Related Experiment Videos
Thoracoscopic pulmonary surgery: indications and results
T Hau1, E Förster, L Gandawidjaja
1Department of General, Thoracic and Vascular Surgery, Nordwest-Krankenhaus Sanderbusch, Sande, Germany.
Objective:
To report our experience of thoracoscopic pulmonary operations from May 1991 to May 1994.
Design:
Prospective open study.
Setting:
District hospital, Germany.
Subjects:
93 patients who underwent 120 thoracoscopic procedures.
Interventions:
Wedge resection (n = 56), pleural biopsy (n = 21), early decortication (n = 16), partial pleurectomy (n = 9), pleurodesis (n = 5), pulmonary biopsy (n = 4), segmentectomy (n = 3), evacuation of haemothorax (n = 3), biopsy of mediastinal tumor (n = 2), and costal biopsy (n = 1).
Main Outcome Measures:
Morbidity, mortality, and avoidance of open thoracotomy.
Results:
Indications for thoracoscopic intervention were: solitary pulmonary nodule (n = 37), recurrent pneumothorax (n = 17), pleural empyema (n = 14), diffuse pulmonary disease/multiple nodules (n = 10), recurrent pleural effusion (n = 11), haemothorax (n = 3), and mediastinal tumour (n = 1). In 29 of 37 patients in whom we attempted resection of a solitary pulmonary nodule we obtained enough tissue for diagnosis, and avoided thoracotomy in 18 patients. Complications included pulmonary embolus (n = 1), recurrent empyema (n = 1), haemorrhage (n = 2), infection of the drain site (n = 3), and two persistent air leaks. One was closed at a second thoracoscopy and the other required open thoracotomy after which he developed pulmonary failure and died. One patient with a haemothorax developed multiple system organ failure and died, and attempted resection of a mediastinal tumour was unsuccessful. Three thoracoscopic procedures had to be abandoned because of dense adhesions.
Conclusions:
Thoracoscopic surgery is a safe, well tolerated, and cost effective alternative to open thoracotomy in selected patients.