VIDEO-ASSISTED THORACOSCOPIC ANATOMIC LUNG RESECTIONS - THE INITIAL HONG-KONG EXPERIENCE

We report our combined experience on video-assisted thoracoscopic (VAT ) anatomic lung resections from two major hospitals in Hong Kong over a 17-month period. From August 1993 to December 1994, 82 cases of majo r lung resections were attempted using the VATS approach, of which 60 were successfully completed (55 lobectomies, 2 bilobectomies, 2 pneumo nectomies, and 1 segmentectomy). Of these 60 cases, there were 43 men and 17 women with a mean age of 66 years (range, 37 to 85 years). The final pathologies were 52 primary lung cancers (37 adenocarcinoma, 11 squamous cell carcinoma, 2 bronchoalveolar carcinoma, 1 adenosquamous carcinoma, and 1 undifferentiated carcinoma); 1 pulmonary metastasis ( from nasopharyngeal carcinoma); and 7 benign lesions (3 tuberculosis, 1 bronchiectasis, 1 sclerosing hemangioma, 2 organizing pneumonia). Th ere was one postoperative death (mortality rate, 1.8%). Complications include persistent air leak over 10 days (four), wound infection (two) , supraventricular tachy; cardia (three), and recurrence of tumor over the utility thoracotomy scar (one). All the patients were followed up from 8 weeks to 19 months (mean, 10 months). The mean duration of che st drainage was 5.4 days (range, 2 to 25 days). The mean hospital stay was 7.2 days (range, 4 to 35 days). The average postoperative parente ral narcotic (meperidine hydrochloride [Pethidine]) requirement by pat ient-controlled analgesia was 275 mg (range, 75 to 800 mg). This compa red favorably with an age- and sex-matched historic group of patients who underwent posterolateral thoracotomy and had a hospital stay of 10 .4 days (statistically nonsignificant) and narcotic requirement of 950 mg (statistically significant by paired t test). We conclude that VAT anatomic lung resection is technically feasible. However, there are s ome specific complications associated with major lung resection throug h minimal access. Refinement of our present technique and attention to details are important to improve our results.