Over the past few years, video-assisted thoracic surgery(VATS) has used increasingly for intrathoracic pathologic problems as a less invasive operative techniques. Today it is viewed as a sparing and safe alternative to thoracotomy for a wide
spectrum
of indications.
Using video-assisted operative thoracoscopy, we performed consecutive 150 operations on 148 patients during the initial 2 years of our experience from July 1992 with the following indications: pneumothorax(n=53), hyperhidrosis(n=29), mediastinal
mass(n=23), pleural disease(n=13), diffuse parenchymal or interstitial lung disease(n=12), benign pulmonary nodule(n=7), metastatic lung mass(n=3), primary lung cancer(n=3), bronchiectasis(n=2), malignant pericardial effusion(n=2), endobronchial
tuberculosis(n=1), esophageal achalasia(n=1), and pulmonary parenchymal foreign body (n=1).
There were no death, and overall complication rate was 24.0%(n=36). The most prevalent complication was persistent air leakage(longer than 5 days) in 14 cases(9.3%). Persistent pleural effusion (longer than 5 days) occurred in 6 cases(4.0%). Six
patients were converted to an open thoracotomy because of inability to control the operative bleeding(n=3), failed adhesiolysis in bronchiectasis(n=2), and radical excision of an lung cancer(n=1). Pneumothorax recurred in 3 cases(2.0%). Other
complications were Horner's syndrome, diaphragm tears, temporary phrenic nerve palsy, hoarseness, subsegmental atelectasis, transient respiratory difficulty, and esophageal mucosal tear.
The advantages of this minimally traumatizing operative technique lie in improved visualization, decreased pain, shortened hospital stay, and less postoperative morbidity. The indications of VATS has been extended increasingly to intrathoracic
pathologies, but its role in the managements of primary lung cancer and esophageal diseases remain to be defined. (Korean J Thoracic Cardiovas Surg 1994; 27:1015-22)
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