Beruflich Dokumente
Kultur Dokumente
The Method of
Medical Thoracoscopy
2nd Edition
Ralf HEINE
Jan Hendrik Bartels
Christian WEISS
®
THE METHOD OF
MEDICAL THORACOSCOPY
2nd Edition
Ralf HEINE, MD
Jan Hendrik BARTELS, MD
Christian WEISS
Table of Contents
1 Historical Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Indications and Contraindications for Thoracoscopy . . . . . . . . . . . 6
2
2.1 Indications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
2.2 Contraindications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
3 Anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Preparations for Thoracoscopy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
4
4.1 Imaging Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
4.2 Diagnostic Pneumothorax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
4.3 Premedication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
4.3.1 The Evening Before the Procedure . . . . . . . . . . . . . . . . . . . . . . . 10
4.3.2 The Day of the Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Technique of Thoracoscopy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
5
5.1 Procedure Room . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
5.2 Instruments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
5.3 Positioning the Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
5.4 Monitoring and Other Measures during the Procedure . . . . . . 12
5.5 Patient Preparation after Positioning . . . . . . . . . . . . . . . . . . . . . 12
5.6 Selection of the Entry Site. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
5.7 Local Anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
5.8 Conscious Sedation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
5.9 Trocar Insertion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
5.10 Inspection of the Thoracic Cavity . . . . . . . . . . . . . . . . . . . . . . . . 14
5.11 Thoracoscopic Biopsy and Lysis of Adhesions . . . . . . . . . . . . 16
5.12 Talc Pleurodesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
5.13 Concluding the Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
7 Complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
8 Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
1 Historical Background
The idea of using optical instruments to enter and during that time; as a result, the diagnostic capabilities of
examine body cavities that cannot be accessed through thoracoscopy were largely forgotten.18
a natural orifice dates back to the Dresden physician The fascination of being able to look into the chest led
G. Kelling (1866 – 945). As early as 1902, he published a R. Korbsch to state in 1927 that ‘in vivo pathology’ could
report detailing how he was able to perform ‘coelioscopy’ be accomplished if gross visual findings could be supple-
in a dog after first insufflating air into the abdominal cavity. mented by the histologic evaluation of biopsy specimens.
His optical system consisted of a cystoscope like the one
previously developed by M. Nitze (1848 –1906).11 The Viennese physician A. Sattler rediscovered the
diagnostic value of thoracoscopy in the early 1960s. He
Diagnostic thoracoscopy was first performed in human performed thoracoscopies in several thousand patients,
patients in 1910 by the Swedish internist H. C. Jacobaeus and we must credit him with making pleural biopsy practical
(1879 –1937).10 The creation of a pneumothorax did not pose for clinical use.18 He also performed thoracoscopy for
a new challenge for Jacobaeus, as C. Forlanini (1847–1918) therapeutic purposes and described life-saving emergency
had already developed the procedure in the late 1800s endoscopies for the treatment of hemothorax.23
for the collapse therapy to treat tuberculosis.6 Jacobaeus With the advent of video-assisted thoracoscopy in the
advanced the capabilities of diagnostic thoracoscopy by 1980s, it also became possible to use thoracoscopy
the introduction of thoracocautery. This technique, which for surgical indications. Since then, video-assisted
became important in the treatment of tuberculosis, used thoracic surgery (VATS) has become an established part
electrocautery for the lysis of pleural adhesions.9 By the end of the thoracic surgical repertoire. At the same time,
of the 1950s, thoracoscopy with thoracocautery was widely video-assisted thoracoscopy continues to be a mainstay in
practiced in the collapse therapy of tuberculosis. Only a few the medical diagnosis of diseases of the pleura, lung, and
clinicians utilized the diagnostic potential of thoracoscopy mediastinum.
3 Anesthesia
Medical thoracoscopy is usually performed under local General anesthesia with muscle relaxation and intubation
anesthesia, which should be combined with adequate with a double-lumen endotracheal tube are rarely necessary
conscious sedation. It is recommended that conscious for medical thoracoscopy and are generally reserved for
sedation and patient monitoring during the procedure children and uncooperative patients.
be conducted by an anesthesiologist or a physician
experienced in conscious sedation who can quickly
recognize and manage any threatening situations that may
arise.
