VIDEO-ASSISTED THORACIC SURGICAL-PROCEDURES - THE MAYO EXPERIENCE

Objective: To describe an initial 3-year experience with video-assiste d thoracic surgical procedures (VATS) at Mayo Clinic Rochester. Design : We review the cumulative data on 771 VATS performed between June 1, 1991, and May 31, 1994, and assess the applications for this technique . Material and Methods: The indications for VATS, our techniques used, and the associated mortality and morbidity are summarized. In additio n, the frequency of conversion of VATS to open procedures and the reas ons for choosing this strategy are discussed. Results: The 771 study p atients (401 male and 370 female patients) had a median age of 62 year s (range, 7 to 96). For all VATS, we used one-lung general anesthesia, without carbon dioxide insufflation. Indications for performing VATS were a pulmonary nodule in 333 patients, pleural effusion in 208, pulm onary infiltrate in 117, pneumothorax in 51, mediastinal mass in 22, p leural mass in 17, air leak in 13, and other in 10. The procedure was a wedge excision in 352 patients, examination of the pleural cavity in 128, pleural biopsy in 86, talc pleurodesis in 85, wedge excision and mechanical pleurodesis in 46, decortication in 27, excision of a medi astinal mass in 12, sympathectomy in 4, and other in 16. The rate of c onversion of VATS to thoracotomy was 33.1% and did not change througho ut the period of the study. The most common reasons for conversion wer e to complete a resection of a malignant lesion or to remove a deep no dule. The overall operative mortality was 1.9%. Complications occurred in 43 patients (8.3%) who underwent VATS without conversion to an ope n procedure and included prolonged air leak in 14, respiratory failure in 8, pneumothorax in 6, and atrial fibrillation in 5. The median hos pitalization was 5 days (range, 1 to 104). Conclusion: VATS is safe an d useful for selected thoracic conditions. We favor conversion to thor acotomy when curative resection of a malignant lesion is intended.