Video-assisted thoracic surgery: applications and outcome

Thoracoscopy has been revived and expanded by recent improvements in endoscopic technology. The enhanced application and outcome of VATS (video assisted thoracic surgery) was retrospectively studied. Between 1992 and 1995, 82 patients underwent diagnostic thoracoscopy or interventional VATS. Indications included: shortness of breath with nonspecific x-ray abnormality (45%), pulmonary nodule (25%), pleural effusion/empyema (21%), pneumothorax (14%), and hemoptysis, chronic cough or lung consolidation (5%). Sixty-six (83%) of the procedures were completed thoracoscopically. Eight procedures (10%) required addition of a utility mini-thoracotomy and 6 procedures (7%) were converted to formal thoracotomy. Specific diagnostic and/or therapeutic applications of VATS included: inspection; lysis of adhesions; stapling of blebs; biopsy of lung, pleura, or mediastinal structures; drainage and decortication of empyema; mechanical and chemical pleurodesis; wedge resection; and segmental resection. Diagnosis was established and/or treatment completed in 95% of cases. Pathologic diagnoses included: interstitial pneumonitis (22%), cancer (19%), bullous disease (15%), cocci nodule (9%), and other (18%). There were twenty-two complications (28.9%) and four deaths (4.8%). All four deaths were from causes unrelated to the surgery. The most common complications were: residual pneumothorax or hydrothorax (7), failed pleurodesis (3), and prolonged incisional pain (2). The advantage of reduced chest wall and muscle trauma utilizing VATS as opposed to traditional thoracotomy translates to less patient discomfort. The excellent magnified visualization afforded by VATS offers the opportunity to successfully conduct diagnostic and therapeutic interventions in the chest with equal or better visibility. Our findings suggest that the applicability and success of VATS is greatly expanding and its complication rate is less or, at worst, comparable to traditional thoracotomy.