 26
2.2 The National Emphysema Treatment Trial 27
2.3 Patient Assessment 32
2.3.1 Symptoms 32
2.3.2 Preoperative Work-Up 33
2.4 Patient Preparation 35
2.5 Operative Technique 36
2.5.1 Anesthetic Management 37
2.5.2 Sternotomy Approach to LVRS 37
2.5.3 VATS Approach to LVRS 41
2.6 Postoperative Management 42
2.7 Alternative Interventions for Severe Emphysema 44
References 45
3: Primary Tumours 46
3.1 Introduction 47
3.2 Assessment of Surgical Risk 47
3.3 Surgical Approaches and Extent of Lung Resection 49
3.4 Extent of Lung Resection 49
3.4.1 Sublobar Resection 52
3.5 Extended Lymphadenectomy Versus Systematic Lymph Node Sampling 52
3.6 Surgery for Early-Stage NSCLC (Stage I and Stage II) 53
3.6.1 Video-Assisted Thoracoscopic Surgery Lobectomy Versus Open Lobectomy 53
3.7 Surgery for Locally Advanced NSCLC (Stage IIIA) 56
3.7.1 Surgery for T3N1 56
3.7.2 T4 Disease 57
3.7.3 T1–T3 N2 Disease 57
References 57
4: Pulmonary Metastases 61
4.1 Introduction 62
4.1.1 Not Every Lung Nodule Is a Metastasis 64
4.1.2 Surgical Approach: Different Ways to Remove Lung Metastases 64
4.1.2.1 Is VATS Indicated for Resection of Pulmonary Metastases? 65
4.1.3 VATS Technique 66
4.1.4 Finding Difficult Lesions 66
4.1.4.1 Open Surgical Approach: Unilateral Disease 66
4.1.5 Thoracotomy 67
4.1.6 Central Lesions 68
4.1.7 Open Surgical Approach: Bilateral Disease 68
4.1.8 Sternotomy 68
4.1.9 Bilateral Anterior Thoracotomies 69
4.2 Is Repeat Metastasectomy Feasible? 69
References 70
5: Lung Transplantation 72
5.1 Introduction 72
5.2 Donor Assessment and Management 73
5.3 Operative Technique 75
References 79
Part II: Infections 80
6: Empyema Thoracis 81
6.1 Introduction 82
6.2 Technical Tips and Tricks of Video-Assisted Thoracoscopic Debridement of Empyema 82
6.2.1 Review the Radiologic Evidence 83
6.3 Tips and Tricks to Avoid and Deal with Intraoperative Anticipated and Unanticipated Complications 83
6.4 Alternative Methods of Empyema Management 84
6.5 Variations and Complex Presentations 85
6.5.1 Failed Urokinase Therapy 85
6.5.2 Failure of Thoracoscopy to Adequately Manage Empyema Debridement 85
6.5.3 Pyopneumothorax and Necrotic Pneumonia 86
6.5.4 Pneumatocele in Consolidated Lung 87
6.5.5 Bilateral Empyema 88
6.5.6 Tuberculous Empyema 88
6.5.7 Secondary Empyema: Ruptured Oesophagus Following Balloon Dilatation 88
6.5.8 Thoracic Tumours, Congenital Lung Lesions and Other Conditions Presenting as Empyema 90
References 91
7: Bronchiectasis 92
7.1 Introduction 92
7.2 Classification 93
7.3 Medical Management 94
7.4 Surgical Management 95
7.4.1 Preoperative Considerations 96
7.4.2 Anaesthetic Considerations 96
7.4.3 Surgical Technical Tips and Tricks 96
7.5 Postoperative Complications 97
References 98
8: Fungal Infections: Current Role of Thoracic Surgeons in Cases of Pulmonary Aspergillosis 99
8.1 Introduction 100
8.2 Practical Classification of Pulmonary Aspergillosis for Thoracic Surgeons 100
8.2.1 Classification by Invasiveness 100
8.2.2 Classification of Aspergillomas 104
8.3 Surgical Management of Aspergillomas 104
8.4 Technical Tips and Tricks for Lung Resection for Aspergilloma 105
8.5 Two-Stage Cavernostomy 105
8.6 One-Stage Cavernostomy 107
8.7 Intracavitary Administration of Antifungal Agents 108
8.8 Role of Surgery in Acute Invasive Aspergillosis 108
8.9 Special Considerations Regarding Aspergillosis and Lung Transplantation 108
8.9.1 Indications for Lung Transplantation in a Patient with Aspergillosis 108
