VIDEOASSISTED SURGERY FOR THE MANAGEMENT OF THORACIC PROBLEMS

Objective. To review the experience in minimally invasive videoassiste d surgery for the diagnosis and treatment of thoracopulmonary problems . Method. Retrospective review of the clinical charts of patients subm itted to thoracic videoassisted surgical procedures at the Institute N acional de Nutricion Salvador Zubiran from February 1993 to March 1995 . Results. A total of 102 patients were submitted to videoassisted tho racic surgery. There were three main indications for the procedure: 1) pleural disease (n = 30); 2) pulmonary disease (n = 66); and 3) vario us (n = 6). A total of 129 procedures were performed: 38 pleural proce dures (biopsy 15, decortication 8, talc poudrage 7, revision/lavage 6, section of adhesions 1, and pleural abrasion 1), 75 pulmonary procedu res (lung biopsy 32, pulmonary nodule wedge resection 30, large core n eedle biopsy 8, bullae resection 3, videoassisted lobectomy with minit horacotomy 2), and 16 various procedures (biopsy of mediastinal adenop athy 6, pericardial window 4, pericardial biopsy 4, subphrenic abscess 1, intercostal artery clippage 1). Morbility appeared in three patien ts (two prolonged air leaks and one empiema) and two patients died (on e cirrhotic patient who developed postoperative acute hepatic failure and a patient with lupus erythematosus who developed sepsis). All othe r patients had an uneventfull postoperative course with a mean pleural drainage of 1.76 days for pulmonary procedures (range 0.5-3 days) and 4.6 days for pleural procedures (range 2-15 days). Conclusions. The u se of the videothorascope as an adjuvant in thoracic surgery allows th e surgeon to perform different procedures using minimally invasive tec hniques. Indications are the same as for any thoracic surgical procedu re and the general philosophy must be to establish a compromise betwee n minimal invasion of the patient and the correct solution for the par ticular problem being treated.