Complications of video-assisted thoracic surgery: a five-year experience.
BACKGROUND
Although thoracoscopy was originally described in 1910, recent developments in video-assisted surgical techniques and endoscopic equipment has expanded the application of video-assisted surgical procedures in the field of thoracic surgery.


METHODS
In an effort to define both high-risk patients for video-assisted thoracic procedures and high-risk video-assisted thoracic surgical procedures, we reviewed the experience of four surgical institutions from June 1991 through May 1995. We looked specifically at complications resulting from the 937 video-assisted thoracic procedures performed during this period.


RESULTS
Perioperative incidents or complications occurred in 35 patients (3.7%), and 116 procedures (12.4%) were converted to a thoracotomy. The in-hospital mortality rate was 0.5%, and death occurred principally in patients operated on for malignant pleural effusion. The overall incidence of postoperative complications was 10.9%, and the most prevalent complications were prolonged air leak (6.7%) and pleural effusion (0.7%).


CONCLUSIONS
The incidence of complications was acceptable and, except for that of prolonged air leak, did not differ significantly from that resulting from analogous open procedures. Video-assisted thoracic surgery appears safe and particularly useful for some indications. However, the possibility of dramatic life-threatening perioperative complications requiring emergency conversion to thoracotomy justifies the fact that only trained thoracic surgeons should perform video-assisted thoracic surgical procedures.
Jancovici
R
R
Department of Thoracic Surgery, Hôpital du Val de Grâce, Paris, France.
Lang-Lazdunski
L
L
Pons
F
F
Cador
L
L
Dujon
A
A
Dahan
M
M
Azorin
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002916:Chylothorax / Q000209:etiology; D004724:Endoscopy / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006801:Humans; D007239:Infections / Q000209:etiology; D008175:Lung Neoplasms / Q000150:complications / Q000601:surgery; D008297:Male; D008479:Mediastinal Neoplasms / Q000150:complications / Q000601:surgery; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D010996:Pleural Effusion / Q000209:etiology / Q000601:surgery; D015996:Survival Rate; D013906:Thoracoscopy / Q000009:adverse effects*; D013908:Thoracotomy / Q000009:adverse effects* / Q000401:mortality; D014743:Videotape Recording