8.9.2 Posttransplant Bronchopulmonary Aspergillosis 109
8.9.3 Prophylaxis After Lung Transplantation 110
8.10 Conclusions 111
8.11 Pediatric Perspective 111
References 111
9: Surgical Management in Pulmonary Tuberculosis 113
9.1 Introduction 114
9.2 Technical Tips and Tricks that Will Enhance Operative Experience and Improve Results 114
9.2.1 Diagnosis 114
9.3 Medical Management 115
9.4 Surgical Management 115
9.4.1 Avoiding Complications of TB Surgery 115
9.4.2 Obtaining Tissue for Diagnosis 116
9.4.3 Surgical Management of Pleural Disease 117
9.4.4 Technique of Decortication 117
9.5 Surgery for Pulmonary Tuberculosis 117
9.6 Surgical Techniques 118
9.6.1 Segmental Resection 118
9.6.2 Tips and Tricks to Deal with Postoperative Complications 118
9.6.3 Thoracoplasty 119
9.7 Indications of Thoracoplasty 119
9.8 Thoracoplasty in Tuberculous Cavities 119
9.9 Thoracoplasty for Post-pneumonectomy Empyema 119
9.9.1 Surgery in Aspergilloma 119
References 126
10: Lung Abscess 128
10.1 Introduction 129
10.2 Classification, Differential Diagnosis 129
10.3 Diagnosis 130
10.4 Management of Acute Lung Abscess 130
10.4.1 Surgical Management 131
10.5 Management of Chronic Lung Abscess 132
10.6 Technical Tips and Tricks that Will Enhance Operative Experience and Improve Results 134
10.6.1 Pulmonary Abscess and Lung Cancer 134
10.6.2 Necrotic Lung Cancer Can Mimic an Acute Lung Abscess or a Parasitic Infection 138
10.6.3 Human Immunodeficiency Virus (HIV) Infection and Lung Abscess 138
10.7 Tips and Tricks to Avoid and Deal with Intraoperative Anticipated and Unanticipated Complications 140
10.7.1 Anaesthesiological Considerations 141
10.7.2 Surgical Considerations 142
10.8 Alternative Ways of Operative Management: Advantages and Disadvantages 144
10.8.1 Percutaneous Transthoracic Drainage 144
10.8.2 Endoscopic Drainage 145
References 146
11: Hydatid Disease 148
11.1 Introduction 148
11.2 Technical Tips and Tricks of Surgical Treatment of Hydatid Disease 151
11.3 Tips and Tricks for Surgical Complications of Hydatid Disease 153
References 154
Part III: Trauma 156
12: Blunt Thoracic Trauma 157
12.1 Introduction: Epidemiology and Outcomes 158
12.2 Mechanisms of Trauma 159
12.3 Mechanism of Death After Blunt Trauma 159
12.4 Tips and Tricks in Diagnosis and Triage 159
12.5 Tips and Tricks in Imaging 160
12.5.1 Chest Radiograph 160
12.5.2 Computed Tomography (CT) 161
12.5.3 Electrocardiogram 162
12.5.4 Focused Abdominal Sonography for Trauma (FAST) 162
12.5.5 Aortography 162
12.6 Tips and Tricks in Managing Life-Threatening Presentations 162
12.6.1 Airway Compromise 162
12.6.2 Cricothyroidotomy 162
12.6.3 Needle Cricothyroidotomy 164
12.6.4 Percutaneous Cricothyroidotomy 164
12.6.5 Surgical Cricothyroidotomy 164
12.6.6 Tension Pneumothorax 164
12.6.7 Thoracostomy 165
12.6.8 Needle Thoracocentesis 165
12.6.9 Open Thoracostomy 166
12.6.10 Tube Thoracostomy 167
12.6.11 Open Pneumothorax 167
12.6.12 Massive Haemothorax 167
12.6.13 Cardiac Tamponade 167
12.7 Tips and Tricks in Emergency Access 168
12.7.1 Thoracotomy and Thoracosternotomy 168
12.7.2 Anterior Thoracotomy 168
12.7.3 Thoracosternotomy 169
12.8 Tips and Tricks in Managing Injuries Associated with Blunt Trauma 169
12.8.1 Rib Fractures 169
12.8.2 Flail Chest 169
12.8.2.1 Rib Fixation 170
12.8.3 Cardiac Tamponade 170
12.8.4 Sternal Fractures 171
12.8.5 Pulmonary Injuries 171
12.8.6 Laceration 171
12.8.7 Tractotomy 171
12.8.8 Lung Resection 172
12.8.9 Blunt Cardiac Trauma 172
12.8.10 Aortic Transection 172
