The safety and versatility of video-thoracoscopy : a prospective analysis of 895 consecutive cases

摘要: BACKGROUND The application of video-endoscopy to general thoracic surgery is radically changing the approach many benign and malignant diseases chest. Since July 1991, we have performed 794 purely thoracoscopic 101 video-assisted surgical (VATS) procedures on 860 patients. STUDY DESIGN Comprehensive, prospectively acquired data examining specific indications for outcomes this new technique were entered into a database. Preoperative, intraoperative, postoperative, outcome variables studied entire group as well three high-risk cohorts: age over 70 years (n = 198), forced expiratory volume in one second (FEV1) less than 1 L 46), Karnofsky performance index 8 61). RESULTS 895 cases involved 449 men 446 women ages 15 89 (mean 56 +/- 16 standard deviation). diagnostic 501 (56 percent), therapeutic 244 (27 both an additional 150 (17 percent). operations lung (569 cases), pleura (196 esophagus (42 mediastinum (51 pericardium (37 cases). Fifty-seven percent process 43 or infectious pathology. There nine deaths series operative mortality rate 1.0 percent. Thirteen patients (1.4 percent) required conversion limited thoracotomy technical reasons. 127 complications 121 yielding morbidity all 14 Mortality rates elderly, poor function, depressed cohorts 1.5, 2.1, 9.8 percent, respectively. Morbidity these populations 19, 30, 18 median postoperative length stay was days after closed thoracoscopy five VATS resection. CONCLUSIONS These underscore flexibility, safety, efficacy, potential cost savings videoscopic with diseases. ability perform excisional biopsy improves specificity sensitivity nearly 100 Video-assisted techniques also offer minimally invasive procedure acceptable risk heretofore inoperable by thoracotomy.