[The status of surgical thoracoscopy in thoracic surgery]

Video-assisted thoracoscopic surgery is viewed as a sparing and safe alternative to thoracotomy for a wide spectrum of benign thoracic diseases. However the loss of palpation as well as the insufficiency of complete mediastinal lymphadenectomy are responsible for the uncertainty of the new method concerning curative oncological therapy. During the last two years we could replace thoracotomy by operative thoracoscopy in nearly all cases of recurrent pneumothorax and recurring pleural effusion. In a series of 447 endoscopic operations in 350 patients following distinct indications and strong prerequisites in terms of operating team and infrastructure of our department we could establish a high standard for this new operating method. The good postoperative results of this large series of thoracoscopic operations indicate the high rank of this new technique in thoracic surgery. Recurrence rates of 1.5% for pneumothorax surgery and 0 for pleurectomy for malignant pleural effusion can be compared to those in open thoracic surgery. Six weeks after the operation the postoperative lung function was normal in 80% of an initial group of patients.