12.8.11 Diaphragmatic Injuries 173
12.8.12 Tracheobronchial Injuries 173
12.8.13 Oesophageal Injury 173
12.9 Post-injury Care and Management 173
12.10 Delayed Presentations and Complications of Thoracic Trauma 174
12.11 Role of Video-Assisted Thoracoscopic Surgery (VATS) in Thoracic Trauma 174
References 175
13: Penetrating Injuries 177
13.1 Introduction 177
13.2 Radiological Imaging 178
13.3 Resuscitative Thoracotomy 178
13.3.1 Indications for a Resuscitative Thoracotomy 179
13.3.2 Contraindications for a Resuscitative Thoracotomy 180
13.4 Surgical Access for Penetrating Trauma 180
13.4.1 Resuscitative or Emergency Thoracotomy 180
13.4.2 Access for Urgent Entry to the Thorax 181
13.4.3 Cardiac Injury 181
13.4.4 Great Vessel Injury 182
13.4.5 Chest Wall Injury 183
13.4.6 Airway Injuries 183
13.4.7 Lung Parenchymal Injury 184
13.4.8 Injury to the Diaphragm 184
13.4.9 Oesophageal Injury 185
13.5 Conclusions 185
13.6 Complications 185
References 186
Part IV: Thoracic Wall 187
14: Chest Wall Tumours 188
14.1 Introduction 188
14.2 Pathology 189
14.3 Diagnosis 189
14.4 Surgical Management of Chest Wall Tumours 190
14.5 Principles of Surgical Resection 191
14.5.1 Curative Resection 191
14.5.2 Operability 191
14.5.3 Planning Resection 191
14.5.4 Entry into the Chest 192
14.5.5 Chest Wall Reconstruction 192
14.5.6 Planning the Operation 192
14.5.7 When to Reconstruct 192
14.5.8 What Prosthetic Material to Reconstruct? 193
14.6 Special Situations 196
14.6.1 Diaphragm 196
14.6.2 Impaction of Scapula 196
14.6.3 Stability of the Spine 197
14.7 Postoperative Management 197
References 198
15: Pleural Pathologies and Malignant Effusion 200
15.1 Background 201
15.2 Pleural Effusion 201
15.2.1 Benign Effusion 201
15.2.2 Malignant Effusion 201
15.2.3 Tips and Tricks for Operative Management 202
15.2.4 Alternative Ways of Operative Management 202
15.2.5 Tips and Tricks to Avoid and Deal with Intraoperative Complications 203
15.2.6 Postoperative Management and Postoperative Complications 203
15.2.7 Conclusions 203
15.3 Pneumothorax 204
15.3.1 Primary (PSP) 204
15.3.2 Secondary (SSP) 204
15.3.3 Tips and Tricks for Operative Management 204
15.3.4 Alternative Ways of Operative Management 205
15.3.5 Tips and Tricks to Avoid and Deal with Intraoperative Complications 206
15.3.6 Postoperative Management and Postoperative Complications 206
15.3.7 Variations and Complex Presentations 207
15.3.8 Conclusions 207
15.4 Pleural Fibroma 207
15.4.1 Tips and Tricks for Operative Management 208
15.4.2 Alternative Ways of Management 208
15.4.3 Postoperative Management 208
15.4.4 Conclusions 209
15.5 Malignant Pleural Mesothelioma (MPM) 209
15.5.1 Tips and Tricks for Operative Management 209
15.5.2 Alternative Ways of Operative Management 211
15.5.3 Tips and Tricks to Avoid and Deal with Intraoperative Complications 212
15.5.4 Postoperative Management and Postoperative Complications 212
15.5.5 Variations and Complex Presentations 213
References 213
16: Thoracic Outlet Syndrome 215
16.1 Neurogenic Thoracic Outlet Syndrome [NTOS] 216
16.2 Conservative Measures 217
16.3 Arterial Thoracic Outlet Syndrome [ATOS] 218
16.4 Venous Thoracic Outlet Syndrome [VTOS] 219
References 222
17: Pectus Excavatum 224
17.1 Assessment of the Adult and Adolescent Patients with PE 226
17.1.1 Psychosocial 228
17.2 Investigations 229
17.3 Criteria for Surgical Repair 230
17.4 Modified Ravitch Repair 232
17.5 Nuss Operation 235
Recommended Reading 239
18: Sternal Cleft 240
