Video assisted thoracic surgery: Our experience with 102 patients

Recent advances in optics, video systems and endoscopic operating instruments have made thoracoscopy easier and more accurate. From May 1992 until December 1993 we performed 102 Video Assisted Thoracic Surgical Procedure (VATS) for diagnosis and treatment. Twenty patients underwent thoracoscopy, twelve had pleurodesis. Seventy operative thoracoscopies included pulmonary wedge resection, dorsal sympathectomy, management of empyema, pleural tumor, bullectomy, pericardial window, anterior release for kyphoscoliosis and resection of posterior mediastinal cyst. In most cases of parenchyma resection, it was necessary to use three ports: one for video-endoscopy and two for preparation instruments and stapler. The average operation time was 58 minutes and average hospital stay was 3.5 days. Four patients died within 30 days after the procedure due to multi-organ failure, end-stage malignant disease and post pneumonectomy pulmonary edema, unrelated to the VATS itself. One patient had thoracotomy due to uncontrolled bleeding. No wound infection or other postoperative complication except intercostal neuralgia after dorsal sympathectomy was noticed. Localization of the target lesion deep within the parenchyma of the lung still poses a problem. We used a small incision (2 cm long), placing a finger to directly palpate the lung and locate the lesion, or made a mini thoracotomy. Conversion to thoracotomy was performed when malignancy was demonstrated at frozen section. Conclusions: 1) Thoracoscopy is a minimally invasive surgical technique causing a low morbidity rate and attaining a high diagnostic accuracy. 2) Postoperative recovery is brief and uneventful. New techniques of imaging are needed to locate the target lesion.