8 The Method of Medical Thoracoscopy
1 Ultrasound localization of the thoracoscopy site in a patient with a 2 Metastasis in the parietal pleura (1). It must be confirmed that the
large pleural effusion (1). Sufficient space is available for safe trocar metastasis is located outside the proposed entry site.
insertion. The liver (3), diaphragm (4) and chest wall (2) are also seen.
3 Loculated pleural effusion. It is reasonable to expect that thoraco- 4 Small pleural effusion (1). Ultrasound cannot identify a safe site for
scopy in this patient will be a time-consuming procedure. It must entering the chest. Spleen (2), lung (3).
include the comprehensive lysis of adhesions to improve visualization.
The Method of Medical Thoracoscopy 9
The pneumothorax should be established immediately incision (Fig. 7). It is connected to a CO2 insufflation pump
prior to thoracoscopy. The patient is positioned on the (KARL STORZ Electronic Endoflator, Figs. 8, 9), which
examination table with the healthy side down. After sterile provides for microprocessor-controlled measurement and
skin preparation and draping of the affected side, local regulation of insufflation pressure and flow rate. A maximum
anesthesia with 10 mL of 1% lidocaine is performed in the intrapleural pressure limit of 2 mmHg should be set on the
fifth intercostal space in the midclavicular line or at another insufflation pump. The flow rate for CO2 insufflation should
puncture site previously identified by ultrasound. When be in the range of 0.5 to 1 L/min. The Electronic Endoflator
local anesthesia is completed, it should be determined also gives a numerical readout of the insufflated CO2
whether the lung is broadly adherent to the chest wall. volume.
This is done by filling the needle hub with local anesthetic When the Veress needle has penetrated the chest wall,
solution and then carefully advancing the needle through the insufflator will give a negative pressure reading of -4 to
the chest wall. When the needle tip penetrates the parietal -6 mmHg. If the needle tip is in the lung, the reading will
pleura and enters the pleural space, the fluid in the hub fluctuate around zero. If this does not occur, it means that
will be sucked into the chest by the negative intrathoracic the needle is in the chest wall or that the pleural layers
pressure. Generally we leave the anesthesia needle in place are obliterated. In this case we recommend moving to a
for a short time so that atmospheric air can enter the pleural different entry site because the pleural adhesion may be a
space through the needle (Figs. 5, 6). local process confined to the initial port.
With the local anesthesia needle removed, a stab incision
is made and a Veress needle is introduced through the
5 Fluid in the needle hub just before insertion through the parietal 6 When the needle penetrates the parietal pleura, the fluid in the hub
pleura. is aspirated into the pleural space by the negative intrathoracic
pressure.
7 Veress needle with a spring-loaded blunt inner cannula and Luer 8 Endoflator with initial settings (2 mmHg = upper limit of intrapleural
Lock adapter, length 10 cm. pressure, 1.0 L/min = insufflation flow rate, 00.0 = insufflated gas
volume) and display during CO2 insufflation (inset, Fig. 9: -1 mmHg =
current intrapleural pressure, 0.5 L/min = current flow rate, 00.3 L = gas
volume already insufflated).
10 The Method of Medical Thoracoscopy
When a negative pressure reading is obtained, 100 mL Occasionally, fresh pleural adhesions can be lysed by
of CO2 is insufflated initially into the pleural space. If applying a slight overpressure (2 mmHg). A total of 600 to
the pressure remains negative, the insufflation may be 800 mL of CO2 should be insufflated into the chest cavity.
continued. During this time the Endoflator will give an We recommend using a C-arm fluoroscope to monitor
intermittent reading of the current intrapleural pressure. If the insufflation process. This allows the operator to track
the pressure exceeds the maximum preset pressure level, the progression of the diagnostic pneumothorax and see
CO2 insufflation will stop automatically. whether enough space has been established between the
chest wall and visceral pleura to permit safe trocar insertion
for thoracoscopy (Fig. 10). Alternatively, the insufflation can
be monitored by chest radiography in the lateral position if
a C-arm fluoroscope is not available (Figs. 11, 12).
