[Experiences in the diagnostic and surgical video-endoscopy of the thoracic cavity]

Thoracoscopy is a well-established method for diagnostic evaluation of various manifestations of intrathoracic disease, with a high degree of sensitivity and specificity. While a rigid telescope is generally used, we have modified this technique by connecting a CCD-chip-camera to the thoracoscope to achieve direct visualization for observers. 52 patients were examined in this manner, 18 for diagnostic reasons and 35 for therapeutic purposes. The mean age of the patients was 55 years, ranging from 26 to 84 years. Potential risk factors associated with this modified endoscopic procedure were analyzed. Mortality was zero, but complications occurred in 5.6%. Surgical re-intervention was necessary in two cases for control of postoperative intrathoracic hemorrhage; in another case the introductory trocar caused superficial injury to the lung without further consequences. In these complications extensive scarring of the pleura was noted. It is only natural that the rate of complications is closely associated with a learning period during which the operative technique is improved. Following adequate mastery of the technique our goal is presently to treat spontaneous pneumothorax and malignant effusions by thoracoscopy. We strongly recommend treatment of malignant effusions and pneumothorax by thoracoscopy as a primary procedure and not secondarily when blind attempts at pleurodesis have failed and given rise to partially obstructive adhesions.