[Video-assisted thoracic surgery with mini-thoracotomy: limits and indications]

Video-assisted thoracic surgery (VATS) combines a 5 cm mini-thoracotomy and videoscopic control using a camera. This technique is designed to reduce surgical invasiveness. From January 1993 to March 1994, we operated on 60 patients by 61 VATS. The conversion rate to classical thoracotomy was 8%. The cases treated included 18 lung cancers, 20 cases of pulmonary emphysema, 6 cases of non-malignant pulmonary nodules, 2 cases of bronchectasies and 10 operations on the pleura, pericardium or thoracic sympathetic nerves. We performed 12 lobectomies, 24 atypical segmentectomies and 10 other operations. The hospital mortality rate was 2/60 (3.5%), the mean thoracic drainage duration was 3.2 days, and the mean hospital stay was 9.2 days. VATS provides certain analgesic and esthetic benefits but the functional benefit must be studied in more detail. VATS can be applied to segmentectomies and lobectomies for T1 or T2 lung cancers; but the benefits relating to malignancy must be precisely identified by long-term studies.