18.1 Introduction 240
18.2 Technical Tips and Tricks 241
18.2.1 Preoperative Assessment 241
18.2.2 Early Neonatal Surgery 244
18.2.3 Late-Presenting Cases 244
18.2.4 Synthetic and Autologous Grafts 245
18.2.5 Postoperative Management 246
References 247
Part V: Mediastinum 248
19: Anterior Mediastinal Tumours 249
19.1 Introduction 250
19.2 Anterior Mediastinal Tumours 251
19.2.1 Thymoma 251
19.2.2 Diagnosis 251
19.2.3 Treatment 252
19.2.4 Surgical Technique 252
19.2.5 Germ Cell Tumours (GCTs) 253
19.2.6 Diagnosis 253
19.2.7 Mediastinal Teratoma 253
19.2.8 Seminomatous and Nonseminomatous Tumours 254
19.2.9 Surgical Technique 254
19.2.10 Mediastinal Lymphoma 254
19.2.11 Diagnosis and Treatment 255
19.3 Middle Mediastinal Tumours 255
19.3.1 Mediastinal Cysts 255
19.3.2 Diagnosis 255
19.3.3 Treatment 256
19.3.4 Bronchogenic Cyst 256
19.3.5 Gastroenteric Cyst 257
19.3.6 Pericardial Cyst 257
References 257
20: Thymic Pathology and Myasthenia Gravis 258
20.1 Introduction 259
20.2 Tips and Tricks in Preoperative Preparation 260
20.3 Tips and Tricks for the Operating Room 262
20.4 Tips and Tricks: Operative Steps 263
20.5 Tips and Tricks: Postoperative Management 268
20.6 Results at Our Institution 268
20.7 Discussion and Published Literature 269
20.8 Conclusion and Future 273
References 274
21: Posterior Mediastinal Tumors 277
21.1 Introduction 278
21.2 Technical Tips and Tricks of Posterior Mediastinal Tumor Resection 278
21.2.1 Preoperative Evaluation 278
21.2.2 General Considerations 279
21.3 Video-Assisted Thoracoscopic Surgery 279
21.4 Video-Assisted Thoracoscopic Surgery in Children 281
21.5 Tips and Tricks That Will Avoid and Deal with Intraoperative Anticipated and Unanticipated Complications 282
21.6 Alternate Methods to Resect Posterior Mediastinal Tumors 282
21.7 Uncommon Pathology 283
21.8 Postoperative Complications and Follow-up 285
21.9 Summary 286
References 286
Part VI: Tracheo-Broncheal Tree 290
22: Bronchoscopy: Rigid and Flexible 291
22.1 Introduction 291
22.2 Rigid Bronchoscopy 292
22.3 Fibre-Optic Bronchoscopy 292
22.4 Indications 292
22.5 Instruments 293
22.5.1 Rigid Bronchoscope 293
22.5.1.1 Adjuncts 293
22.5.2 Fibre-Optic Bronchoscope 294
22.5.2.1 Adjuncts 294
22.6 Anaesthetic Considerations 294
22.6.1 Performing the Procedure 295
22.6.1.1 Flexible Bronchoscopy 295
22.6.1.2 Rigid Bronchoscopy 295
22.7 Diagnostic Bronchoscopy 296
22.7.1 Flexible Bronchoscopy 296
22.7.2 Rigid Bronchoscopy 296
22.7.2.1 Preoperative Bronchoscopy 297
22.7.2.2 Biopsy 297
22.7.2.3 Assessment of Tracheal Stenosis 298
22.8 Staging with Bronchoscopy 299
22.8.1 Assessment with Rigid Bronchoscope 299
22.8.2 Transbronchial Needle Aspiration and Endobronchial Ultrasound 299
22.9 Therapeutic Bronchoscopy 299
22.9.1 Tracheobronchial Toilet 299
22.9.2 Dilation of Tracheal Stenosis 299
22.9.3 Ablation of Endobronchial Tumours 301
22.9.4 Stenting of the Airway 302
22.9.5 Removal of Foreign Bodies 303
22.9.6 Guide to Tracheostomy 304
22.10 Endobronchial Volume Reduction 304
22.11 Rare Utility of Bronchoscopy 304
22.12 Bronchoscopy Training 305
References 305
23: Acquired Tracheal Stenosis 307
23.1 Introduction 307
23.2 Patient Assessment 310
23.2.1 Symptoms and Signs 310
23.2.2 Preoperative Workup 311
23.2.3 Initial Management 312
23.3 Patient Preparation 313
23.4 Anesthetic Management 314
23.5 Operative Technique 315
23.5.1 Tracheal Release Maneuvers [7] 319
23.6 Postoperative Management 323
23.7 Outcomes 323