Carbon dioxide insufflation is recommended for creating
the pneumothorax because if a gas embolism should occur
as a result of visceral pleural injury, the CO2 will be quickly
reabsorbed. This minimizes the risk to the patient. In cases
where the pneumothorax is created the day before the
examination, CO2 should not be used because generally it
will be completely absorbed by the scheduled procedure
time on the following day.
4.3 Premedication
4.3.1 The Evening Before the Procedure
Generally there is no need to premedicate patients on the
evening before the procedure. Very anxious patients may
take 5 mg of midazolam (Dormicum®) orally at night.
11 Chest radiograph of a diagnostic pneumothorax. 12 Chest radiograph in right lateral decubitus shows a left seropneu-
mothorax and identifies a safe entry site for thoracoscopy.
The Method of Medical Thoracoscopy 11
5 Technique of Thoracoscopy
5.4 Monitoring and Other Measures an analogous technique is used to locate the site that offers
during the Procedure sufficient clearance between the lung and chest wall. In
patients with little or no pleural effusion or if a pneumo-
Oxygen saturation is continuously monitored by pulse thorax is present, the midaxillary line at the level of the fifth
oximetry throughout the procedure. An ECG trace should intercostal space is particularly favorable for obtaining a
be recorded to monitor cardiac rhythm, and blood-pressure comprehensive view of the pleural cavity. The preliminary
readings should be taken at 5-minute intervals. Oxygen creation of a pneumothorax will enhance safety and
is administered by oronasal mask at a rate of 3 – 4 L/min. facilitate the procedure.
Asecure IV line (20-gauge indwelling venous cannula) is
placed for administering medications during the procedure. 5.7 Local Anesthesia
Local anesthesia is administered in layers by the intra- and
5.5 Patient Preparation after Positioning subcutaneous injection of 1% lidocaine over an area of
When the patient has been positioned, a sterile skin prepa- 2 – 3 cm within the intercostal space. Then the cranial
ration is carried out around the proposed thoracoscopy and caudal rib margins are located, and depots of local
site. Then the patient is completely covered with sterile anesthetic are placed along the rib margins bordering
drapes, leaving an approximately 30 x 30-cm field exposed the intercostal space. Repeated aspirations are done
for trocar insertion (Fig. 16). to ensure that the needle does not enter a vessel. Next,
local anesthetic depots are injected into the muscles
and at the subpleural level. Air will be aspirated when the
5.6 Selection of the Entry Site needle has pierced the costal pleura. At that point the
The selected entry site should give optimum access needle is withdrawn with continuous aspiration until air is
to the pleural lesion requiring biopsy. In patients with a no longer obtained. This indicates that the needle tip is at
large pleural effusion, the best entry site is determined by the immediate subpleural level, and an additional depot of
ultrasonography (Section 4.1). The effusion volume at 3 – 4 mL lidocaine is placed in that region.
the proposed site should be sufficient to allow safe trocar Optimal local anesthesia is essential for a painless
insertion. In patients with an encapsulated pleural effusion, examination!
Intrathoracic Views
Inspection of the
Left Hemithorax
19 View into the posterior part of the left 20 View into the left pleural dome. The lung
hemithorax demonstrates the left upper shows mild anthracosis (1). Notable
lobe (1), lower lobe (2), and oblique interlobar structures in the pleural dome (2) are the left
fissure (3). The intercostal arteries and veins (4) subclavian artery (3) and the internal thoracic
and the ribs (5) are clearly visualized. The lung artery and accompanying veins on the anterior
shows mild signs of anthracosis. The pleura chest wall (4).
has a smooth, glistening appearance (normal).
21 Anteriorly directed view displays the 22 View of the bulging left diaphragm (1). 23 View of the posterior chest wall displays
lingula (1), pericardial fat (2), the phrenic The posterolateral chest wall (2) is visible the ribs (1), intercostal spaces (2) and
nerve and accompanying vessels (3), and the on the left side of the field. vessels (3), and the upper (4) and lower lobe
lower lobe of the left lung (4). Anterior chest (5).
wall (5).
