title: Hand-assisted Thoracoscopic Surgery causes less postoperative pain than limited thoracotomy after cessation of epidural analgesia.
abstract: BACKGROUND
  Hand-assisted Thoracoscopic Surgery (HATS) is a novel minimally invasive technique for performing procedures conventionally performed by posterolateral thoracotomy. HATS overcomes a major drawback of thoracoscopic surgery in allowing full manual palpation of the lungs via a subcostal (mini-Kocher's) incision under videoscopic guidance, avoiding a thoracotomy, when the indication is pulmonary metastasectomy with curative intent or resection of undiagnosed lung nodules. It is postulated HATS may produce improved postoperative quality of life outcomes compared to thoracotomy.
  
  
  OBJECTIVE
  To determine if HATS compared to limited posterolateral thoracotomy causes less postoperative pain after cessation of epidural anaesthesia.
  
  
  METHODS
  Fifty-two patients were prospectively randomised to receive a limited thoracotomy (n=26) or HATS (n=26). Pain scores, measured on a visual analogue scale, were recorded during standard nursing observations and after analgesia demands in the 24h after epidural removal.
  
  
  RESULTS
  Pain scores were significantly lower after HATS compared to limited thoracotomy (3.8 versus 5.2, p=0.04). There was no difference in postoperative respiratory function.
  
  
  CONCLUSIONS
  HATS results in lower postoperative pain after cessation of epidural analgesia. This form of analgesia may therefore not be required, reducing the management complexity, complications and hospital stay associated with its use. SHORT ABSTRACT: Hand-assisted Thoracoscopic Surgery (HATS) is a novel technique allowing full manual lung palpation as an adjunct to Video-assisted Thoracoscopic Surgery (VATS). Fifty-two patients were prospectively randomised to receive limited thoracotomy or HATS. Pain scores were significantly lower after HATS compared to thoracotomy, indicating epidural analgesia may not be required.
authors.affiliation: The University of Melbourne, Department of Surgery, St. Vincent's Hospital Melbourne, 55 Victoria Parade, Fitzroy, Vic. 3065, Australia.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Paiva
authors.forename: Gavin M
authors.initials: GM
authors.lastname: Wright