title: Thoracoscopic lung biopsy in 285 patients with diffuse pulmonary disease.
abstract: BACKGROUND
  Surgical lung biopsy is generally considered the most appropriate method for diagnosing diffuse lung disease. However, there are few reports focusing on only one thoracoscopic technique. This study was designed to determine the morbidity and mortality related to video-assisted thoracoscopic lung biopsy in a single center, thereby providing data on the severity of morbidity and clarifying the risk factors.
  
  
  METHODS
  We analyzed 285 patients with undiagnosed diffuse lung disease who underwent video-assisted thoracoscopic lung biopsy at Kanagawa Cardiovascular and Respiratory Center from February 2007 to April 2012. We recorded the severity of postoperative complications using the Clavien-Dindo classification.
  
  
  RESULTS
  The surgical morbidity was 7.0% (20/285), including delayed pulmonary fistulas in 11 patients, acute exacerbation in 3, prolonged air leakage (>7 days) in 2, hypoxemia in 2, atrial fibrillation in 1, and premature ventricular contraction in 1. Based on the Clavien-Dindo classification, grade I, II, IIIa, IIIb, and IVa complications accounted for 20%, 10%, 50%, 5%, and 15%, respectively. The 30-day mortality was 0%. The diagnostic yield was 100%. Although acute exacerbation occurred in 2 patients with idiopathic pulmonary fibrosis and 1 with fibrotic nonspecific interstitial pneumonia, there were no distinctive features that allowed preoperative prediction of acute exacerbation.
  
  
  CONCLUSIONS
  Our findings indicate that video-assisted thoracoscopic lung biopsy is a feasible procedure. We hope to clarify risk factors in future research.
authors.affiliation: Department of Thoracic Surgery, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan.
authors.forename: Joji
authors.initials: J
authors.lastname: Samejima
authors.affiliation: Department of Thoracic Surgery, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan tajiri@kanagawa-junko.jp.
authors.forename: Michihiko
authors.initials: M
authors.lastname: Tajiri
authors.affiliation: Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Ogura
authors.affiliation: Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan.
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Baba
authors.affiliation: Department of Thoracic Surgery, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Omori
authors.affiliation: Respiratory Disease Center, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tsuboi
authors.affiliation: Department of Surgery, Yokohama City University School of Medicine, Yokohama, Japan.
authors.forename: Munetaka
authors.initials: M
authors.lastname: Masuda
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007564:Japan; D008171:Lung Diseases / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000401:mortality; D055815:Young Adult
keywords: Acute disease; biopsy; interstitial; lung diseases; postoperative complications; pulmonary fibrosis; thoracic surgery; video-assisted