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Thoracoscopic lobectomy for benign disease--a single centre study on 64 cases
A Weber1, U Stammberger, I Inci
1Division of Thoracic Surgery, University Hospital, Raemistrasse 100, CH-8091, Zurich, Switzerland.
Insights
Thoracoscopic lobectomy (TL) is safe for selected patients with chronic inflammatory lung disease, particularly bronchiectasis. This minimally invasive approach shows reduced operation times and a low conversion rate to open lobectomy (OL).
Area of Science:
- Thoracic Surgery
- Minimally Invasive Procedures
- Pulmonary Medicine
Background:
- Chronic lung infections are a primary indication for lobectomy in benign pulmonary disease.
- Inflammatory changes in chronic lung disease can make lobectomy technically challenging.
- The efficacy of thoracoscopic lobectomy (TL) for these conditions requires further definition.
Purpose of the Study:
- To evaluate the safety and outcomes of thoracoscopic lobectomy (TL) versus open lobectomy (OL) for benign pulmonary disease.
- To compare operative time, blood loss, drainage duration, and hospital stay between TL and OL.
- To assess the feasibility of TL in complex cases involving chronic inflammation.
Main Methods:
- Retrospective analysis of 117 lobectomies for benign disease (64 TL, 53 OL) performed between 1992 and June 1999.
- Comparison of patient data between the TL and OL groups.
- Nonparametric statistical analysis due to non-normally distributed data.
Main Results:
- Thoracoscopic lobectomy (TL) demonstrated significantly decreased operation times over the study period (2.5h to 1.5h).
- TL showed a trend towards less blood loss compared to open lobectomy (OL).
- Drainage time and hospital stay did not differ significantly between TL and OL; conversion rate to thoracotomy was low (12 cases due to adhesions).
Conclusions:
- Thoracoscopic lobectomy (TL) is a safe and effective option for selected patients with chronic inflammatory lung disease, especially bronchiectasis.
- The technique's efficiency has improved, with significantly reduced operative times.
- TL offers a viable minimally invasive alternative to open lobectomy (OL) in these challenging cases.
Objective:
Chronic lung infection is the main indication for lobectomy in benign pulmonary disease and may be technically demanding due to inflammatory changes such as adhesions, lymph node enlargement and neovascularization. The role of the thoracoscopic operation in these indications is yet ill-defined.
Methods:
We retrospectively analyzed the results of patients who underwent thoracoscopic lobectomy (TL) between 1992 and June 1999 and compared this study group with patients who underwent open lobectomy (OL), all for benign disease. Data were not normally distributed, therefore, the median and range is given and nonparametric statistical analysis was applied.
Results:
A total of 117 lobectomies for benign disease (64 TL) were analyzed. Indications included bronchiectasis (36 TL; 18 OL), chronic infections (13 TL; eight OL), tuberculosis (five TL; 15 OL), emphysema (five TL; one OL), AV-malformations (two TL; one OL), severe haemoptysis (four OL), and others (three TL; six OL). Twelve conversions to thoracotomy were necessary due to severe adhesions. One patient in the open lobectomy group died within 30 days postoperative. Drainage time was 5.0 (1-32) days in TL and 6.0 (3-21) days in OL, hospital stay was 8.5 (4-41) days and 10.0 (5-52) days, respectively. Blood loss was 0 (0-2000) ml in TL and 300 (0-6000) ml in OL. Operation time for thoracoscopic lobectomies significantly decreased from 2.5 (1-6) h for cases between 1992 and 1997 (n=49) to 1.5 (0.5-2.5) h for recent cases (n=15) (P<0.01). In addition, a trend towards less blood loss was noted (100 (0-2000) ml vs. 0 (0-400) ml; P=0.06). Drainage time and hospital stay did not differ significantly.
Conclusions:
Thoracoscopic lobectomy in chronic inflammatory disease can be performed safely in selected patients, especially with bronchiectasis. Conversion rate to thoracotomy is low. Operation time with this approach declined significantly over time.
