Thoracoscopic operations on reoperated chests

A previous operation is generally considered to be a relative contraindication to the minimal access approach. We reviewed our combined experience from three centers with video-assisted thoracic surgery on reoperated chests.

From September 1992 to December 1996, 2,477 patients underwent video-assisted thoracic surgery of whom 40 patients (33 men; age range, 9 to 78 years) had prior operations on the ipsilateral side of the chest: 23 after prior open procedures (22 thoracotomies, 1 median sternotomy) and 17 after video-assisted thoracic surgery. The second procedures consisted of bullectomy or bulla ligation (8), mediastinal and hilar mass biopsy (8), wedge lung resection (6), pericardial window (5), lung volume reduction (4), redo thoracodorsal sympathectomy (3), talc insufflation alone (3), decortication (2), and suturing of a pleural rent (1).

Adhesions were noted in all patients ranging from minimal to strong fibrous adhesions. However, in only 2 patients (5%) were the procedures abandoned because of adhesions. Video-assisted thoracic surgery was safely completed in all other patients. There was no mortality or intraoperative complications and mean hospital stay was 5.1 +/- 3.2 days (range, 0 to 17 days).

Video-assisted thoracic surgery on reoperated chests is feasible and does not carry a higher morbidity or mortality compared with first-time operations, even though it may be technically more difficult. Experience and clinical judgment, however, are required to select these patients for reoperation with video-assisted thoracic surgery.