The Method of Medical Thoracoscopy 15
24 Close-up view of the left subclavian artery 25 View of the anterior chest wall displays the 26 Close-up view of the costal pleura, which
(1) and vein (2) along with the internal internal thoracic artery and veins (1). The appears normal. The yellowish areas are
thoracic artery and left internal thoracic veins surface of the left upper lobe (2) is visible on the subpleural fat (1).
(3). Left upper lobe (4), anterior chest wall (5). right side of the field. The costal pleura appears
smooth and shiny and shows normal vascularity.
27 Close-up view of the left pleural dome 28 Pleural carcinomatosis involving the left 29 Pleural empyema.
displays the aortic arch (1), left subclavian parietal pleura. The velvety red appear-
artery (2), and the collapsed upper lobe (3) ance of the pleura is consistent with chronic
and lower lobe (4). pleuritis.
Inspection of the
Right Hemithorax
30 View into the right hemithorax shows the 31 View of the right cardiophrenic angle with
‘border triangle’ formed by the junction of the right atrium (1), diaphragm (2) and
the middle lobe (1), lower lobe (2) and upper middle lobe (3).
lobe (3). The visceral and parietal pleura
appear thickened and fibrotic due to chronic
fibrosing pleuritis.
16 The Method of Medical Thoracoscopy
32 Biopsy with an optical forceps. 33 Electrocautery with an optically guided 34 Result of hemostasis by electrocautery.
hook electrode.
The Method of Medical Thoracoscopy 17
35 Optical powder dispenser. 36 Talc pleurodesis with a powder dispenser 37 Intrathoracic view after talc application.
under vision. The talc dust has been uniformly
distributed over the lung surface.
18 The Method of Medical Thoracoscopy
38 The thoracoscope is inserted into the 39 40 Placement of the drain under vision.
drain lumen, and the drain is carefully
advanced under vision.
Patients are monitored in the recovery room for 1– 2 hours response necessary for pleurodesis. Vital signs (pulse and
after thoracoscopy. A chest radiograph is obtained when blood pressure) should be taken hourly for the first 6
the patient is returned to the floor. This is necessary to hours after the procedure. Nursing staff should make
check for lung reexpansion and drain position. sure that the chest tube remains patent. Drain output and
Adequate pain management is important after thoraco- fluid appearance should be recorded and documented.
scopy. For this purpose, 50 mg pethidine may be given When the output falls below 100 mL/24 hours, the drain
subcutaneously or 0.2 – 0.4 mg buprenorphine sublingually may be removed. It is important to ambulate the patient
as needed. Following talc pleurodesis, care should be immediately after thoracoscopy. Prophylactic antibiotics
taken that the patient does not receive corticosteroids are unnecessary.
or NSAIDs as they would suppress the inflammatory
7 Complications
The complication rate after thoracoscopy is low. Our own This appears relatively high and is not consistent with our
studies indicate a rate of 2.34%. A total of 214 cases were experience. The longer the drain remains in place, however,
reviewed.7 More recent studies also document the safety of the higher the risk of infection. No thoracoscopy-related
thoracoscopy. Brims et al. (2012)4 report an infection rate of deaths have been reported.
10.5% in 57 cases (4 cases of pneumonia, 2 empyemas).
8 Summary
Medical thoracoscopy is an economical, highly effective In recent years medical thoracoscopy has been increasingly
interventional procedure that can be learned quickly, has applied for therapeutic purposes. It has a major role in the
few complications, and permits the rapid and safe diagnosis treatment of complicated parapneumonic pleural effusions
of pleural diseases. This opinion is shared by many other and pleural empyema. At present, thoracoscopic talc
authors.16, 24 If necessary, thoracoscopy can also be used to pleurodesis is the most effective and economical method
investigate lesions in the peripheral lung and mediastinum. that we have for inducing pleurodesis.
‘Minithoracoscopy,’ which employs thoracoscopes 2 – 5 mm
in diameter, is also described by other authors as a highly
effective, minimally invasive diagnostic procedure.27
20 The Method of Medical Thoracoscopy
References
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anderen invasiven Eingriffen Mitteilung der Kommission Eur Respir J. 1998;11(1):213–21.
für Krankenhaushygiene und Infektionsprävention
17. MATZEL W: Diagnostische Thorakoskopie bei
am Robert-Koch-Institut. Bundesgesundheitsblatt
intrathorakalen Rundherden. Z Tbk. 1963;120:1–13.
