The role of video-assisted thoracoscopic surgery in the management of pulmonary tuberculosis.
Tuberculosis remains a major health problem worldwide. The current role of video-assisted thoracoscopic surgery (VATS) in the management of this condition is unclear. We reviewed our experience over a 36-month period from a single institution. Thirty-seven patients (26 male, 11 female, with age ranging from 22 days to 71 years), in whom the final diagnosis was tuberculosis, underwent VATS procedures. There were 12 pleural biopsies, 3 decortications, 12 wedge lung resections, 5 drainages of empyema, and 5 lobectomies. All the patients were studied prospectively. There were no mortality or intraoperative complications. The overall median postoperative hospital stay was 4 days (range, 2 to 35 days). Postoperative parenteral narcotics requirement (mean, 310 mg meperidine hydrochloride [Pethidine]) was significantly less than a historic group of 30 patients who underwent conventional thoracotomy for lung resection or empyema drainage for tuberculosis (mean, 875 mg). Postoperative complications include 2 persistent air leaks over 7 days (5.4%) and 1 wound infection (2.7%). We conclude the following: (1) VATS is safe and effective in achieving the diagnosis of tuberculosis through pleural biopsies or wedge lung resection of indeterminate pulmonary nodules; it is particularly useful for those patients who are debilitated, thus making them poor candidates for conventional open surgery; (2) in patients with trapped lung or tuberculous empyema, VATS could achieve full lung reexpansion with minimal morbidity; and (3) therapeutic lung resection using VATS in patients with tuberculosis is technically demanding and potentially hazardous. Its role is, at present, limited.
Yim
A P
AP
Department of Surgery, Chinese University of Hong Kong, Hong Kong.
D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D013906:Thoracoscopy; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000601:surgery*; D014741:Video Recording