European Journal of Cardio-Thoracic Surgery, Vol 10, 483-489, Copyright © 1996 by European Association for Cardio-thoracic Surgery
Risk and hazards of video-thoracoscopic surgery: a collective review
RG Inderbitzi and MP Grillet
Department of Surgery, Limmattal Hospital, Schlieren-Zurich, Switzerland.
OBJECTIVE: Since 1990, video-thoracoscopy has rapidly gained widespread
acceptance. In contrast to conventional thoracoscopy no comprehensive
studies of potential risks and hazards have been carried out. To date
interest has centered on possible indications and thoracoscopic techniques.
Based on a review of the literature, this article summarizes and comments
on possible complications. METHODS: In a meta- analysis (Medline, January
1989 until December 1994), all publications dealing with thoracoscopy were
collected. Those papers concerned with video-thoracoscopy were further
evaluated if the following criterias were fulfilled: first, the endoscopist
employed a video-camera connected to the thoracoscope; second, separate
entry sites were used for telescope and instruments. RESULTS: Of 345
papers, 145 met the above criterias, 5280 thoracoscopies could be analysed
for more than 30 indications. The calculated mortality rate was 0.3% and
the complication rate 3.61%. In 55 of all cases (1.04%), the intervention
had to be converted to open surgery. CONCLUSIONS: Video-thoracoscopic
thoracic surgery has gained acceptances as a complement to open thoracic
surgery. It may now be regarded as a safe technique. Nevertheless, serious
complications such as implantation metastasis of the thoracic wall after
thoracoscopy or injury to the recurrent nerve demonstrate the complexity of
thoracoscopic surgery. Practitioners should therefore be proficient in
thoracic surgery. The importance of meticulous technique and rigid
adherance to safety guidelines even in diagnostic procedures, must be
stressed.
