VIDEO-ASSISTED THORACOSCOPIC SURGERY - INDICATIONS, RESULTS, COMPLICATIONS, AND CONTRAINDICATIONS

In recent times minimally invasive surgery has secured a firm place am ong the therapeutic options in thoracic surgery. The experience and re sults gained from video-assisted surgery on 109 patients between Janua ry 1, 1992 and July 31, 1993 are critically discussed. The procedure c ould be completed thoracoscopically on 94 of them. A change of method was necessary nine times for technical reasons and six times for oncol ogical reasons (two times due to metastasis, four times due to bronchi al carcinoma). A total of 154 individual operations were conducted. Si xty-three patients with recurrent spontaneous pneumothorax were succes sfully treated. The relapse rate was 1.5%. With the exception of three rethoracotomies (one due to postoperative hemorrhaging and two to per sistent fistula) no significant complications occurred. Further indica tions included capsulated pleural empyema (n = 1), persistent hematoth orax (n = 2), pleurectomy for malignant pleural effusion (n = 2), pleu ral tumors (n = 3), pulmonary parenchyma (n = 2), interstitial lung di seases (n = 3), bullous emphysema (n = 2), peripheral lung nodules (n = 18), mediastinal tumors (n = 8), and sympathectomy (n = 2). The adva ntages of video-assisted thoracoscopic surgery for patients include co smetic considerations, low pain, earlier postoperative mobilization, a nd for some indications, a shorter operation period. The significant d isadvantages for the surgeon are the loss of binocular vision as well as the impossibility of intraoperative palpation.