[Video-assisted thoracoscopic surgery]

Since the team at the Laennec hospital first performed an extra-pleural thoracoscopy in 1990, a certain number of thoracic surgery units have started using this new technique. Video-assisted thoracoscopy is an absolutely revolutionary technique allowing an intrapleural approach to the mediastinum and to the pulmonary parenchyma without a thoracotomy. It requires a sophisticated technical set up including a video camera, direct or angular optics, and a video screen. The patient is placed in the same position as for a thoracotomy. For the pneumothorax and dystropic bullae, Video assisted thoracoscopic surgery has been largely shown to be the superior technique. The pleura is treated by avivement or sometimes by pleurectomy. Pulmonary biopsies are often taken. Preoperative computed tomography with methylene blue injection is often required for the exeresis of peripheral parenchymatous sub-pleural nodules and sometimes a small fishhook has to be placed within the tumour. Inversely, segmentectomies or lobectomies are rarely performed. There is a certain amount of risk involved in closed chest vascular dissections, and the question of carcinologic rigour has to be raised. Tumours of the mediastinum, both cystic and solid tumours, are relatively easy to approach by dissection using video assisted thoracoscopy. Finally, this technique offers new possibilities for staging bronchial cancers, the treatment of broncho-pleural fistulas, and more recently for non operated chest trauma. This new technique is of great importance for the thoracic surgeon, although an evaluation of long-term results are still required.