European Journal of Cardio-Thoracic Surgery, Vol 8, 431-435, Copyright © 1994 by European Association for Cardio-thoracic Surgery
Video-assisted thoracic surgery: the approach of choice for selected diagnosis and therapy
JW Rubin
Section of Cardiothoracic Surgery, Medical College of Georgia, Augusta 30912-4040.
Unconvinced of the benefits of video-assisted thoracic surgery (VATS) over
conventional posterolateral thoracotomy (PLT) we undertook an evaluation of
the VATS approach for various diagnostic and therapeutic intrathoracic
procedures. For the 18 months ending December 31, 1992, 55 consecutive
patients (28 males, 27 females, age 48 +/- 17 years) were eligible to
undergo VATS for diagnosis and/or treatment of a variety of conditions.
Thirty-eight were chosen for VATS and 17 for PLT. Three VATS patients were
converted to PLT (7.9%). Thus 35 VATS patients formed our first experience
with the minimally invasive approach. We observed operating time (OT),
length of stay (LOS), days of postoperative narcotic use (DNA), achievement
of diagnostic and/or therapeutic objectives and morbidity and mortality.
For analysis of LOS and DNA due to the procedure alone patients were
outliers if LOS was prolonged for reasons other than the procedure, pain or
related complications. For estimation of anticipated LOS and DNA due to
VATS, 9 of the 35 VATS patients were outliers. For the remaining 26, LOS
was 4.9 +/- 2.5 days and DNA was 2.6 +/- 1.7 days after surgery. For the 35
VATS patients OT was 87 +/- 30 minutes. Complications after VATS were few
and similar to those experienced after PLT. A diagnostic and/or therapeutic
objective was achieved in all patients without mortality. We found that
definitive procedures carried out with VATS require fewer hospital days and
less postoperative analgesia than expected after similar procedures
performed through standard PLT. Diagnostic and therapeutic objectives are
easily attainable and complications are few. (ABSTRACT TRUNCATED AT 250
WORDS)
