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Thoracoscopic surgery for diseases of the lung and pleura. Effectiveness, changing indications, and limitations.

Abstract：

OBJECTIVE:This study compared the results of video-assisted thoracic surgery (VATS) with thoracoscopic surgery (TS) for diseases of the lung and pleura. SUMMARY BACKGROUND DATA:No studies exist that compare the capabilities of VATS with advanced video systems and instrumentation to that of TS which has been done for 80 years. METHODS:A retrospective study was done comparing the effectiveness, indications, complications, and limitations of TS and VATS done for four categories of pleural disease: 1) pleural fluid problems, 2) diffuse lung disease, 3) lung masses, and 4) pneumothorax. The TS period was 1981-1990. The VATS period was 1991-1992. RESULTS:Eighty-nine consecutive TS cases and 64 consecutive VATS cases were reviewed. TS for resolution of pleural fluid problem was successful in 29 of 34 patients (85%), and VATS was successful in 18 of 20 (90%). Diffuse lung disease was diagnosed by TS using a cup biopsy on end-stage patients in respiratory failure. Since 1991 the diagnosis has been made with VATS using stapled wedge excisions on ambulatory patients. Surgical mortality decreased from 33% (10 of 30) to 9% (1 of 11) and the postoperative stay from 16.6 +/- 2.4 days to 8.2 +/- 2.2 days. Lung masses were diagnosed entirely by incisional biopsies using TS. Diagnosis was made in 83% and postoperative stay was 5.3 +/- 1.0 day. VATS allowed excisional biopsies permitting diagnosis in 100% with a postoperative stay of 3.0 +/- 0.2 days (p = 0.05). However, 20% required conversion to thoracotomy to locate the subpleural mass. TS was performed for spontaneous pneumothorax in only 26% (5 of 19) of the total pneumothorax cases, whereas, VATS was used for spontaneous pneumothorax in 67% (12 of 18). CONCLUSION:VATS has continued the effectiveness of TS for treating pleural fluid problems, has resulted in earlier surgical diagnostic intervention in diffuse lung disease and earlier therapeutic intervention in primary pneumothorax states, and has markedly expanded the safety, efficacy and indications for lung mass biopsy.

journal_name

Ann Surg

journal_title

Annals of surgery

authors

Daniel TM,Kern JA,Tribble CG,Kron IL,Spotnitz WB,Rodgers BM

doi

10.1097/00000658-199305010-00018

subject

Has Abstract

pub_date

1993-05-01 00:00:00

pages

566-74; discussion 574-5

issue

eissn

0003-4932

issn

1528-1140

journal_volume

217

pub_type

杂志文章

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Thoracoscopic surgery for diseases of the lung and pleura. Effectiveness, changing indications, and limitations.