ROLE OF THORACOSCOPY (VATS) IN PLEURAL AND PULMONARY PATHOLOGY

Although thoracoscopy is not a new procedure, there was a real revival after the introduction of laparoscopy. VATS (video-assisted thoracic surgery) has potential advantages of reduced pain due to smaller incis ions and a shorter hospital stay. Main disadvantages are expensive equ ipment and a probably less adequate operation, especially for therapy of malignant disorders where long-term results are not known. VATS is very useful for investigation of pleural effusion and malignancy. Spon taneous pneumothorax is a very good indication for thoracoscopic treat ment, as well as lung biopsy and diagnostic resection of lung metastas es. Therapeutic metastasectomy, however, should not be performed by VA TS. Regarding bronchogenic carcinoma, VATS is indicated for staging of lung cancer, facilitating sampling of mediastinal and hilar lymph nod es, investigation of pleural effusion, possible pleural dissemination and suspicion of intrapulmonary metastases. Wedge excision of solitary pulmonary nodules by VATS readily reveals the exact diagnosis, but it s role in therapy of lung cancer is very limited at the present time.