title: [Pulmonary resection using video-assisted thoracoscopic surgery--20 years experience].
abstract: Major lung resection using minimally invasive techniques - video-assisted thoracoscopic surgery (VATS) - was first described 20 years ago. However, its development has been slow in many countries because the value of this approach has been questioned. Different techniques and definitions of VATS are used and this can be confusing for physicians and surgeons. The benefit of minimally invasive thoracic surgery was not always apparent, while many surgeons pointed to suboptimal operative outcomes. Recently, technological advances (radiology, full HD monitor and new stapler devices) have improved VATS outcomes. The objectives of this review are to emphasize the accepted definition of VATS resection, outline the different techniques developed and their results including morbidity and mortality compared to conventional approaches. Minimally invasive thoracic surgery has not been proven to give superior survival (level one evidence) compared to thoracotomy. A slight advantage has been demonstrated for short-term outcomes. VATS is not a surgical revolution but rather an evolution of surgery. It should be considered together with the new medical environment including stereotactic radiotherapy and radiofrequency. VATS seems to be more accurate in the treatment of small lung lesions diagnosed with screening CT scan. In the academic field, VATS allows easier teaching and diffusion of techniques.
authors.affiliation: Service de chirurgie générale et thoracique, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France. Electronic address: Jean-marc.baste@chu-rouen.fr.
authors.forename: J-M
authors.initials: JM
authors.lastname: Baste
authors.affiliation: Service de chirurgie thoracique, des maladies de l'œsophage et de transplantations pulmonaires, hôpital Nord, Aix Marseille université, Assistance publique-Hôpitaux de Marseille, chemin des Bourrely, 13915 Marseille, France.
authors.forename: B
authors.initials: B
authors.lastname: Orsini
authors.affiliation: Service de chirurgie générale et thoracique, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France.
authors.forename: P
authors.initials: P
authors.lastname: Rinieri
authors.affiliation: Service de chirurgie générale et thoracique, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France.
authors.forename: J
authors.initials: J
authors.lastname: Melki
authors.affiliation: Service de chirurgie générale et thoracique, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France.
authors.forename: C
authors.initials: C
authors.lastname: Peillon
mesh_terms: D005544:Forecasting; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D008171:Lung Diseases / Q000601:surgery; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D008197:Lymph Node Excision / Q000379:methods; D008207:Lymphatic Metastasis; D015201:Meta-Analysis as Topic; D015337:Multicenter Studies as Topic; D010149:Postoperative Pain / Q000517:prevention & control; D011013:Pneumonectomy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000191:economics / Q000193:education / Q000379:methods* / Q000639:trends; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Chirurgie mini-invasive; Chirurgie thoracique; Lung; Lung volume reduction; Minimally invasive surgery; Poumon; Réduction de volume pulmonaire; Thoracic surgery; Videothoracoscopy; Vidéothoracoscopie