The impact of thoracic surgical access on early shoulder function: video-assisted thoracic surgery versus posterolateral thoracotomy.
OBJECTIVE
Whether video-assisted thoracic surgery (VATS) is associated with less shoulder dysfunction when compared with posterolateral thoracotomy (PLT) remains unclear. We therefore conducted this prospective study to assess the shoulder function in patients following major lung resection using either the VATS or PLT approach.


METHODS
Twenty-nine consecutive patients were prospectively recruited into the study. Eighteen patients underwent major lung resection through VATS (VATS group) and 11 patients through PLT (open group). Shoulder function was measured preoperatively, and postoperatively at 1 week, 1 month and at 3 months. All assessments were done by two experienced physiotherapists using the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form.


RESULTS
Shoulder strength was significantly better preserved in the VATS group at 1 week after surgery when compared with the PLT group (92 versus 81% of preoperative value; P=0.024). VATS patients also had better range of motion especially with respect to external rotation at 1 week (98 versus 91%; P=0.015) and forward elevation at 1 month (98 versus 93%; P=0.024) and 3 months after surgery (100 versus 96%; P=0.021). Analgesic requirement was significantly less in the VATS group postoperatively at 1 week (P=0.009) and 1 month (P=0.004).


CONCLUSIONS
VATS major lung resection is associated with significantly less shoulder dysfunction and pain medication requirement in the early postoperative period when compared to the PLT approach.
Li
Wilson W L
WW
Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.
Lee
Rosanna L M
RL
Lee
T W
TW
Ng
Calvin S H
CS
Sihoe
Alan D L
AD
Wan
Innes Y P
IY
Arifi
Ahmed A
AA
Yim
Anthony P C
AP
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000700:Analgesics / Q000008:administration & dosage; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D011184:Postoperative Period; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012785:Shoulder Joint / Q000503:physiopathology*; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects* / Q000534:rehabilitation; D013908:Thoracotomy / Q000009:adverse effects* / Q000534:rehabilitation
D000700:Analgesics