The diverse potential of thoracoscopic assisted surgery

Thoracoscopy has been a part of thoracic surgical practice for many years. The introduction of the camera chip and newer instrumentation has awakened a new interest in this technique and led to the development of video-assisted thoracic surgery (VATS). One hundred and seventy consecutive procedures performed on 158 patients are reviewed. Video-assisted techniques have proven useful in a broad spectrum of thoracic surgical procedures both diagnostic (n = 90) and therapeutic (n = 80). Hospital mortality was 1.3%. Conversion to formal thoracotomy was required in 2.5%, and re-exploration for bleeding in 0.6%. The technique was safe and the incidence of complications acceptable. VATS was particularly helpful in diagnosing "indeterminate" pulmonary nodules (sensitivity of 95%), interstitial lung disease (histological diagnosis in all), anterior mediastinal masses and post transplant pneumonitis. VATS may now be the surgical treatment of choice in those with spontaneous pneumothorax, and it also proved useful in a variety of benign disorders. Its role in the management of empyaema is limited with a 57% conversion rate. While pulmonary resections are feasible, its role in the therapeutic management of malignancy is questioned. Further studies are required to define the precise role of VATS in thoracic surgery.