Video-assisted thoracic surgery: the approach of choice for selected diagnosis and therapy

Unconvinced of the benefits of video-assisted thoracic surgery (VATS) over conventional posterolateral thoracotomy (PLT) we undertook an evaluation of the VATS approach for various diagnostic and therapeutic intrathoracic procedures. For the 18 months ending December 31, 1992, 55 consecutive patients (28 males, 27 females, age 48 +/- 17 years) were eligible to undergo VATS for diagnosis and/or treatment of a variety of conditions. Thirty-eight were chosen for VATS and 17 for PLT. Three VATS patients were converted to PLT (7.9%). Thus 35 VATS patients formed our first experience with the minimally invasive approach. We observed operating time (OT), length of stay (LOS), days of postoperative narcotic use (DNA), achievement of diagnostic and/or therapeutic objectives and morbidity and mortality. For analysis of LOS and DNA due to the procedure alone patients were outliers if LOS was prolonged for reasons other than the procedure, pain or related complications. For estimation of anticipated LOS and DNA due to VATS, 9 of the 35 VATS patients were outliers. For the remaining 26, LOS was 4.9 +/- 2.5 days and DNA was 2.6 +/- 1.7 days after surgery. For the 35 VATS patients OT was 87 +/- 30 minutes. Complications after VATS were few and similar to those experienced after PLT. A diagnostic and/or therapeutic objective was achieved in all patients without mortality. We found that definitive procedures carried out with VATS require fewer hospital days and less postoperative analgesia than expected after similar procedures performed through standard PLT. Diagnostic and therapeutic objectives are easily attainable and complications are few. (ABSTRACT TRUNCATED AT 250 WORDS)