– Gesundheitsforschung – Gesundheitsschutz.
2000;43(8):644-8. 18. MATZEL W: Thorakoskopie. Z Tbk. 1964;122:252–3.
2. ARAPIS K, CALIANDRO R, STERN JB, et al.: Thoraco- 19. MATZEL W: Thorakoskopie. In: Emmrich R, Hrsg.
scopic palliative treatment of malignant pleural effusions: Arbeitsmethoden der inneren Medizin und ihr verwandter
results in 273 patients. Surg Endosc. 2006;20(6):919–23. Gebiete. 3. Ausg. Jena: Gustav Fischer; 1966. p. 177–92.
3. BRIDEVAUX PO, TSCHOPP JM, CARDILLO G, et al.: 20. MORENO-MERINO S, CONGREGADO M, GALLARDO G,
Short-term safety of thoracoscopic talc pleurodesis et al.: Comparative study of talc poudrage versus pleural
for recurrent primary spontaneous pneumothorax: a abrasion for the treatment of primary spontaneous
prospective European multicentre study. Eur Respir J. pneumothorax. Interact Cardiovasc Thorac Surg.
2011;38(4):770–3. 2012;15(1):81–5.
4. BRIMS FJ, ARIF M, CHAUHAN AJ: Outcomes and
21. PASCHOALINI MDA S, VARGAS FS, MARCHI E, et al.:
complications following medical thoracoscopy.
Prospective randomized trial of silver nitrate vs talc
Clin Respir J. 2012;6(3):144–9.
slurry in pleurodesis for symptomatic malignant pleural
5. BRUTSCHE MH, TASSI GF, GYORIK S, et al.: effusions. Chest. 2005;128(2):684–9.
Treatment of sonographically stratified multiloculated
thoracic empyema by medical thoracoscopy. Chest. 22. RAVAGLIA C, GURIOLI C, TOMASSETTI S, et al.:
2005;128(5):3303–9. Is medical thoracoscopy efficient in the management
of multiloculated and organized thoracic empyema?
6. FORLANINI C: Zur Behandlung der Lungenschwind- Respiration. 2012;84(3):219–24.
sucht durch künstlich erzeugten Pneumothorax.
Deutsche med Wochenschr. 1906;32:1401–5. 23. SATTLER A: 3. Tagung der wissenschaftlichen
Gesellschaft für Tuberkulose und Lungenkrankheiten.
7. HEINE R: Methode und Ergebnisse der Pleuroskopie.
Z Tbk. 1964;122:257.
Diplomarbeit, Martin-Luther-Universität Halle-
Wittenberg. 1985. 24. SIMPSON G: Medical thoracoscopy in an Australian
8. HIEN P: Diagnostische Thorakoskopie. Praktische regional hospital. Intern Med J. 2007;37(4):267–9.
Pneumologie. Springer Berlin Heidelberg; 2012. p. 71–3. 25. SOLER M, WYSER C, BOLLIGER CT, et al.: Treatment
9. JACOBAEUS HC: Endopleurale Operation unter Leitung of early parapneumonic empyema by "medical"
des Thorakoskopes. Beitr Klin Tuberk. 1916;35:1–35. thoracoscopy. Schweiz Med Wochenschr. 1997;127(42):
10. JACOBAEUS HC: Kurze Übersicht über meine 1748–53.
Erfahrungen mit der Laparo-Thorakoskopie. 26. STANZEL F: Instrumentarium für die internistische
Münchener med Wochenschr. 1911;58:2017–9. Thorakoskopie – „Pleuroskopie“. EndoGramm,
11. KELLING G: Über Ösophagoskopie, Gastroskopie KARL STORZ GmbH & Co KG. 2005:1–8.
und Kölioskopie. Münchener med Wochenschr. 27. TASSI GF, MARCHETTI GP, PINELLI V:
1902;49:21–4. Minithoracoscopy: a complementary technique for
12. KERN L, ROBERT J, BRUTSCHE M: Management medical thoracoscopy. Respiration. 2011;82(2):204–6.
of parapneumonic effusion and empyema: medical
28. TSCHOPP JM, PUREK L, FREY JG, et al.: Titrated
thoracoscopy and surgical approach. Respiration.
