In patients with pleural adhesion, video-assisted thoracic surgery(VATS) has been regarded as a contraindication. When such adhesions were found during a thoracoscopic trial, the thoracotomy proceeded with for fear of parenchymal injury and
bleeding, We
had a question whether or not thoracoscopic surgery should be done in such pleural adhesion.
Of the 226 consecutive thoracoscopic surgeries from Jul. 1992 through Sep. 1995, pleural adhesions were detected intraoperatively in 50 cases(22.1%); a detailed breakdown is as follows: pneumothorax(16 cases), pleural disease(15), benign
pulmonary
nodule(7), mediastinal mass(5), hyperhidrosis(2), diffuse parenchymal or interstitial lung disease(2), bronchiectasis(2), and primary lung cancer(1). We classified pleural adhesions according to their extent and severity. Extent is categorized as
the
involved area of the lung: degree I, II, or III; severity is given one of four grades; mild, moderate, severe, or very severe. In cases of very severe severity requiring decortication the possibility of VATS was excluded.
Of the 50 cases, mild adhesions were detected in 15 cases(30.0%), moderate in 29(58.0%), and severe in 6(12.0%). As for the extent of the adhesions, 8 cases(16.0%) were categorized as degree I, 32 cases(64.0%) as degree II, and 10 cases(20.0%) as
degree
III. For patients with pleural adhesions, the operation time, the chest tube indwelling time, and the postoperative hospital stay were all longer than for patients in the non-adhesion group. Postoperative complications, namely prolonged
air-leakage
and
pleural drainage, were more common(18.0% and 6.0%, respectively) than in the non-adhesion group(5.1% and 1.7%, respectively). Only two bronchiectatic patients(4%) were converted to an open thoracotomy because of inability to control bleeding.
Although complications were encountered more frequently in the group with adhesions, patients were still able to enjoy the benefits of thoracoscopic surgery. It is advisable to proceed with thoracoscopic surgery even in cases of unpredicted
pleural
adhesions.
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