23.8 Alternative Interventions for Central Airway Pathology 324
References 325
Part VII: Oesophagus 327
24: Congenital Oesophageal Atresia and Tracheo-oesophageal Fistula 328
24.1 Introduction 329
24.2 Tips and Tricks for Repair of OA + TOF 329
24.2.1 Bronchoscopy 330
24.2.2 Proximal Pouch Identification and Transanastomotic Tube (TAT) 330
24.2.3 Approach 330
24.2.4 TOF Division 331
24.2.5 Oesophageal Anastomosis 332
24.2.6 Thoracoscopic OA Repair 332
24.2.7 H-Type Fistula 334
24.3 Difficult Situations 334
24.3.1 Long-Gap Type C Oesophageal Atresia 334
24.3.2 Right-Sided Aortic Arch 335
24.3.3 Respiratory Compromise 335
24.3.4 Ruptured Stomach 336
24.3.5 Concurrent Duodenal Atresia and/or Anorectal Malformation 336
24.4 Post-operative Care 336
24.5 Post-operative Complication 337
24.5.1 Large Anastomotic or Fistula Leak 337
24.5.2 Small Anastomotic Leak 337
24.5.3 Recurrent Fistula 337
24.5.4 Stricture 337
24.5.5 Tracheomalacia 338
References 339
25: Long-Gap Oesophageal Atresia 341
25.1 Introduction 342
25.2 Technical Tips and Tricks of Thoracoscopic Elongation on Long-Gap Oesophageal Atresia 342
25.3 Other Procedures That May Be Considered in Variation of Presentation 348
25.4 Tips and Tricks That Will Avoid and Deal with Intraoperative Anticipated and Unanticipated Complications 349
25.5 Discussion of Uncommon Pathology and Operative Findings 350
25.5.1 Proximal Tracheoesophageal Fistula 350
25.5.2 Unusual Forms 350
25.5.3 Tips and Tricks to Deal with Postoperative Complications 350
25.6 Discussion 351
References 351
26: Foregut Duplication Cysts 353
26.1 Introduction 353
26.2 Technical Tips and Tricks 354
26.3 Thoracoscopic Surgery 355
26.4 Thoracotomy 357
26.5 Cervical Excision 357
26.6 Intraoperative Anticipated and Unanticipated Complications 357
References 358
27: Oesophageal Tumours: Benign and Malignant 359
27.1 Introduction 359
27.2 Technical Tips and Tricks 360
27.3 Tips and Tricks that Will Avoid and Deal with Intraoperative Anticipated and Unanticipated Complications 366
27.3.1 Splenic Injury 366
27.3.2 Bleeding 366
27.3.3 Chyle Leaks 367
27.3.4 Lymph Node Fracture 367
27.3.5 Airway Injury 367
27.4 Alternative Methods 368
27.5 Uncommon Pathology 369
27.6 Postoperative Management 369
27.7 Tips and Tricks to Deal with Postoperative Complications 369
27.8 Conclusions and the Future 370
References 370
28: Oesophageal Strictures 372
28.1 Introduction 373
28.2 Diagnosis and General Management 373
28.3 Technical Tips and Tricks of Indwelling Balloon Catheter Treatment for Persistent Oesophageal Strictures 374
28.3.1 Technique 374
28.4 Other Procedures That May Be Considered in Variation of Presentation 375
28.5 Tips and Tricks That Will Avoid and Deal with Intraoperative and Unanticipated Complications 376
28.6 Discussion of Uncommon Pathology and Operative Findings 376
28.7 Tips and Tricks to Deal with Postoperative Complications 377
28.8 Discussion 378
References 378
29: Oesophageal Replacement by Gastric Transposition 379
29.1 Introduction 379
29.2 Procedure of Gastric Transposition: Technical Tips and Tricks 380
29.2.1 Preoperative Planning 380
29.2.2 Operative Technique 381
29.2.3 Post-operative Management 385
29.3 Alternative Approaches 386
29.4 Follow-Up and Outcomes 386
29.4.1 Nutrition 386
29.4.2 Growth 387
29.4.3 Anastomotic Leak/Stricture 387
29.4.4 Gastric Emptying 387
29.4.5 Achlorhydria/Gastro-oesophageal Reflux 388
29.4.6 Barrett’s Oesophagus 389
29.4.7 Respiratory Function 389
29.4.8 Quality of Life 390