sedation with propofol for medical thoracoscopy: a
2011;82(2):193–6.
feasibility and safety study. Respiration. 2011;82(5):
13. KOLSCHMANN S, BALLIN A, GILLISSEN A: Clinical 451–7.
efficacy and safety of thoracoscopic talc pleurodesis in
malignant pleural effusions. Chest. 2005;128(3):1431–5. 29. TSCHOPP JM, RAMI-PORTA R, NOPPEN M, et al.:
Management of spontaneous pneumothorax: state of
14. KORBSCH R: Lehrbuch und Atlas der Laparo- und the art. Eur Respir J. 2006;28(3):637–50.
Thorakoskopie. München: J.F. Lehmann; 1927
(Zit. nach Matzel W, 1966). 30. VAZIRI M, ABED O: Management of thoracic empyema:
15. LEE WJ, KIM HJ, PARK JH, et al.: Chemical pleurodesis review of 112 cases. Acta Med Iran. 2012;50(3):203–7.
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The Method of Medical Thoracoscopy 21
THORAX and
TELEPRESENCE, IMAGING SYSTEMS,
DOCUMENTATION AND ILLUMINATION
22 The Method of Medical Thoracoscopy
26072 BA
26072 A
26072 SU
It is recommended to check the suitability of the product for the intended procedure prior to
The Method of Medical Thoracoscopy 23
26072 TK
26072 UF
40120 NAL
26120 J
Instrument Set 11 mm
26038 AA
26120 J
30103 WX
37470 SC 30804
34421 MB
26778 UF
40492 TK
26046 BA
40120 NAL
40170 LB 30804
43249 DUP
40775 LF
40491 TKU
Innovative Design
## Dashboard: Complete overview with intuitive ## Automatic light source control
menu guidance ## Side-by-side view: Parallel display of standard
## Live menu: User-friendly and customizable image and the Visualization mode
## Intelligent icons: Graphic representation changes ## Multiple source control: IMAGE1 S a llows
when settings of connected devices or the entire the simultaneous display, processing and
system are adjusted documentation of image information from
two c onnected image sources, e.g., for hybrid
operations
TC 200EN
Specifications:
HD video outputs - 2x DVI-D Power supply 100 – 120 VAC/200 – 240 VAC
- 1x 3G-SDI Power frequency 50/60 Hz
Format signal outputs 1920 x 1080p, 50/60 Hz Protection class I, CF-Defib
LINK video inputs 3x Dimensions w x h x d 305 x 54 x 320 mm
USB interface 4x USB, (2x front, 2x rear) Weight 2.1 kg
SCB interface 2x 6-pin mini-DIN
TC 300
Specifications:
Camera System TC 300 (H3-Link)
Supported camera heads/video endoscopes TH 100, TH 101, TH 102, TH 103, TH 104, TH 106
(fully compatible with IMAGE1 S)
22 2200 55-3, 22 2200 56-3, 22 2200 53-3, 22 2200 60-3, 22 2200 61-3,
22 2200 54-3, 22 2200 85-3
(compatible without IMAGE1 S technologies CLARA, CHROMA, SPECTRA*)
LINK video outputs 1x
Power supply 100 – 120 VAC/200 – 240 VAC
Power frequency 50/60 Hz
Protection class I, CF-Defib
Dimensions w x h x d 305 x 54 x 320 mm
Weight 1.86 kg
Specifications:
IMAGE1 FULL HD Camera Heads IMAGE1 S H3-Z
Product no. TH 100
Image sensor 3x 1/3" CCD chip
Dimensions w x h x d 39 x 49 x 114 mm
Weight 270 g
Optical interface integrated Parfocal Zoom Lens,
f = 15 – 31 mm (2x)
Min. sensitivity F 1.4/1.17 Lux
Grip mechanism standard eyepiece adaptor
Cable non-detachable
Cable length 300 cm
Specifications:
IMAGE1 FULL HD Camera Heads IMAGE1 S H3-ZA
Product no. TH 104
Image sensor 3x 1/3" CCD chip
Dimensions w x h x d 39 x 49 x 100 mm
Weight 299 g
Optical interface integrated Parfocal Zoom Lens,
f = 15 – 31 mm (2x)
Min. sensitivity F 1.4/1.17 Lux
Grip mechanism standard eyepiece adaptor
Cable non-detachable
Cable length 300 cm
32 The Method of Medical Thoracoscopy
Monitors
9619 NB 19" HD Monitor,
color systems PAL/NTSC, max. screen
