Thoracoscopic surgery: indications and outcome.
BACKGROUND
Video-assisted thoracoscopic surgery (VATS) has become an established technique in both diagnostic and therapeutic thoracic surgery procedures.


METHODS
In an attempt to evaluate the current indications and outcome of this technique, 143 VATS procedures, which were performed over a three-year period, were retrospectively evaluated. Indications included lung biopsy in 46, recurrent or persistent pneumothorax in 42, and pleural disease in 16 patients. Other indications included sympathectomy in eight, mediastinal mass in three, pericardial window in three, metastasectomy in three, and staging of lung cancer in two patients.


RESULTS
There was one postoperative death (0.7%), a patient with massive pleural effusion and end-stage renal and hepatic failure. Conversion to formal thoracotomy was necessary in six patients (4.2%), and was the result of adhesions in four, bleeding in one, and failure to identify the lesion in one patient. Diagnostic procedures were considered successful in 44 out of 46 lung biopsies (95.7%), 15 out of 16 pleural disease cases (93.8%), and two lung cancer staging cases. The other 79 therapeutic VATS procedures were all effective, both in the long and short term, apart from two cases of prolonged air leak after VATS for pneumothorax, one of which was considered a failure (2.4%).


CONCLUSIONS
VATS should be available in each thoracic surgery unit. It is both safe and effective in a variety of diagnostic and therapeutic procedures.
Al-Kattan
K
K
Department of Surgery, King Khaled University Hospital, Riyadh, Saudi Arabia. kkattan@kfshrc.edu.sa