29.5 Conclusions and Future 390
References 390
30: Oesophageal Replacement: Jejunal Interposition 392
30.1 Introduction 393
30.2 Indications 393
30.3 Technical Tips and Tricks 393
30.3.1 Preoperative Assessment 394
30.3.2 Orthotopic Pedicled Jejunal Interposition 395
30.3.3 Alternative Operative Techniques 397
30.3.4 Uncommon Pathology 398
30.3.5 Postoperative Management 399
30.4 Postoperative Complications 400
30.4.1 Early Complications 400
30.4.2 Long-Term Complications 401
References 402
31: Achalasia of the Cardia 403
31.1 Introduction 404
31.1.1 Clinics Visit 404
31.2 Symptoms 404
31.3 Preoperative Workup 406
31.3.1 Patient Preparation 407
31.3.2 Operative Technique 407
31.4 Other Technical Considerations 414
References 417
32: Anti-Reflux Surgery 419
32.1 Introduction 419
32.2 Selection for Surgery 420
32.2.1 Gastro-Oesophageal Reflux Disease (GORD) 420
32.2.2 Giant Hiatus Hernia/Intrathoracic Stomach with  Gastric Volvulus 420
32.3 Primary Laparoscopic Fundoplication 421
32.4 Revision Fundoplication 425
32.4.1 Assessment for Revisional Surgery 425
32.5 Giant Hiatus Hernia and Gastric Volvulus 427
32.6 Postoperative Complications 428
References 430
Part VIII: Diaphragm 431
33: Congenital Diaphragmatic Hernia 432
33.1 Introduction 433
33.2 Tips and Tricks for the Surgical Repair of CDH 434
33.2.1 Open Approach 434
33.3 Technical Tips and Tricks in Open Hernia Repair of Large Diaphragmatic Defects (Bochdalek Hernia) with Gore-­Tex® Patch 434
33.4 Technical Tips and Tricks in Thoracoscopic Hernia Repair of the Diaphragmatic Defects (Bochdalek Hernia) with or Without the Gore-Tex® Patch 435
33.5 Technical Tips and Tricks in Laparoscopic Hernia Repair of Diaphragmatic Defects (Morgagni Hernia) with or Without Gore-Tex® Patch 437
33.6 Tips and Tricks That will Avoid and Deal with Intraoperative Anticipated and Unanticipated Complications 439
References 440
34: Diaphragmatic Eventration 442
34.1 Introduction 442
34.2 Technical Tips and Tricks of Thoracoscopic Plication 443
34.3 Postoperative Complications 445
References 446
Part IX: Miscellaneous 447
35: Spontaneous Pneumothorax 448
35.1 Introduction 448
35.2 Pathophysiology 449
35.3 Clinical Presentation 449
35.4 Primary Spontaneous Pneumothorax 452
35.5 Secondary Spontaneous Pneumothorax 453
35.6 Management of Spontaneous Pneumothorax 453
35.6.1 Observation 453
35.6.2 Thoracocentesis 454
35.6.3 Thoracostomy 454
35.6.4 Surgery for Spontaneous Pneumothorax 454
35.7 Tips and Tricks for Thoracoscopic Bullectomy and Parietal Pleurectomy 455
35.8 Tips and Tricks for Specific Aetiology 456
References 459
36: Hyperhidrosis 460
36.1 Introduction 461
36.2 Technical Tips and Tricks of Video-Assisted Thoracoscopic Sympathectomy 461
36.3 Patient Selection 461
36.4 Anaesthesiological Considerations 463
36.5 Surgical Technique 463
36.6 Level of Targeting the Sympathetic Chain 465
36.7 Tips and Tricks to Avoid and Deal with Intraoperative Anticipated and Unanticipated Complications 465
36.8 Alternative Methods of Hyperhidrosis Management 466
36.9 Variations and Complex Presentations 467
References 467
37: Chylothorax 469
37.1 Introduction 470
37.2 Typical Thoracic Duct Anatomy [2] 470
37.3 Technical Tips and Tricks 470
37.3.1 Establish the Diagnosis 470
37.3.2 Medical Management 471
37.3.3 Operative Interventions 472
37.4 Chylothorax Post Congenital Diaphragmatic Hernia (CDH) Repair 473
37.5 Chylothorax in Congenital Lymphatic Malformation and Mediastinal Cysts 474
References 475
Index 476