resolution 1280 x 1024, image format 4:3,
power supply 100 – 240 VAC, 50/60 Hz,
wall-mounted with VESA 100 adaption,
including:
External 24 VDC Power Supply
Mains Cord
9619 NB
9826 NB
The Method of Medical Thoracoscopy 33
Monitors
Optional accessories:
9826 SF Pedestal, for monitor 9826 NB
9626 SF Pedestal, for monitor 9619 NB
Specifications:
KARL STORZ HD and FULL HD Monitors 19" 26"
Desktop with pedestal optional optional
Product no. 9619 NB 9826 NB
Brightness 200 cd/m2 (typ) 500 cd/m2 (typ)
Max. viewing angle 178° vertical 178° vertical
Pixel distance 0.29 mm 0.3 mm
Reaction time 5 ms 8 ms
Contrast ratio 700:1 1400:1
Mount 100 mm VESA 100 mm VESA
Weight 7.6 kg 7.7 kg
Rated power 28 W 72 W
Operating conditions 0 – 40°C 5 – 35°C
Storage -20 – 60°C -20 – 60°C
Rel. humidity max. 85% max. 85%
Dimensions w x h x d 469.5 x 416 x 75.5 mm 643 x 396 x 87 mm
Power supply 100 – 240 VAC 100 – 240 VAC
Certified to EN 60601-1, EN 60601-1, UL 60601-1,
protection class IPX0 MDD93/42/EEC,
protection class IPX2
34 The Method of Medical Thoracoscopy
Workflow-oriented use
Patient
Entering patient data has never been this easy. AIDA seamlessly
integrates into the existing infrastructure such as HIS and PACS.
Data can be entered manually or via a DICOM worklist.
ll important patient information is just a click away.
Checklist
Central administration and documentation of time-out. The checklist
simplifies the documentation of all critical steps in accordance with
clinical standards. All checklists can be adapted to individual needs
for sustainably increasing patient safety.
Record
High-quality documentation, with still images and videos being
recorded in FULL HD and 3D. The Dual Capture function allows for
the parallel (synchronous or independent) recording of two sources.
All recorded media can be marked for further processing with just
one click.
Edit
With the Edit module, simple adjustments to recorded still images
and videos can be very rapidly completed. Recordings can be quickly
optimized and then directly placed in the report.
In addition, freeze frames can be cut out of videos and edited and
saved. Existing markings from the Record module can be used for
quick selection.
Complete
Completing a procedure has never been easier. AIDA offers a large
selection of storage locations. The data exported to each storage
location can be defined. The Intelligent Export Manager (IEM) then
carries out the export in the background. To prevent data loss,
the system keeps the data until they have been successfully exported.
Reference
All important patient information is always available and easy to access.
Completed procedures including all information, still images, videos,
and the checklist report can be easily retrieved from the Reference module.
36 The Method of Medical Thoracoscopy
UI400S1
ENDOFLATOR® 40 SCB,
Set, with integrated SCB module,
power supply 100 – 240 VAC, 50/60 Hz
including:
ENDOFLATOR® 40
Mains Cord, length 300 cm
SCB Connecting Cable, length 100 cm
Universal Wrench
Insufflation Tubing Set, with gas filter, sterile,
for single use, package of 5 *
DUOMAT®
Suction and Irrigation Pump
20 3210 08
DUOMAT®
Suction and Irrigation Pump,
including:
DUOMAT®,
power supply 100 – 120,
230 – 240 VAC, 50/60 Hz
Mains Cord
VACUsafe Promotion
Pack Suction, 2 l *
(not illustrated)
Equipment Cart
UG 540
38 The Method of Medical Thoracoscopy
UG 310
UG 410
UG 510
with the compliments of
KARL STORZ — ENDOSKOPE