THORACOSCOPIC PULMONARY SURGERY - INDICATIONS AND RESULTS

Objective: To report our experience of thoracoscopic pulmonary operati ons from May 1991 to May 1994. Design: Prospective open study. Setting : District hospital, Germany. Subjects: 93 patients who underwent 120 thoracoscopic procedures. Interventions: Wedge resection (n = 56), ple ural biopsy (n = 21), early decortication (n = 16), partial pleurectom y (n = 9), pleurodesis (n = 5), pulmonary biopsy (n = 4), segmentectom y (n = 3), evacuation of haemothorax (n = 3), biopsy of mediastinal tu mour (n = 2), and costal biopsy (n = 1). Main outcome measures: Morbid ity, mortality, and avoidance of open thoracotomy. Results: Indication s for thoracoscopic intervention were: solitary pulmonary nodule (n = 37), recurrent pneumothorax (n = 17), pleural empyema (n = 14), diffus e pulmonary disease/multiple nodules (n = 10), recurrent pleural effus ion (n = 11), haemothorax (n = 3), and mediastinal tumour (n = 1). In 29 of 37 patients in whom we attempted resection of a solitary pulmona ry nodule we obtained enough tissue for diagnosis, and avoided thoraco tomy in 18 patients. Complications included pulmonary embolus (n = 1), recurrent empyema (n = 1), haemorrhage (n = 2), infection of the drai n site (n = 3), and two persistent air leaks. One was closed at a seco nd thoracoscopy and the other required open thoracotomy after which he developed pulmonary failure and died. One patient with a haemothorax developed multiple system organ failure and died, and attempted resect ion of a mediastinal tumour was unsuccessful. Three thoracoscopic proc edures had to be abandoned because of dense adhesions. Conclusions: Th oracoscopic surgery is a safe, well tolerated, and cost effective alte rnative to open thoracotomy in selected patients.